Clinical applications, accuracy and limitations of guided endodontics: a systematic review.

BACKGROUND: The novel concept of guided endodontics has been reported as an effective method to obtain safe and reliable results in root canal treatment. AIM: To evaluate by means of a systematic review the clinical applications, accuracy and limitations of guided endodontic treatment. DATA SOURCES: A search of the literature was performed on PubMed, Embase, Web of Science and Cochrane Library databases, until 25 April 2019. No language or year restrictions were applied. STUDY ELIGIBILITY CRITERIA: Articles that answered the research question, including case reports, in vitro and ex vivo studies were included. Data extraction was performed independently by two reviewers. STUDY APPRAISAL: Quality assessment was done using STROBE, CARE and Modified CONSORT guidelines for observational, case reports and pre-clinical studies, respectively. RESULTS: A total of 22 articles, including fifteen case reports, six pre-clinical studies (in vitro and ex vivo studies) and one observational study, were included. LIMITATIONS AND CONCLUSIONS: Even though the level of evidence is low, and the methodology described among studies heterogeneous, all articles describe guided access cavity preparation and guided surgery as being highly accurate and successful techniques when comparing the drilled path to the planned treatment. More studies with a larger number of patients are necessary to obtain significant conclusions.

Anatomical relation of third molars and the retromolar canal.

The study was designed to assess, by direct anatomical observations and cone-beam computed tomography (CT), the prevalence of a retromolar canal and foramen in relation to the mandibular third molar in dry human mandibles. Dry mandibles from European skeletons (n=89) were observed directly and after cone-beam CT scanning (Newtom VGI evo). The following variables were assessed: the presence of a retromolar foramen and canal; the presence of a third molar, and orientation of the third molar. From the total of 89 mandibles selected, 73 showed a retromolar foramen (49 of which were bilateral). A retromolar canal was identified in 64 mandibles based on cone-beam CT assessment, with a total of 101 canals, including 74 that were bilateral. A total of 112 hemimandibles contained a third molar. Orientation of the third molar did not seem to indicate the presence of retromolar foramina or canals. A similar prevalence of retromolar canals was found for both vertically (41/79) and mesially (17/33) orientated third molars. A retromolar foramen and canal were present in most mandibles, with more than half being bilateral. We were unable to confirm a potential relation between the retromolar foramen and canal on the one hand, and the orientation of the third molar on the other.