Accuracy of Guided Endodontics in Simulated Perforated Teeth with Calcified Canals

Abstract

Introduction: Endodontic treatment in teeth following iatrogenic accidents can be challenging and difficult to correct. Guided Endodontic Access (GEA) has been used as an adjunct in endodontic treatment to in in treating teeth with complex anatomy and may assist in treating teeth with procedural accidents. The accuracy of GEA stents in teeth with a simulated procedural accident will be assessed. Objective: This in vitro study will utilize a 3D model of a tooth with a simulated procedural accident: deviation and perforation during root canal treatment(RCT). GEA stents will be fabricated designed to overcome and compare the previous ledge formation and perforation. The influence on the degree of deviation of the designed access path from the prepared path will be determined by assessing the degree of angle of deviation and amount of deviation in millimeters. Materials and Methods: A 3-D printed maxillary model of an anonymous patient will be used. The deviated path and perforation will be simulated in a 3D printed tooth #4 using the meshmixer software tooth at two levels: apical and mid-root. The stent extends from tooth #3 to tooth #14 and was designed using coDiagnostiX software over tooth #4 with a simulated perforation. 15 GEA stents will have guides for the mid root perforation, 15 GEA stents will have guides for the canals not in contact with the perforation, and 15 GEA stents will have guides for canals apical to the perforation. All cases will be accessed with a 1.0 mm drill that is planned to fit the access sleeve. Results: The distal( base), the distal(tip) and the vestibular (tip) for the guided access in which the canal was in contact with the deviated path had no significant difference in deviation. The angle was significantly deviated in all models, but the model in which the canal was in contact with the deviated canal had a significantly lower angle, distal base, and vestibular base that both models in which the canal was not in contact with the deviated path and at different heights. The degree of deviation for all samples ranged from 1.40° to 10.60°. The largest degree of deviation corresponds with the increased depth of the original canal system. Conclusion: In conclusion, our study revealed that the utilization of GEA in calcified teeth with PCO and a deviated path demonstrated greater effectiveness in canals located in closer proximity compared to those located farther away from the deviated path. Therefore, we can infer that the use of a GEA stent in calcified teeth with PCO and a deviated path is favorable only under certain conditions.