(TC24) Static vs Dynamic Guided-Endodontic Access: Work-flow assessment for Postgraduate Training

Abstract: Root canal therapy (RCT) in calcified teeth often presents a technical challenge for clinicians to locate the canal(s) while preserving tooth structure. The majority of iatrogenic mishaps are related to pulp canal space calcifications and inadequate clinical assessment. The objective of this research was to compare the workflow and accuracy of static guided endodontics (SGE) and dynamic guided endodontics (DGE) in an academic setting. RCT cases were grouped (n=5) into SGE or DGE. Preoperative intraoral surface and CBCT scans were superimposed using Co-Diagnostix^® software (Dental Wings). Virtual images of Steco-system-Technik bur and corresponding sleeve for access cavity preparation were designed and implemented using the software. Templates were generated using a 3D printer (SprintRay). For the DGE group (Navident EVO, ClaroNav), a jaw tracker was fabricated and adapted interdentally, and a pre-operative CBCT scan was done with the jaw tracker with marked landmarks. The total time taken to access and the difference in angular deviation coronal and apical was recorded. Data were analyzed using a t-test (p <.05). The mean time taken to set up and access the canal in DGE was 12±6 minutes, and it was 23 minutes for SGE. The mean angular deviation in coronal was 1.6°±1.5° for both groups. Both SGE and DGE have shown accuracy and predictability for minimally invasive access preparations in complex endodontic cases. For the workflow, both techniques were very efficient. Advantages of SGE over DGE include a shorter learning curve and lower cost. Disadvantages noted are the need for additional intraoral scanning and equipment costs. Overall, DGE may be more feasible for endodontic residency programs.