Department of Conservative Dentistry and Endodontics, AMC Dental College and Hospital, Ahmedabad, Gujarat, India.
Department of Conservative Dentistry and Endodontics, SRM Dental College, Bharathi Salai, Chennai, India.
BMC Oral Health. 2024 Jun 10;24(1):678. doi: 10.1186/s12903-024-04450-z.
This systematic review aims to comparatively analyse the amount of dentin removal by free hand and static guided endodontics with dynamic navigation system (DNS) in endodontic access cavity preparation.
The systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Based on the structured PICO framework of "Comparative evaluation of dynamic navigation system (I) to freehand (C) and static guided endodontics (C) in endodontic access cavity preparation on the preservation of tooth structure (O) when assessed on permanent human teeth (P)", the keywords were formulated and the articles were retrieved from three databases namely PubMed, Scopus and Embase, based on the keywords from the time of inception of DNS till June 2023. The risk of bias assessment was done using a modified Joanne Briggs Institute checklist, which evaluated domains such as randomisation, sample size, image acquisition using CBCT, angulation, accuracy and time taken. As the data was heterogenous, a quantitative meta-analysis was not performed.
Initially, 174 articles were retrieved from the three databases, 30 duplicates were removed, after title check 108 articles were excluded and following abstract check only 10 articles qualified for full text analysis. On reviewing the 10 full text articles, 5 articles were excluded and the remaining 5 articles were subjected to the risk of bias analysis which showed that 2 articles displayed low risk of bias and three articles showed high risk of bias. The RoB analysis revealed that only 2 studies evaluated the preservation of dentin in terms of accuracy, angulation and time taken proving the increased precision with minimal loss of tooth structure using DNS. In both the studies, DNS proved to be superior to free hand technique in terms of precision, accuracy and efficiency in locating the canals during access cavity preparation with maximal preservation of tooth structure.
With the minimal literature evidences, the present systematic review highlights maximal preservation of dentin using DNS. However, further invitro and invivo studies comparing the free hand, static guided endodontics to DNS must be carried out for its translation into clinical practice.
Dynamic navigation system provides maximal preservation of dentin during access cavity preparation.
本系统评价旨在比较手动和静态导向根管治疗与动态导航系统（DNS）在根管治疗入口腔制备中对牙本质去除量的影响。
本系统评价根据 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 指南进行。基于“动态导航系统（I）与手动（C）和静态导向根管治疗（C）在永久性人类牙齿（P）上保存牙本质（O）时对根管治疗入口腔制备的比较评估”的结构化 PICO 框架，制定关键词，并根据 DNS 创立以来的关键词，从三个数据库（PubMed、Scopus 和 Embase）检索文章，检索时间截至 2023 年 6 月。使用改良的 Joanne Briggs Institute 清单进行偏倚风险评估，该清单评估了随机化、样本量、使用 CBCT 进行图像采集、角度、准确性和时间等领域。由于数据存在异质性，因此未进行定量荟萃分析。
最初从三个数据库中检索到 174 篇文章，去除 30 篇重复文章，标题筛选后排除 108 篇文章，摘要筛选后仅 10 篇文章符合全文分析标准。在审查了这 10 篇全文文章后，排除了 5 篇文章，剩余的 5 篇文章进行了偏倚风险分析，结果显示 2 篇文章显示低偏倚风险，3 篇文章显示高偏倚风险。偏倚风险分析显示，只有 2 项研究评估了准确性、角度和时间方面的牙本质保留情况，证明使用 DNS 可提高精度，同时最大限度地减少牙体结构的损失。在这两项研究中，DNS 在定位根管方面均优于手动技术，在入口腔制备中最大限度地保留牙体结构的同时，提高了精度、准确性和效率。
根据有限的文献证据，本系统评价强调了 DNS 在牙本质保留方面的最大优势。然而，为了将其转化为临床实践，必须进行进一步的离体和体内研究，比较手动、静态导向根管治疗与 DNS。
动态导航系统在制备入口腔时提供最大的牙本质保留。
