Microguided Endodontics: a method to achieve minimally invasive access cavity preparation and root canal location in mandibular incisors using a novel computer‐guided technique

AIM To present a novel miniaturized and minimally invasive treatment approach for root canal localization in mandibular incisors with pulp canal calcification and apical periodontitis. SUMMARY A 51-year-old male patient presented with pain from his mandibular incisors. The patient had a history of severe dental trauma over 30 years ago. Both mandibular central incisors (teeth 31, 41) were tender to percussion and had a yellowish discoloration. They did not respond to thermal and electrical sensitivity tests. Two periapical radiographs from different projections revealed severe pulp canal calcifications and signs of periapical periodontitis. To facilitate the 'Microguided Endodontics' technique, a CBCT and an intra-oral surface scan were aligned using special software. This allowed the virtual planning of optimal access cavities up to the apical third of the root. In this technique, a 3D-printed template guides a customized drill to the orifice of the root canal. After negotiation of the root canals, conventional root canal treatment was performed. This case report demonstrates that minimally invasive and apically extended access cavities are feasible in mandibular incisors with this technique. KEY LEARNING POINTS The 'Microguided Endodontics' technique is a safe and minimally invasive method for root canal location and prevention of technical failures in anterior teeth with pulp canal calcification.

[1]  J. Holcomb,et al.  Calcific metamorphosis of the pulp: its incidence and treatment. , 1967, Oral surgery, oral medicine, and oral pathology.

[2]  F. Sayegh,et al.  Calcification in the dental pulp. , 1968, Oral surgery, oral medicine, and oral pathology.

[3]  J. Andreasen,et al.  Luxation of permanent teeth due to trauma. A clinical and radiographic follow-up study of 189 injured teeth. , 1970, Scandinavian journal of dental research.

[4]  B Hedegård,et al.  Traumatized permanent teeth in children aged 7-15 years. , 1975, Svensk tandlakare tidskrift. Swedish dental journal.

[5]  K. Kerekes,et al.  Long-term prognosis of traumatized permanent anterior teeth showing calcifying processes in the pulp cavity. , 1977, Scandinavian journal of dental research.

[6]  M Cvek,et al.  Failures and healing in endodontically treated non-vital anterior teeth with posttraumatically reduced pulpal lumen. , 1982, Acta odontologica Scandinavica.

[7]  G. J. Sauer,et al.  Incidence of canal calcification in the orthodontic patient. , 1982, American journal of orthodontics.

[8]  P. Andersen,et al.  Occurrence of pulp canal obliteration after luxation injuries in the permanent dentition. , 1987, Endodontics & dental traumatology.

[9]  E. Saunders,et al.  The heat generated on the external root surface during post space preparation. , 1989, International endodontic journal.

[10]  A Robertson,et al.  Incidence of pulp necrosis subsequent to pulp canal obliteration from trauma of permanent incisors. , 1996, Journal of endodontics.

[11]  D L Hussey,et al.  Thermographic assessment of heat generated on the root surface during post space preparation. , 1997, International endodontic journal.

[12]  D. Avery,et al.  Comparison of mineral trioxide aggregate and formocresol as pulp-capping agents in pulpotomized primary teeth. , 2004, Pediatric dentistry.

[13]  P. Brodin,et al.  Messung der aktuellen Pulpadurchblutung nach orthodontischer Kraftapplikation , 1996, Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie.

[14]  H. Lang,et al.  Impact of Endodontic Treatments on the Rigidity of the Root , 2006, Journal of dental research.

[15]  Adeleke O Oginni,et al.  Evaluation of radiographs, clinical signs and symptoms associated with pulp canal obliteration: an aid to treatment decision. , 2009, Dental traumatology : official publication of International Association for Dental Traumatology.

[16]  C. Walter,et al.  Endodontics or implants? A review of decisive criteria and guidelines for single tooth restorations and full arch reconstructions. , 2009, International endodontic journal.

[17]  P. Dummer,et al.  Pulp canal obliteration: an endodontic diagnosis and treatment challenge. , 2012, International endodontic journal.

[18]  H Shemesh,et al.  European Society of Endodontology position statement: the use of CBCT in endodontics. , 2014, International endodontic journal.

[19]  J B Ludlow,et al.  Effective dose of dental CBCT-a meta analysis of published data and additional data for nine CBCT units. , 2015, Dento maxillo facial radiology.

[20]  P. Parashos,et al.  Endodontics and the ageing patient. , 2015, Australian dental journal.

[21]  H. Arslan,et al.  Effect of the size of the apical enlargement with rotary instruments, single-cone filling, post space preparation with drills, fiber post removal, and root canal filling removal on apical crack initiation and propagation. , 2015, Journal of endodontics.

[22]  T. Attin,et al.  Narrowing of the radicular pulp space in coronally restored teeth , 2017, Clinical Oral Investigations.

[23]  T. Connert,et al.  Guided Endodontics: a novel treatment approach for teeth with pulp canal calcification and apical pathology. , 2016, Dental traumatology : official publication of International Association for Dental Traumatology.

[24]  M S Zehnder,et al.  Guided endodontics: accuracy of a novel method for guided access cavity preparation and root canal location. , 2016, International endodontic journal.

[25]  Gabriel Krastl,et al.  Microguided Endodontics: Accuracy of a Miniaturized Technique for Apically Extended Access Cavity Preparation in Anterior Teeth , 2017, Journal of endodontics.

[26]  T. Connert,et al.  Treatment of calcified root canals in elderly people: a clinical study about the accessibility, the time needed and the outcome with a three‐year follow‐up , 2017, Gerodontology.