Application of an Endodontic Static Guide in Fiber Post Removal from a Compromised Tooth

Abstract

Removing a fiber post from a root canal that requires endodontic retreatment is often very challenging. Conventional freehand techniques for removing fiber posts are time-consuming, sometimes result in iatrogenic errors, and heavily rely on the practitioner's experience. The endodontic static guide can be an alternative method. While the use of an endodontic 3D-printed static guide for fiber post removal has been reported as highly successful, it can also cause complications. Skipping any critical steps during the guide construction or its clinical application can lead to errors. This case report presents the saving of a compromised tooth with a fractured fiber post and a periapical lesion around the apex through the use of an endodontic static guide for fiber post removal. This study describes possible sources of error that may happen during construction and clinical use of the guide.

Figure 1

(a) Perioperative clinical examination showing a fractured tooth #9. (b) Perioperative periapical radiograph showing inadequate endodontic treatment with a fractured fiber post in the root canal. (c) Perioperative CBCT assessment. The sagittal slice of tooth #9 confirms a radiolucent area with an intact buccal and palatal plate.

Figure 2

(a) Optical impression of the maxillary arch using STL format. (b) The STL file and the DICOM file obtained by CBCT are virtually merged. (c) Virtual planning of fiber post removal in the coronal plane and (d) sagittal plane. The drill was positioned along the long axis of the fiber post set up to its apical tip.

Figure 3

(a) Munce bur and static endodontic guide with metallic sleeve. (b) The guide was positioned on the teeth to check the correct fitting. (c) A microscopic view showing a check on the drilling axis towards the gutta-percha. (d) Periapical radiograph indicates some deviation from the intended pathway. (e) Working length determination radiograph. (f) Final radiograph with temporary filling.

Figure 4

(a) Postoperative clinical view of a permanent restoration. (b) Clinical view of 6 months postoperatively. (c) Radiograph view of 6 months postoperatively showing periapical healing. (d, e) Coronal and sagittal view of postoperative CBCT showing the dimensional reduction of the periapical lesion. The superimposed preplanned pathway is located in the center of the canal.