Qin Li, Qiao Weiwei, Chen Chen, Lin Yeyu, Zhang Xining, Meng Liuyan
State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Cariology and Endodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China.
State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Cariology and Endodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China.
J Endod. 2025 Apr;51(4):521-527. doi: 10.1016/j.joen.2025.01.015. Epub 2025 Jan 27.
Fiber posts present significant challenges for nonsurgical endodontic retreatment, as improper removal may result in iatrogenic root perforation or even root fracture. Recently, robotic technology has attracted considerable attention in dentistry and active dental robotic (ADR) systems can perform procedures based on preset instructions, minimizing reliance on the dentist's experience. This case report describes the application of an ADR system for fiber post removal through an existing zirconia crown. A 26-year-old female was diagnosed with previously treated, symptomatic apical periodontitis of the mandibular left second premolar. Based on cone-beam computed tomography (CBCT) and intraoral scanning, the ADR system was used to achieve precise fiber post removal through a zirconia crown with minimally invasive coronal access under rubber dam isolation. The robotic arm executed flexible pumping motions to simulate the hand movements of dentists. This was achieved by establishing preset force and distance thresholds tailored to the characteristics of the materials being drilled. Residual gutta-percha was removed, followed by canal preparation and obturation. The tooth was then restored with a fiber post and composite resin. At the 2.5-month follow-up, the patient was completely asymptomatic, and the radiograph displayed evidence of periradicular healing. In this case, robotic technology proved effective and feasible for the endodontic retreatment of a mandibular second premolar, suggesting its potential for similar applications in other teeth where there is adequate inter-arch space. Further research is needed to simplify procedures for robot-assisted endodontic retreatment.
纤维桩给非手术性牙髓再治疗带来了重大挑战，因为去除不当可能导致医源性牙根穿孔甚至牙根折断。近年来，机器人技术在牙科领域引起了广泛关注，主动牙科机器人（ADR）系统可以根据预设指令执行操作，最大限度地减少对牙医经验的依赖。本病例报告描述了ADR系统在通过现有的氧化锆冠去除纤维桩中的应用。一名26岁女性被诊断为下颌左第二前磨牙曾接受治疗且出现症状的根尖周炎。基于锥形束计算机断层扫描（CBCT）和口内扫描，在橡皮障隔离下，使用ADR系统通过氧化锆冠实现精确的纤维桩去除，并进行微创冠部入路。机器人手臂执行灵活的抽吸动作以模拟牙医的手部动作。这是通过根据所钻材料的特性设定预设的力和距离阈值来实现的。去除残留的牙胶，随后进行根管预备和充填。然后用纤维桩和复合树脂对牙齿进行修复。在2.5个月的随访中，患者完全无症状，X线片显示根尖周愈合迹象。在本病例中，机器人技术被证明对下颌第二前磨牙的牙髓再治疗有效且可行，表明其在其他有足够牙弓间隙的牙齿中类似应用的潜力。需要进一步研究以简化机器人辅助牙髓再治疗的程序。
