Minimally invasive treatment of calcified root canals in anterior teeth with digital guide technique.

Abstract

This study aims to establish a minimally invasive treatment using a customized digital template and a miniaturized bur for pulp canal obliteration (PCO). Cone-beam computed tomography (CBCT) and digital oral scans of patients diagnosed with PCO in anterior teeth were obtained. Root canal morphology was reconstructed to accurately show the location, length, and direction of obliteration. A digital template was designed and fabricated using visual design software and 3D printing technology and used as guide for the miniaturized bur and drill sleeve during calcified tissue removal. A conventional root canal treatment was performed after the lumen of the root canal was reached. In both cases, the planned access cavity and glide paths were successfully established. In case 1, the deviated angle of the access cavity was 1.37°±0.07°, the deviation at the bottom of the miniaturized bur was 0.08-0.81 mm, the deviation at the tip of the bur was 0.05-1.13 mm, and difference in substance loss was 0.84-4.25 mm³. In case 2, the deviated angle of the access cavity was 3.09° ± 0.12°, the deviation at the bottom of the bur was 0.09-0.68 mm, the deviation at the tip of the bur was 0.29-0.66 mm, and the difference in substance loss was 0.55-3.79 mm3. Micro-guided endodontics is a novel approach for localizing and negotiating obliterated root canals and guarantees long-term prognosis without requiring excessive hard tissue removal.