Departments of Endodontics, School of Dentistry, Virginia Commonwealth University, Richmond, Virgini.
Dental Public Health and Policy, School of Dentistry, Virginia Commonwealth University, Richmond, Virginia.
J Endod. 2020 Dec;46(12):1894-1900. doi: 10.1016/j.joen.2020.09.001. Epub 2020 Sep 10.
This study presents a novel method to deliver intraosseous anesthesia using dynamic navigation technology. The study aimed to evaluate its safety and 3-dimensional (3D) accuracy in comparison to traditional freehand injection of intraosseous anesthesia.
Six identical sets of 3D-printed surgical jaw models (TrueJaw; DELendo, Santa Barbara, CA) comprising simulated alveolar and dental anatomy with 54 interradicular sites were used in this study. The injection sites were equally distributed based on the range of the inter-radicular distance (ie, 1.5-2.5 mm, 2.5-3.5 mm, and 3.5-4.5 mm). A board-certified endodontist randomly completed intraosseous drilling at inter-radicular sites of varying distance using freehand technique and the Navident dynamic navigation system (ClaroNav, Toronto, Ontario, Canada) with the X-Tip system (Dentsply Sirona, York, PA). The rate of root perforation associated with inter-radicular distance was compared between the 2 groups using the Fisher exact test. Two-dimensional (2D) and 3D horizontal, vertical, and angulation discrepancies between the planned and dynamically navigated guide sleeves were digitally measured using superimposed cone-beam computed tomographic scans. Analysis of variance models were used to determine if the interdental distance was associated with the accuracy measures from the dynamic navigation system. The significance level was set at 0.05.
The rate of root perforation was significantly higher for the freehand group than the dynamic navigation (22% vs 0%, P < .05). For dynamic navigation, the 2D entry deviation was 0.71 mm (95% confidence interval [CI], 0.56-0.87). The mean 2D horizontal deviation was 0.96 mm (95% CI, 0.79-1.14), and the mean 2D vertical deviation was 0.70 mm (95% CI, 0.55-0.84). The 3D deviation at the tip was on an average 1.23 mm (95% CI, 1.05-1.42). The overall 3D angular deviation was on average 1.36° (95% CI, 1.15-1.56). The inter-radicular distance was not significantly associated with any 2D or 3D discrepancies.
Successful and accurate drilling of dynamically navigated intraosseous delivery occurred in 100% of injection sites irrespective of the inter-radicular distance. It was significantly safer in comparison to freehand intraosseous drilling to prevent injury of the roots of the adjacent teeth in close proximity.
本研究提出了一种使用动态导航技术进行骨内麻醉的新方法。该研究旨在评估其安全性，并与传统的骨内麻醉徒手注射相比，评估其三维（3D）准确性。
本研究使用了 6 套相同的 3D 打印手术颌模型（TrueJaw；DELendo，圣巴巴拉，加利福尼亚州），包括模拟牙槽和牙齿解剖结构，有 54 个根管间位点。根据根管间距离的范围（即 1.5-2.5mm、2.5-3.5mm 和 3.5-4.5mm），将注射部位均等分配。一名经过董事会认证的牙髓病专家使用徒手技术和 Navident 动态导航系统（ClaroNav，多伦多，安大略省，加拿大）以及 X-Tip 系统（Dentsply Sirona，约克，宾夕法尼亚州）在不同距离的根管间位点随机完成骨内钻孔。使用 Fisher 确切检验比较两组间与根管间距离相关的根穿孔率。使用叠加锥形束计算机断层扫描，对计划和动态导航引导套管之间的二维（2D）和三维水平、垂直和角度差异进行数字测量。使用方差分析模型来确定牙齿间距离是否与动态导航系统的准确性测量值相关。显著性水平设为 0.05。
徒手组的根穿孔率明显高于动态导航组（22%比 0%，P<.05）。对于动态导航，2D 入口偏差为 0.71mm（95%置信区间[CI]，0.56-0.87）。平均 2D 水平偏差为 0.96mm（95%CI，0.79-1.14），平均 2D 垂直偏差为 0.70mm（95%CI，0.55-0.84）。尖端的 3D 偏差平均为 1.23mm（95%CI，1.05-1.42）。总体 3D 角度偏差平均为 1.36°（95%CI，1.15-1.56）。牙齿间距离与任何 2D 或 3D 差异均无显著相关性。
无论根管间距离如何，动态导航的骨内注射均能 100%成功、准确地进行，且与徒手骨内注射相比，安全性更高，可防止邻近牙齿根部受伤。
