Chong Bun San, Dhesi Manpreet, Makdissi Jimmy
Quintessence Int. 2019;50(3):196-202. doi: 10.3290/j.qi.a41921.
To investigate the novel use of computer-aided dynamic navigation for guided endodontics.
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.
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.
The results of this study demonstrate the potential of using computer-aided dynamic navigation technology in guided endodontics in clinical practice.
研究计算机辅助动态导航在引导性牙髓治疗中的新应用。
用拔除的人类牙齿制作牙模。对每个带有模制热塑性支架和附着的放射标记物的牙模进行锥形束计算机断层扫描（CBCT），并将其导入动态导航种植手术系统的规划软件中。模拟种植手术但用于引导性牙髓治疗，为29颗选定的牙齿规划虚拟种植体的钻孔入口点、角度、路径和深度。将放射标记物换成颌标签并安装在仿真头模中。在钻头上附着一个钻标签。校准后，在立体运动跟踪摄像头通过标签和计算机显示器上的图像引导下，提供实时动态加视觉术中反馈，将钻头相应对齐并进行牙髓开髓腔制备。使用根尖片和CBCT确认根管定位成功。
成功制备了保守的开髓腔，26颗牙齿（n = 29）中所有预期的根管均成功定位。由于跟踪困难，两颗上颌第二磨牙中仅定位了一条根管；在上颌第一磨牙中，仅定位了两条根管，第三条根管的开髓准备未对准且偏离目标。
本研究结果证明了在临床实践中，计算机辅助动态导航技术在引导性牙髓治疗中的应用潜力。
