Yang Xiaoxia, Zhang Yinchun, Chen Xuan, Huang Lei, Qiu Xiaoling
Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China.
Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China.
J Endod. 2024 Jan;50(1):96-105. doi: 10.1016/j.joen.2023.10.010. Epub 2023 Oct 27.
Nonsurgical endodontic teeth treatment with severe pulp canal obliteration poses challenges, primarily locating canals. By combining 3-dimensional reconstruction and spatial location registration, the dynamic navigation technique uses an optical tracking system to guide the clinician to drill in real time according to the predesigned path until access to the canal is established. Several in vitro studies and case reports have shown that calcified canal location with dynamic navigation system (DNS) is more accurate and efficient, yet the technique has limitations. In 4 cases with 7 teeth, this work presents manipulation process and clinical outcomes of DNS helping in calcified canal location. We performed handpiece adaptation and elucidated the failure to locate the canals with DNS in 2 teeth, resulting in canal geometry alteration and canal path deviation. Subsequently, the more experienced endodontist located the canals by combining cone-beam computed tomographic imaging and dental operating microscopy. All patients were completely asymptomatic after treatment. At the 1-year follow-up visit, the bone healing of periapical lesions progressed well according to the periapical radiography or cone-beam computed tomographic imaging. These findings indicate that DNS is a promising technique for locating calcified canals; however, it needs to be refined before clinical use.
对严重牙髓腔闭锁的牙齿进行非手术牙髓治疗具有挑战性，主要在于确定根管位置。动态导航技术通过结合三维重建和空间位置配准，利用光学跟踪系统引导临床医生根据预先设计的路径实时钻孔，直至建立进入根管的通道。多项体外研究和病例报告表明，使用动态导航系统（DNS）定位钙化根管更准确、高效，但该技术存在局限性。本文报告了4例共7颗牙齿使用DNS辅助定位钙化根管的操作过程及临床结果。我们进行了手机适配，并阐明了2颗牙齿使用DNS未能定位到根管的情况，导致根管形态改变和根管路径偏差。随后，经验更丰富的牙髓病医生通过结合锥形束计算机断层扫描成像和牙科手术显微镜定位到了根管。所有患者治疗后均完全无症状。在1年的随访中，根据根尖片或锥形束计算机断层扫描成像，根尖周病变的骨愈合进展良好。这些发现表明，DNS是一种有前景的钙化根管定位技术；然而，在临床应用前还需要进一步完善。
