Khare Mrunmayee V, Sivarajan Ranjith Kumar, Venkatesh Vijay
Department of Conservative Dentistry and Endodontics, Sri Ramaswamy Memorial (SRM) Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology (SRMIST), Chennai, IND.
Cureus. 2024 Aug 8;16(8):e66424. doi: 10.7759/cureus.66424. eCollection 2024 Aug.
Background Access cavity preparation is a crucial step in nonsurgical root canal treatment. Recent advancements in access cavity designs focus on preserving maximum tooth structure while ensuring sufficient access to canal orifices for effective cleaning and shaping, resulting in minimally invasive procedures. However, there is limited information on the impact of three-dimensional (3D)-guided access cavity preparation in molars. A literature review found no prior studies comparing the effects of various access cavity preparation techniques on apical transportation, untouched surfaces, and debris formation within the canal. Objective The objective of this study is to compare and evaluate the effects of three different access cavity techniques on apical transportation, untouched surfaces, and debris formation within the root canal. Material and methods Thirty extracted permanent mandibular first molars were selected and randomly assigned to three groups for this study: Group I received 3D-printed static guided cavity preparation, Group II underwent conservative access cavity preparation, and Group III was subjected to traditional access cavity (TAC) preparation. The mesial canals in all samples were cleaned and shaped using TruNatomy files. Preoperative and postoperative micro-CT imaging was performed on each sample to assess the effects of the different access cavity preparation techniques on apical transportation, untouched surfaces, and debris formation within the root canal. Results The study found that Group I, which used 3D-printed static guided cavity preparation, exhibited significantly less apical transportation compared to Groups II and III, with mean differences of -0.1677 and -0.2079, respectively. Debris accumulation was similar across all groups, with mean values of 0.928 ± 0.824 for Group I, 0.751 ± 0.495 for Group II, and 0.938 ± 0.681 for Group III, indicating no significant impact of cavity preparation type on debris levels. For untouched canal surfaces, Group III (TAC preparation) had the fewest untouched surfaces, with mean differences of 3.0380 and 3.9020 compared to Groups II and I, respectively. Conclusions While TAC preparation reduces substantial tooth structure, it shows higher instrumentation efficacy and better cleaning of the root canal system. However, in complex cases where tooth structure preservation is crucial, guided access cavity preparation provides an effective balance between structural conservation and adequate canal access. This approach offers a tailored solution, optimizing treatment outcomes based on the specific clinical scenario.
开髓腔预备是牙髓病非手术根管治疗中的关键步骤。开髓腔设计的最新进展集中在保留最大量的牙齿结构，同时确保有足够的通道进入根管口以进行有效的清理和塑形，从而实现微创操作。然而，关于三维（3D）引导下磨牙开髓腔预备的影响的信息有限。一项文献综述发现，此前没有研究比较过各种开髓腔预备技术对根尖移位、未触及表面以及根管内碎屑形成的影响。
本研究的目的是比较和评估三种不同的开髓腔技术对根尖移位、未触及表面以及根管内碎屑形成的影响。
选取30颗拔除的下颌第一恒磨牙并随机分为三组进行本研究：第一组接受3D打印静态引导开髓腔预备，第二组进行保守开髓腔预备，第三组进行传统开髓腔（TAC）预备。所有样本的近中根管均使用TruNatomy锉进行清理和塑形。对每个样本进行术前和术后微计算机断层扫描（micro-CT）成像，以评估不同开髓腔预备技术对根尖移位、未触及表面以及根管内碎屑形成的影响。
研究发现，使用3D打印静态引导开髓腔预备的第一组与第二组和第三组相比，根尖移位明显更少，平均差异分别为-0.1677和-0.2079。所有组的碎屑堆积情况相似，第一组的平均值为0.928±0.824，第二组为0.751±0.495，第三组为0.938±0.681，表明开髓腔预备类型对碎屑水平没有显著影响。对于未触及的根管表面，第三组（TAC预备）的未触及表面最少，与第二组和第一组相比，平均差异分别为3.0380和3.9020。
虽然TAC预备会减少大量的牙齿结构，但它显示出更高的器械操作效率和对根管系统更好的清理效果。然而，在牙齿结构保存至关重要的复杂病例中，引导式开髓腔预备在结构保存和足够的根管通路之间提供了有效的平衡。这种方法提供了一种量身定制的解决方案，可根据具体临床情况优化治疗效果。
