Expert consensus on digital guided therapy for endodontic diseases

Abstract

Digital guided therapy (DGT) has been advocated as a contemporary computer-aided technique for treating endodontic diseases in recent decades. The concept of DGT for endodontic diseases is categorized into static guided endodontics (SGE), necessitating a meticulously designed template, and dynamic guided endodontics (DGE), which utilizes an optical triangulation tracking system. Based on cone-beam computed tomography (CBCT) images superimposed with or without oral scan (OS) data, a virtual template is crafted through software and subsequently translated into a 3-dimensional (3D) printing for SGE, while the system guides the drilling path with a real-time navigation in DGE. DGT was reported to resolve a series of challenging endodontic cases, including teeth with pulp obliteration, teeth with anatomical abnormalities, teeth requiring retreatment, posterior teeth needing endodontic microsurgery, and tooth autotransplantation. Case reports and basic researches all demonstrate that DGT stand as a precise, time-saving, and minimally invasive approach in contrast to conventional freehand method. This expert consensus mainly introduces the case selection, general workflow, evaluation, and impact factor of DGT, which could provide an alternative working strategy in endodontic treatment.

Comparing accuracy in guided endodontics: dynamic real-time navigation, static guides, and manual approaches for access cavity preparation – an in vitro study using 3D printed teeth

“…While research used to focus mainly on single-rooted obliterated front teeth, and less on sparsely available molars or anatomical issues other than obliterations [ 18 – 21 , 49 ], for this study, 3D printed replica teeth with different anatomical challenges were utilized. The advantage of using 3D printed teeth is that they can be replicated on a large scale, allowing for the investigation of specific, and even rare, challenging anatomies or pathological changes [ 50 – 52 ].…”

“…Guided endodontics in general shows increasing implications for clinical practice, as has been reviewed in a current expert consensus paper [ 21 ], given the rising prevalence of tooth obliterations due to aging, increased use of regenerative endodontic procedures, fiber post insertions/removals, and treatment of teeth with special morphological abnormalities. In terms of clinical implications, our study contributes to the existing knowledge by examining the accuracy and substance loss associated with guided endodontic treatment of teeth with different anatomical challenges using 3D printing.…”

“…In the software, the bur’s virtual placement at the orifice ensures direct access, minimizing substance loss even without direct sight. Static navigation has been explored in numerous prior studies, primarily consisting of case reports or in vitro investigations utilizing either human or 3D-printed teeth [ 19 – 21 ]. For this method the CBCT-based planning is merged with a surface scan, and a template for guided drilling is fabricated, either by subtractive or additive manufacturing.…”