Template-guided endodontic access

Abstract

Background and overview: Endodontics is a rewarding and challenging profession. The tasks of negotiating, cleaning, and shaping canals can frustrate even the most talented clinicians, particularly if the canals are blocked by calcifications. Circumventing these obstructions can be a slow, tedious process, and at times it is not possible. Various techniques have been developed to assist with this problem but have met with limited success. Given that the success of endodontic treatment is dependent on the elimination or reduction of bacterial influences on periapical tissues, this is a critical issue.

Case description: A new application of an existing technology is available. This technique uses 3-dimensional (3D) radiography (cone-beam computed tomography) and 3D intraoral imaging. Through the integration of the data sets, pathways are planned to locate blocked canals. Templates can be designed and fabricated on 3D printers that fit intimately on the dentition. Special drills are selected that fit through the sleeves embedded in the template. These pathways align the drill and guide the depth of the access. Once the canals are accessed, conventional root canal treatment is possible.

Conclusions and practical implications: This case report reviews a new technique for treating a necrotic calcified root canal. The canal was identified in the apical one-third of the root. A pathway was planned to negotiate the canal using digital technology. The blockage was bypassed, and the root canal was successfully treated using a "template-guided access technique" with minimal tooth loss.

Keywords: Canal calcification; cone-beam computed tomography; guided root canal therapy; guided templates; obstructed canals.