Guided endodontics: The impact of new technologies on complex case solution

Abstract

Discuss the impact of new diagnostic and planning technologies on the resolution of a clinical case of an upper central incisor with lateral perforation, root canal calcification and apical periodontitis. A 44-year-old woman sought treatment because of a colour change in an anterior tooth. The tooth had already been endodontically accessed, and she reported that two different clinicians had failed to locate the root canal. A Cone Beam Computed Tomography scan showed excessive wear and root perforation in the middle third, as well as pulp canal obliteration in the apical third. The perforation was treated using a biomaterial, and the root canal was located using guided endodontics. This treatment protocol was used to access, prepare, medicate with calcium hydroxide for 21 days and fill the root canal. Treatment results were satisfactory at 6month follow-up.

Guided Endodontics: A Literature Review

“…From the 37 selected case reports ( Table 2 ), 25 of them had at least one year of follow-up with excellent results in terms of the absence of symptomatology or evidence of bone regeneration [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ]. Eighteen of them were performed with only single-rooted teeth [ 3 , 9 , 38 , 40 , 44 , 46 , 50 , 51 , 52 , 53 , 55 , 58 , 60 , 61 , 62 , 63 , 64 , 65 ]. In twenty-five of them, GE was used for the treatment of pulp obliteration [ 3 , 9 , 35 , 36 , 37 , 38 , 39 ,…”

“…Eighteen of them were performed with only single-rooted teeth [ 3 , 9 , 38 , 40 , 44 , 46 , 50 , 51 , 52 , 53 , 55 , 58 , 60 , 61 , 62 , 63 , 64 , 65 ]. In twenty-five of them, GE was used for the treatment of pulp obliteration [ 3 , 9 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 54 , 58 , 60 , 63 , 64 , 65 ], eight for osteotomy and apicoectomy [ 57 , 59 , 61 , 66 , 67 , 68 , 69 , 70 ], two for re-treatment or removal of fiberglass posts [ 43 , …”

“…Pulp calcifications . The most common treatment performed with GE was the treatment of pulp calcifications [ 3 , 9 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 54 , 58 , 60 , 63 , 64 , 65 ]. Jain SD et al [ 22 ] aimed to locate calcified canals by performing minimally invasive cavities using high-speed drills and DGE.…”

“…Guided endodontics (GE), which is based on the use of endodontic treatment planning with the help of computer technology, emerged to solve these problems. Thus, the risk of perforations and other iatrogenic problems is reduced by creating a specific pathway for root canal access and instrumentation [ 9 , 10 ].…”

Present status and future directions – Guided endodontics

“…The clinical implementation of guided endodontics has been demonstrated in various further case reports published during the past 5 years (Buchgreitz et al, 2019a;Casadei et al, 2020;Fonseca Tavares et al, 2018;Hegde et al, 2019;Ishak et al, 2020;Kamburoğlu et al, 2021;Krug et al, 2020b;Lara-Mendes et al, 2018a, 2018bLlaquet Pujol et al, 2021;Loureiro et al, 2021;Maia et al, 2019;Tavares et al, 2020;Todd et al, 2021;Torres et al, 2019).…”