Elsevier

Journal of Endodontics

Volume 47, Issue 2, February 2021, Pages 315-321
Journal of Endodontics

Case Report/Clinical Techniques
Guided Endodontics for Managing Severely Calcified Canals

https://doi.org/10.1016/j.joen.2020.11.026Get rights and content

Abstract

Endodontic treatment of teeth with pulp canal obliteration presents a challenge given the high likelihood of procedural errors and complications during treatment. These drawbacks can be avoided by using a personalized 3-dimensional (3D) guide designed by overlaying a cone-beam computed tomographic scan with an intraoral scan of the patient. This 3D guide enables the clinician to obtain a straight access to the obliterated root canal.This article described guided endodontics in managing 7 severely obliterated teeth using both virtually designed 3D guides and a customized 1-mm-diameter cylindrical bur. This treatment approach was demonstrated to be safe and fast and can be considered as a predictable technique for the location of calcified canals, thus minimizing complications.

Section snippets

Case Report

Seven consecutive adult patients (aged 27–53 years, mean age = 40.5 years) with a previous history of dental trauma experiencing tooth discomfort in the anterior region were referred to the dental office (endodontic referral clinic in Barcelona, Spain) between 2015 and 2017. No teeth responded to thermal or electric pulp testing (Fig. 1A), although sensitivity to palpation was observed in 4 cases and to percussion in 2 cases (Table 1). Radiographic examination, which included a periapical

Discussion

McCabe and Dummer18 used a treatment decision flowchart to determine that procedures on PCO teeth should be limited to cases with symptomatic and/or radiographic signs of periapical pathosis. They also suggested that endodontic treatment should be considered for discolored teeth that were unresponsive to vital bleaching techniques. However, in their flowchart, radiographic assessment was limited to intraoral radiographs, which may be insufficient for proper visualization of the root canal

Conclusion

Within the limitations of the present report, guided endodontics was demonstrated to be a safe, accurate, and conservative approach for the endodontic management of severely anterior obliterated canals when precise virtual planning is used. CBCT imaging should be used to determine the need for guided endodontic access depending on the degree of tooth obliteration. Additional research should focus on comparing different planning software, materials, and designs for both 3D guides and burs.

Acknowledgments

The authors thank the staff members of Autrán Dental for its logistic contribution and Jesús Muñoz for his assistance with the digital planning. The authors deny any conflicts of interest related to this study.

References (46)

  • T. Kim et al.

    Accuracy of a simplified 3D-printed implant surgical guide

    J Prosthet Dent

    (2020)
  • J.S. Shim et al.

    Printing accuracy, mechanical properties, surface characteristics, and microbial adhesion of 3D-printed resins with various printing orientations

    J Prosthet Dent

    (2020)
  • Y. Jang et al.

    Accuracy of 3-unit fixed dental prostheses fabricated on 3D-printed casts

    J Prosthet Dent

    (2020)
  • G.B. Brown et al.

    Accuracy of 3-dimensional printed dental models reconstructed from digital intraoral impressions

    Am J Orthod Dentofacial Orthop

    (2018)
  • S.Y. Kim et al.

    Precision and trueness of dental models manufactured with different 3-dimensional printing techniques

    Am J Orthod Dentofacial Orthop

    (2018)
  • M. Salmi et al.

    Accuracy of medical models made by additive manufacturing (rapid manufacturing)

    J Craniomaxillofac Surg

    (2013)
  • J.W. Stansbury et al.

    3D printing with polymers: challenges among expanding options and opportunities

    Dent Mater

    (2016)
  • N. Kalberer et al.

    CAD-CAM milled versus rapidly prototyped (3D-printed) complete dentures: an in vitro evaluation of trueness

    J Prosthet Dent

    (2019)
  • J.Y. Choi et al.

    Analysis of errors in medical rapid prototyping models

    Int J Oral Maxillofac Surg

    (2002)
  • F.M. Andreasen et al.

    Occurrence of pulp canal obliteration after luxation injuries in the permanent dentition

    Endod Dent Traumatol

    (1987)
  • I. Jacobsen et al.

    Long-term prognosis of traumatized permanent anterior teeth showing calcifying processes in the pulp cavity

    Scand J Dent Res

    (1977)
  • A.O. Oginni et al.

    Evaluation of radiographs, clinical signs and symptoms associated with pulp canal obliteration: an aid to treatment decision

    Dent Traumatol

    (2009)
  • J. Greenwall-Cohen et al.

    The single discoloured tooth: vital and non-vital bleaching techniques

    Br Dent J

    (2019)
  • Cited by (0)

    View full text