This paper demonstrates the usefulness of endodontic guides for the removal of fibre posts. A 36-year-old man consulted for retreatment of a maxillary first molar presenting a periapical pathology. This tooth revealed a composite reconstruction together with a glass-fibre post in the palatal root canal. To assist removal, use of an endodontic 3D-printed guide was indicated. A cone beam computed tomography examination and an optical impression were made to produce a tooth-supported guide by means of implant planning software (Blue Sky Plan, Blue Sky Bio ® ). The software enabled definition of a drilling pathway, which was transferred clinically using a resin template together with a sleeve and a 0.75-mm drill. The drill was guided as far as the gutta-percha situated in the apical third, limiting any risk of impairment or perforation.
In this work, we intended to assess the reliability of guided endodontic technique to remove a bonded fibre-post when there are artefacts in the conebeam computed tomography (CBCT) images caused by composite dental materials. We mounted natural posterior teeth on ten simulated models. Forty fibre-post and composite-core restorations were inserted in the teeth. We merged a pre-operative CBCT and optical surface scan on the Blueskyplan TM software to digitally design and subsequently 3D-printed the guides. Two operators initiated endodontic access into the fibre-post restorations using the template to guide the drill. Post-operative CBCT was taken and merged onto the pre-operative plan to measure the deviations at the coronal and apical segments. The mean deviation between the planned and actual drill paths were, respectively, of 0.39 AE 0.14 mm coronally and 0.40 AE 0.19 mm apically. Microguided endodontics is a predictable and accurate method to remove fibre-post restorations efficiently.
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