Master of Science in Dentistry
Janina Golob Deeb
Purpose: Pulp canal obliteration (PCO) is a common sequela of dental trauma, caries, restorations and vital pulp therapy procedures. Despite the application of high magnification and CBCT imaging, access cavity preparation for such cases is prone to procedural errors that may lead to substantial loss of dentin structure thereby reducing the long-term prognosis. This study aimed to achieve dentin conservation using a novel computer assisted dynamic navigation system (Navident) in comparison to freehand access preparation for locating calcified canals.
Methods: Forty maxillary and mandibular central incisors (tooth #9 and tooth #25) were 3-D printed to simulate PCO. They were randomly assigned to the following treatment groups – Group 1: Freehand access; Group 2: Dynamic navigation access. Successful location of the canal, perforations and treatment times were noted, and volumetric analysis of remaining tooth structure was performed utilizing ITK-SNAP open source segmentation.
Results: The access treatment method (freehand vs dynamic navigation) did not result in a significant difference in perforations or ability to locate the canal. Dynamic navigation resulted in significantly less tooth structure removed in maxillary teeth (35.5 vs. 62.2, p-value0.05). Dynamic navigation was associated with significantly faster drilling times for the first 8 treatment attempts in maxillary teeth (p0.05). The time was not significantly different between freehand and dynamic navigation for any of the treatment attempts in mandibular teeth (p >0.05). Drilling time significantly improved across the attempts for the freehand method in maxillary teeth by an average of 52.4 seconds per attempt (p
Conclusion: This study demonstrates the potential of applying dynamic 3-D navigation technology to preserve tooth structure and predictably locate root canals in teeth with PCO.
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