Computer-assisted Dynamic Navigation for Localizing Severely Calcified Root Canals: An Analysis of Deviations, Task-focused Performance, and Operator Perception

Abstract

Introduction: Pulp canal obliteration (PCO) presents a significant challenge to the endodontist. This study aimed to evaluate deviations, task-focused performance, and operator perceptions during canal orifice localization using computer-assisted dynamic navigation (C-ADN) in tooth replicas with severe PCO, comparing experienced and less experienced operators.

Methods: A total of 120 tooth replicas were assigned to two operators with differing experience levels. To assess variations between planned and actual access preparations, preoperative and postoperative cone-beam computed tomography scans were superimposed using C-ADN software. Operator's task-focused performance and subjective elements resultant from operator's perspective linked to C-ADN were also evaluated. Statistical assessments were conducted using parametric methods, chi-square tests, or Fisher exact tests.

Results: Correlation analysis indicated a positive relationship among PCO depth and drilling time (r = 0.336, P < .001). Although precision measurements, including linear/angular deviations, were statistically similar among the operators (P > .05), the less experienced operator demonstrated significantly greater visuomotor coordination and drilling times, as well as higher proportions of mishaps, leading to a significantly lower task-focused performance (all P < .05). Over successive attempts, both operators showed progressive improvement in visuomotor skills and reported enhanced situational awareness, procedural quality, and safety features of C-ADN. The less experienced operator expressed concerns about workload and usability.

Conclusions: C-ADN systems are promising tools for locating calcified root canals, offering reliable guidance regardless of operators' experience. However, efficiency and mishap rates depend on experience, as mastering the visuomotor skills requires an adequate learning curve. Positive operators' perception and usability support its integration into endodontics, provided skill development is emphasized to enhance proficiency.

Keywords: Access cavity; computer-assisted dynamic navigation; cone-beam computed tomography; pulp canal obliteration; task performance.