Guided endodontic treatment of the lower molar with dystrophic calcification : A case report

Abstract

Abstract : Purpose : The endodontic treatment of calcified root canals in molars is a challenging and time-consuming procedure. Even with the aid of a surgical microscope, the risk of root perforation is high, especially in the furcation area. The purpose of this study is to report the Computer-Aided-Design and Manufacturing (CAD-CAM) workflow, the innovative strategies for the template ideation, and the guided endodontic treatment of a mandibular molar with dystrophic calcification in the distal root canals.

 Case : A 56-year-old female patient who was referred for endodontic treatment in the right first mandibular molar for not being able to access the root canals. The disto-buccal and disto-lingual canals appeared obliterated in the radiographic images. The absence of dental crown and tooth inclination contributed to a poor visual reference of the tooth in the dental arch and the direction of the remaining lumens of the canals. Despite using surgical microscopy, the conventional technique led to the deviation of the disto-buccal canal towards the furcation area. The obliteration of both distal root canals was confirmed using the Cone Beam Computer Tomography. The clinical history associated with the tomography diagnosis was compatible with dystrophic calcifications in the pulp canals. The patient was submitted to an intra-oral scanning as well. The Digital Imaging and Communications in Medicine data (DICOM) were segmented. The Standard Tessellation Language (STL) files were processed following the CAD-CAM workflow, aiming to create endodontic template.

 Discussion : Guided endodontics was initially proposed for cases of anterior teeth with dental anomalies or calcific metamorphosis. This case report demonstrated that guided endodontics was a successful technique for accessing obliterated root canals, even in more complex cases such as the distal root canals of mandibular molar. The digital plan for treating the mandibular molar with dystrophic calcification reinforces guided endodontics as personalized treatment. The knowledge of anatomy and creativity in templates design led to automation, safety, and precision to access the root canals. The “digital future” holds an increase in the success of endodontic treatments.

 Conclusion : Guided endodontics using a static template appears to be a safe and minimally invasive method for detecting calcified root canals. However, limitations of the procedure are that static guidance can only be performed on straight roots or straight parts of curved roots.