Computer-aided dynamic navigation: a novel method for guided endodontics

Objectives: To investigate the novel use of computer-aided dynamic navigation for guided endodontics. Method and materials: Dental casts were fabricated from sets of extracted human teeth. A cone beam computed tomography (CBCT) scan of each cast, with a molded thermoplastic stent and a radiographic marker attached, was obtained and imported into the planning software of a dynamic navigation implant surgery system. Simulating implant surgery but for guided endodontics, the drilling entry point, angle, pathway, and depth of virtual implants were planned for 29 selected teeth. The radiographic marker was replaced with a jaw tag and mounted in a phantom head. A drill tag was attached to the drill handpiece. Following calibration, guided by the stereoscopic motion-tracking camera via the tags and images on a computer monitor providing real-time dynamic plus visual intraoperative feedback, the handpiece was aligned accordingly and endodontic access cavity preparation carried out. Successful root canal location was confirmed using periapical radiographs and CBCT. Results: Conservative access cavities were achieved and all the expected canals were successfully located in 26 teeth (n = 29). Due to tracking difficulties, only one canal was located in two maxillary second molars; in a maxillary first molar, only two canals were located and the access preparation for the third canal was misaligned and off-target. Conclusions: The results of this study demonstrate the potential of using computer-aided dynamic navigation technology in guided endodontics in clinical practice. Keywords: access cavity, cone beam computed tomography, dynamic navigation, endodontics, guided endodontics