Computer-aided design–based guided endodontic: A novel approach for root canal access cavity preparation

Abstract

In cases of teeth with unusual morphology like calcified pulp canal, guided endodontic treatment is suggested. An endodontic guide which navigates burs according to a preplanned path is used. Existing approaches of endodontic guide design are based on visual observation and analysis of tomographic scan of teeth. Hence, they are time-consuming and expert-dependent. Computer-aided design-based methodology was employed to design and fabricate a customized endodontic guide. A cone beam computed tomographic scan with MIMICS software was used to create a solid model of the teeth. The solid model generated was sliced through the developed program in MATLAB. The geometric centers of consecutive slices were joined to plot the root canals central axis. To gauge the optimum bur angulation for guide design, a straight line fitted in the data set of the geometric center helped create minimally invasive access. Methodology involved simulated verification of the drill path to judge the accuracy and feasibility of root canal access cavity preparation. Next, endodontic guides for extracted teeth were designed and fabricated using a three-dimensional printer, followed by guided root canal access cavity preparation for extracted teeth. To validate the proposed methodology, using a MATLAB image processing tool box, the deviation between the prepared root canal access cavity axis and root canal axis was analyzed in radiographs of post-treated teeth. The deviation between the tool path axis and root canal axis in simulated root canals was found to be not more than 0.210 ± 0.04 mm. The deviation between the axis of the planned root canal access cavity and the prepared root canal access cavity was 0.07 ± 0.02 mm. The proposed method reveals encouraging results for endodontic guide design.

Endodoncia guiada como alternativa para el manejo de dientes con conductos radiculares calcificados: Una revisión integrativa de la literatura

“…En los últimos años, la endodoncia al igual que otras áreas de la odontología ha experimentado un proceso de digitalización, lo que ha dado lugar a que los procedimientos guiados sean una técnica cada vez más utilizada para el manejo de casos como conductos calcificados, dientes invaginados y evaginados, preparación de cavidades de acceso precisas, mínimamente invasivas, en línea recta y micro procedimientos quirúrgicos endodónticos (Ali & Arslan, 2019;Nayak et al, 2018;Shah & Chong, 2018;Zubizarreta-Macho, de Pedro Muñoz, Riad Deglow, Agustín-Panadero, & Mena Álvarez, 2020).…”

“…V) Permite realizar una cavidad de acceso precisa, en línea recta y acorde a la geometría del conducto: las guías direccionales impresas en 3D facilitan la ubicación de los conductos radiculares calcificados, crean un acceso en línea recta al conducto radicular, permiten realizar una cavidad conservadora, mínimamente invasiva acorde a la geometría del conducto (Nayak et al, 2018;Shah & Chong, 2018). VI) Reduce los errores de procedimiento clínico: reducen de manera significativa los errores de procedimiento clínico, como la perforación de la raíz que puede comprometer el resultado del tratamiento (Nayak et al, 2018;Shah & Chong, 2018 A y B demuestran la cantidad de perdida de tejido coronal después de la preparación de la cavidad de acceso en modelos maxilares, mientras que C, D, E y F detallan a través de varios cortes la precisión de cada técnica endodóntica para encontrar los conductos radiculares calcificados y preservar la estructura dental remanente.…”

Three‐dimensional printing: The potential technology widely used in medical fields

“…3D‐printed surgical guide plate can accurately locate the root canal treatment, guide the optimal drilling angle of root canal treatment, and improve the accuracy of root canal entering the cavity. Torres, Shaheen, Lambrechts, Politis, and Jacobs (2019), Nayak, Jain, Kankar, and Jain (2018), and Strbac, Schnappauf, Giannis, Moritz, and Ulm (2017) all used 3D‐printed surgical guides to assist root canal treatment. Before dental implantation, doctors need to understand bone mass and bone structure with the help of CT and computer processing technology and determine the implantation plan, including the size and location of the implant.…”

Effect of volumetric shrinkage of restorative materials on tooth structure: A finite element analysis

“…The volumetric shrinkage of the direct composite restorative material cannot be avoided completely, it can be controlled up to some extent. 13–15 The volumetric strain can be reduced by keeping the size of the root canal access cavity 16 (RCAC) as small as possible. The effect of different direct restorative materials of different volumetric shrinkage and the size of the RCAC has been studied in this article.…”