Private Practice, Allerød, Denmark.
Section of Cariology and Endodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
J Endod. 2019 Jun;45(6):818-823. doi: 10.1016/j.joen.2019.03.010. Epub 2019 May 3.
The aim of this case report was to show the concept of guided endodontics in a maxillary first molar with limited interocclusal space. Guided endodontics involves merging cone-beam computed tomographic imaging and a surface scan of the tooth in order to create a guide to perform a drill path into the seemingly obliterated root canal. In the molar region, the interocclusal space is often too small to accommodate the guide, bur, and handpiece at once, and, therefore, a modified approach is presented. A 52-year-old man was referred because the dentist had failed to localize the distobuccal root canal of a maxillary molar (#3) associated with apical pathosis. After reopening and rubber dam placement, a glide path was established for both the palatal first mesiobuccal root canal and the second mesiobuccal using a size 10 hand file and coronal flaring. Further instrumentation to the working length was achieved by reciprocating file size 25. All 3 canals were temporarily filled with calcium hydroxide. For the distobuccal root canal, guided endodontics was chosen in order to avoid further impairment of the tooth because negotiation of the canal failed even with the use of the operating microscope. Following the merged data obtained from the cone-beam computed tomographic and surface scans, a translucent SICAT Optiguide (SICAT, Bonn, Germany) was constructed containing a sleeve representing the proper direction of a drill path in order to reach the distobuccal root canal. The access cavity was temporarily filled with a composite material made for light-curing. Before light curing, the Optiguide was replaced on the teeth, and a steel pin was pressed through the sleeve and the composite whereby the proper drill path direction was transferred into the composite. After polymerization and removal of the Optiguide and pin from the composite base sleeve, the guided drilling could be performed. This case report is the first on guided access preparation in a molar with pulp canal obliteration and limited interocclusal space. The demand for more interocclusal space was solved by transforming the virtual drill path into a composite-based intracoronal guide. The use of digital technology was essential.
本病例报告旨在展示在有限的颌间距离的上颌第一磨牙中采用导向牙髓学的概念。导向牙髓学涉及结合锥形束计算机断层扫描成像和牙齿的表面扫描，以便创建一个引导通道，以便在看似闭塞的根管中进行钻头路径。在磨牙区域，颌间距离通常太小，无法同时容纳引导器、车针和手机，因此提出了一种改良方法。一名 52 岁男性因牙医未能定位上颌磨牙（#3）的远颊根管而就诊，该磨牙与根尖病变有关。重新打开和橡皮障放置后，使用 10 号手用锉建立腭侧近中颊根和第二近中颊根的滑入路径，并用冠向扩孔。使用 25 号往复锉进一步达到工作长度。所有 3 个根管均用氢氧化钙暂时填充。对于远颊根管，选择导向牙髓学是为了避免进一步损害牙齿，因为即使使用手术显微镜，根管的疏通也失败了。根据从锥形束计算机断层扫描和表面扫描中获得的合并数据，构建了半透明的 SICAT Optiguide（SICAT，波恩，德国），其中包含一个套管，代表到达远颊根管的适当钻头路径方向。临时用光固化复合材料填充入口腔。在光固化之前，将 Optiguide 更换到牙齿上，并用钢针穿过套管和复合材料，将适当的钻头路径方向转移到复合材料中。在聚合并从复合材料基底套管上移除 Optiguide 和钢针后，即可进行导向钻孔。本病例报告是首例关于牙髓通道闭塞和有限颌间距离的磨牙导向备洞。通过将虚拟钻头路径转化为基于复合材料的根管内导向器，解决了对更多颌间距离的需求。数字技术的使用至关重要。
