Expert Consensus on Digital Guided Therapy for Endodontic Diseases. It was published in International Journal of Oral Science volume 15, article number 54 in 2023. Here is an overview of its main content:
Background and Definition
The inspiration for digital guided therapy (DGT) for endodontic diseases was derived from guided implantology. In 2016, Krastl et al. and Zehnder et al. first proposed the new concept of guided endodontics (GE) to access the root canals through computer-designed templates. DGT was initially carried out by performing cone-beam computed tomography (CBCT) and oral scan (OS), matching them through software to plan the optimal access cavity, and then fabricating templates by 3D printing. After positioning the templates on the teeth, specific drill burs were used to access the root canals. The subsequent procedures of root canal instrumentation, irrigation, and obturation were routinely performed by clinicians.
Classification of DGT
Static Guided Endodontics (SGE): It requires a meticulously designed template. Based on CBCT images superimposed with or without OS data, a virtual template is crafted through software and subsequently translated into a 3D printing.
Dynamic Guided Endodontics (DGE): It utilizes an optical triangulation tracking system. The system guides the drilling path with real-time navigation, allowing clinicians to visualize the location, depth, and angle of the access cavity preparation or osteotomy and make real-time adjustments.
Case Selection
Root Canal Obliteration: For anterior teeth with single straight roots and obvious signs of periapical periodontitis in PCO cases, the DGT strategy is recommended first. When most of the root canals in the apical third are visible in CBCT, the designed template can effectively guide the drill bur through the obliterated part of the root canal and reach the apical part.
Anatomical Abnormalities: Dental anomalies in humans include missing teeth, hypodontia, delayed tooth formation or eruption, anatomically abnormal teeth, and supernumerary teeth. Some case reports have shown that SGE can be used to treat dens invaginatus (DI) with pulp or periapical diseases.
General Workflow
SGE: Perform CBCT and OS, match the data through software to design a virtual template, print the template in 3D, position the template on the tooth, and then use a specific drill bur to access the root canal.
DGE: Perform CBCT and possibly OS, register the data, and then use the dynamic navigation system to guide the drilling process in real time, adjusting the drilling path as needed.
Evaluation and Impact Factors
Case reports and basic researches all demonstrate that DGT is a precise, time-saving, and minimally invasive approach in contrast to the conventional freehand method. It can improve the success rate of treatment, reduce the occurrence of complications, and enhance patient comfort and satisfaction. However, factors such as the accuracy of imaging data, the quality of template fabrication, and the operator's skill level may affect the outcome of DGT.