Guided endodontic treatment in a region of limited mouth opening: a case report of mandibular molar mesial root canals with dystrophic calcification

Abstract

Background The endodontic treatment of calcified root canals in molars is a challenging and time-consuming procedure. Even with the aid of a surgical microscope, the risk of root perforation is high, especially in the furcation area. The purpose of this study is to report the Computer-Aided-Design and Manufacturing (CAD–CAM) workflow, the innovative strategies for the template ideation, and the guided endodontic treatment of a mandibular molar with dystrophic calcification in the mesial root canals. Case presentation A 58-year-old female patient, ASA I, was referred to endodontic treatment in the right first mandibular molar for prosthetic reasons. The mesiobuccal and mesiolingual canals appeared obliterated in the radiographic images. The absence of dental crown, tooth inclination, and the limited mouth opening of the region contributed to a poor visual reference of the tooth in the dental arch and the direction of the remaining lumens of the canals. Despite using surgical microscopy, the conventional technique led to the deviation of the mesiobuccal canal towards the furcation area. The obliteration of both mesial root canals was confirmed using the Cone Beam Computer Tomography. The clinical history associated with the tomography diagnosis was compatible with dystrophic calcifications in the pulp canals. The patient was submitted to an intra-oral scanning as well. The Digital Imaging and Communications in Medicine data (DICOM) were segmented. The Standard Tessellation Language (STL) files were processed following the CAD–CAM workflow, aiming to create two different endodontic templates with a new open design concept. The templates with open design allowed direct visualization of the operative field, irrigation, and dentin debris removal. The strategy of the guidance sleeves niche as half-cylinders allowed the drill insertion in a limited mouth opening region. Conclusions The digital planning and guided access permitted to overcome the case limitations and then re-establish the glide path following the original anatomy of the root canals. The guided endodontic represents a personalized technique that provides security, reduced risks of root perforation, and a significant decrease of the working time to access obliterated root canals even in the mesial root canal of mandibular molars, a region of limited mouth opening.

EDTA Combined with C-Pilot Files and Microultrasound for Root Canal Calcification: Dredging Effect and Safety Analysis

“…As an excellent imaging tool, CBCT can clearly display root canal curvature, calcification position, and degree, providing an accurate basis for clinical root canal treatment and effectively reducing the rate of root canal omission [ 17 ]. It is pointed out that with the assistance of CBCT, even an inexperienced stomatologist can achieve an ideal root canal preparation effect [ 18 ], which fully demonstrates the application value of CBCT for root canal calcification.…”

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 ].…”

“…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.…”

Fiber Post Removal Using a Conservative Fully Guided Approach: A Dental Technique

“…Zehnder and his colleagues introduced the concept of "guided endodontics" to facilitate access cavity preparation for teeth with root canal obliteration and reported that deviations of planned and prepared access cavities were ranging from 0.17 to 0.47 mm at the tip of the bur, while the mean of angle deviation was 1.81 ° [18]. In this case, a custom sleeve was fabricated and integrated with the endo-guide template to adequately guide the drilling pathway without the risk of resin being damaged by over-heating or undesirable resin drilling [25]. Therefore, in comparison to guided implant surgery, the accuracy of guided endodontics is considered relatively high [26].…”