Dynamic Navigation in Endodontics: Guided Access Cavity Preparation by Means of a Miniaturized Navigation System

Podsumowanie

Dynamic navigation systems (DNS) provide real-time visualization and guidance to the operator during endodontic access cavities preparation. The planning of the procedure requires three-dimensional imaging utilizing cone beam computed tomography and surface scans. After the export of the planning data to the DNS, access cavities can be prepared with minimal invasion.

Streszczenie

In the case of teeth with pulp canal calcification (PCC) and apical pathology or pulpitis, root canal treatment can be very challenging. PCC are common sequelae of dental trauma but can also occur with stimuli such as caries, bruxism, or after placing a restoration. In order to access the root canal as minimally invasive as possible in case of a necessary root canal treatment, dynamic navigation has recently been introduced in endodontics in addition to static navigation. The use of a dynamic navigation system (DNS) requires pre-operative cone-beam computed tomography (CBCT) imaging and a digital surface scan. If necessary, reference markers must be placed on the teeth before the CBCT scan; with some systems, these can also be planned and created digitally afterward. By means of a stereo camera connected to the planning software, the drill can now be coordinated with the help of reference markers and virtual planning. As a result, the position of the drill can be displayed on the monitor in real-time during preparation in different planes. In addition, the spatial displacement, the angular deviation, and the depth position are also displayed separately. The few commercially available DNS mostly consist of relatively large camera-marker-systems. Here, the DNS contains miniaturized components: a low-weight camera (97 g) mounted on the micromotor of the electric handpiece utilizing a manufacturer-specific connecting mechanism and a small marker (10 mm x 15 mm), which can be easily attached to an individually manufactured intraoral tray. For research purposes, a post-operative CBCT scan can be matched with the pre-operative one, and the volume of tooth structure removed can be calculated by the software. This work aims to present the technique of guided access cavity preparation by means of a miniaturized navigation system from imaging to clinical implementation.

Wprowadzenie

In non-surgical endodontic treatment, the preparation of an adequate access cavity is the first invasive step¹. Teeth that have undergone pulp canal calcification (PCC) are difficult and time-consuming to treat², leading to more iatrogenic errors such as perforations that may be crucial for the prognosis of the tooth³. PCC is a process that can be observed after dental trauma^4,5 and as a response to stimuli such as caries, restorative procedures, or vital pulp therapy⁶, leading to a relocation of the root canal orif....

Protokół

Approval or consent to perform this study was not required since the use of patients' data is not applicable.

1. Planning procedure

1. Open the planning software and reinsure that the newest version is installed.
2. Click on EXPERT to switch the Work mode from EASY to EXPERT.
3. Click on NEW on the right sidebar to start a new case planning.
4. Choose the Image Source by selecting the folder with the pre-operative DICOM CBCT data.
   NOTE: Adjustment of the Hounsfield Units (HU) threshold may be necessary depending on the image quality ....

Wyniki

Figure 7A shows the occlusal view of a prepared endodontic access cavity in a model central incisor with the aid of the DNS. Figure 7B shows the associated CBCT scan in sagittal view. The post-operative segmentation is then matched with the pre-operative CBCT data (Figure 7C). Pre- and post-operative 3D models are matched (Figure 7D) and the pre- (412.12 mm³) and post-operative (405.09mm^.......

Dyskusje

Several studies and case reports have demonstrated the feasibility of guided access cavity preparation in endodontics⁷. Navigation utilizing templates and sleeves for bur guidance (static navigation) was described to be a precise and safe method to access calcified root canals. Besides, the method was found to be independent from the operator's degree of clinical experience¹⁶, offering the possibility to treat teeth with advanced PCC without the risks of large loss of t.......

Materiały

Name	Company	Catalog Number	Comments
Accuitomo 170	Morita Manufacturing	NA	CBCT machine
coDiagnostiX	Dental Wings Inc	Version 10.4	Planning software, which is mainly intended for implant surgery. Endodontic access cavities can be planned by adding the utlized bur to the implant database
DENACAM	mininavident	NA	Dynamic Nagivation System, consisting of (1) camera, which is mounted to an electric handpiece, (2) marker, (3)computer and screen, (4) associated software
TRIOS 3	3Shape A/S	NA	Surface scanner