OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium.
Department of Oral Health Sciences, Endodontology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
Int Endod J. 2021 Sep;54(9):1659-1667. doi: 10.1111/iej.13563. Epub 2021 Jun 12.
To evaluate 3D accuracy and outcome of a dynamic navigation method for guided root canal treatment of severe pulp canal obliteration (PCO) in 3D printed jaws.
Three operators with different levels of experience in Endodontics performed navigated access cavities, using the Navident system (ClaroNav), in two sets (maxillary and mandibular) of 3D-printed jaw models with teeth presenting severe PCO. Models were mounted on a phantom to mimic a real clinical situation. After treatment, a postoperative high resolution Cone-Beam Computer Tomography (CBCT) scan (NewTom) was taken for each model and registered to the preoperative model. All access cavities were then segmented using 3-Matic Medical software 15.0 (Materialise). Length and volume of each access cavity were measured, and a comparison was done by measuring the distance deviation in mm at the coronal entry point, apical point, vertical deviation, total deviation and angular deviation of the access cavity in comparison with the virtual planning. Additionally, all access cavities were scouted with a size 10 K-file and inspected on the CBCT to confirm that the canal was located. Descriptive statistics for each parameter were performed. Normality of the data was assessed; data were transformed if needed to make it normally distributed. One-way analysis of variance (anova) was applied to assess differences between parameters for tooth type, jaw, and operators and corrected for simultaneous hypothesis testing according to Tukey. Significance level was set at .05.
After training with the system (28 cavities per operator), a total of 132 teeth and 168 access cavities (56 per operator) were prepared. All operators located a total of 156 canals, obtaining an overall success of 93% without a difference between operator experience (p > .05). The mean deviation at the apical point was 0.63 mm (SD 0.35) and was significantly lower in anterior teeth in comparison with molars (p < .05). The mean angular deviation from the planning was 2.81° (SD 1.53).
Dynamic navigation was an accurate approach for root canal treatment in teeth with severely calcified canals. However, the technique has a learning curve and requires extensive training prior to its use clinically.
评估 3D 打印颌骨中严重牙髓管闭塞（PCO）引导根管治疗的动态导航方法的 3D 准确性和结果。
3 名具有不同牙髓学经验水平的操作人员在具有严重 PCO 的牙齿的两组（上颌和下颌）3D 打印颌骨模型中使用 Navident 系统（ClaroNav）进行了导航式窝洞制备。模型安装在幻影上，以模拟真实的临床情况。治疗后，对每个模型进行术后高分辨率锥形束计算机断层扫描（CBCT）（NewTom）扫描，并与术前模型进行注册。然后使用 3-Matic Medical 软件 15.0（Materialise）对所有窝洞进行分段。测量每个窝洞的长度和体积，并通过测量在冠状入口点、根尖点、垂直偏差、总偏差和窝洞角度偏差方面与虚拟规划的毫米距离偏差进行比较。此外，使用尺寸为 10 K 文件对所有窝洞进行探查，并在 CBCT 上进行检查，以确认根管的位置。对每个参数进行描述性统计。评估数据的正态性；如果需要，将数据转换为正态分布。应用单因素方差分析（anova）评估牙型、颌骨和操作人员之间参数的差异，并根据 Tukey 进行同时假设检验校正。显著性水平设为.05。
在系统培训（每个操作人员 28 个窝洞）后，共制备了 132 颗牙齿和 168 个窝洞（每个操作人员 56 个）。所有操作人员共定位了 156 个根管，成功率为 93%，操作人员经验之间无差异（p>.05）。根尖点的平均偏差为 0.63mm（SD 0.35），前牙明显低于磨牙（p<.05）。与规划相比，平均角度偏差为 2.81°（SD 1.53）。
动态导航是治疗严重钙化根管牙齿根管治疗的一种准确方法。然而，该技术具有学习曲线，在临床使用前需要进行广泛的培训。
