Learning Curve for Dynamic Navigation Procedure during Endodontic Management of Permanent Maxillary Anterior Teeth with Pulp Canal Calcification: A Risk-Adjusted Cumulative Summation Analysis of a Single Operator's Experience.

INTRODUCTION

The dynamic navigation system (DNS) in endodontics presents a significant learning curve. This cross-sectional study aimed to assess the number of cases required to achieve consistent performance in DNS-assisted treatment of maxillary anterior teeth with pulp canal calcification.

METHODS

A series of DNS procedures were performed on 45 calcified maxillary anterior teeth with pulp necrosis by a single endodontist who had no prior clinical DNS experience. Preoperative cone-beam computed tomography was obtained. After trace registration and calibration, drilling was executed using a low-speed bur. Once the canal was located and scouted to the working length, a postoperative cone-beam computed tomography was taken immediately. Angular deviation (AD), linear deviation (LD), and operating time (OT) were measured. The learning curve was evaluated using the risk-adjusted cumulative sum analysis method.

RESULTS

The overall success rate in locating canals was 93.33% (95% CI 80.7, 98.3). The mean (±SD) for AD, LD and OT was 3.21 ± 2.23°, 0.52 ± 0.33 mm and 34.14 ± 13.18 minutes, respectively. For AD, 2 distinct peaks were observed at the 5th and 18th cases, identifying 3 learning phases: Phase I (cases 1-5), Phase II (cases 6-18), and Phase III (cases 19-45). Similarly, LD exhibited peaks at the 13th and 28th cases. Two peaks for OT were identified at the 7th and 26th cases.

CONCLUSIONS

Achieving technical proficiency in locating calcified canals using DNS required approximately 18 to 28 cases, indicating a significant learning curve that must be overcome for optimal accuracy.