Skip to main content
Download PDF

Retreatment and aesthetic restoration of maxillary incisor with calcified root canal using a dynamic navigation system: a case report

BMC Oral Health volume 24, Article number: 1358 (2024) Cite this article

Abstract

Background

Pulp canal occlusion (PCO) increases the difficulty of root canal treatment as well as tooth preservation and restoration. This is the first case report of successful localization of a calcified root canal under the guidance of a dynamic navigation system (DNS) for complete root canal retreatment and aesthetic restoration after a failed attempt to locate the calcified root canal with a traditional dental operating microscope (DOM).

Case presentation

The patient was scheduled for root canal treatment for a labially inclined maxillary central incisor and post-core crown restoration with resin veneers in another hospital, but the calcified root canal could not be located with a microscope, so the patient was referred to our department. Root canal retreatment was planned for tooth #8, and the calcified root canal of tooth #9 was planned to be located and dredged under the guidance of a DNS. We used a DNS for successful positioning and to complete the root canal retreatment operation in the following 4 steps: preoperative CBCT imaging, preoperative plan design, calibration and registration, and real-time dynamic navigation. Three months later, teeth #8 and #9 presented no clinical symptoms, after which the fiber post-cores and zirconia all-ceramic crown restorations were completed. At the 12-month follow-up visit, the patient continued to be symptom­free, and satisfied with the final aesthetic restoration.

Conclusions

This case report suggests that DNS may be a promising technique with high accuracy and effectiveness to reduce the risk of iatrogenic errors and provide maximal preservation of dentin, when the traditional treatment of calcified root canals approaches failure (lateral perforation).

Peer Review reports

Background

Although the specific pathogenesis of pulp canal obliteration (PCO) remains unclear, the potential causes include trauma [1], caries, restorations [2], vital pulp therapy [3], orthodontic treatment [4], physiological changes in elderly patients [5], and the use of statin drugs [6]. Histological samples from teeth with PCO typically show narrow root canals [7]. Accessing narrow and calcified root canals is challenging due to the increased risk of iatrogenic complications such as perforation, alterations in canal geometry, and loss of dental hard tissues, even for experienced clinicians [8,9,10].

The utilization of dental operating microscope (DOM), ultrasonic tips, long shank burs, and cone-beam computed tomography (CBCT) imaging for magnification and illumination can facilitate the determination of the position and direction of partially obstructed root canals, aiding in root canal pathway planning [11, 12]. Despite these tools, accessing and preparing calcified root canals remains time-consuming and difficult [13], potentially leading to excessive removal of the tooth structure [8].

Guided endodontics is a novel approach intended to prevent iatrogenic damage and involve the use of computer-assisted static navigation guides and dynamic navigation system (DNS) [14]. Static navigation guides involve the use of manufactured templates created on the basis of CBCT data and guiding dental drills to facilitate precise but fast and conservative root canal treatment [15,16,17]. However, this approach is limited in that it is only suitable for straight or slightly curved portions of roots, requires extensive planning, and is incompatible with water cooling. Fabricating guides are expensive and time-consuming to construct, and implementation in limited space in the posterior dental region presents challenges [18]. Furthermore, modifications during the operation are not feasible, leading to impracticalities in the case of mishaps [19].

The DNS allows virtual planning of the operation on the basis of patient CBCT data. Optical and motion tracking of operating instruments and oral specific mark point registration [8] allow real-time, visual guidance [14, 20] during both surgical and nonsurgical treatments [11, 21,22,23,24]. Recent in vitro studies of natural tooth models suggest that DNS is more accurate and effective in locating root canals in calcified human teeth and in reducing the extent of tooth structure removal than the freehand technique is, and that DNS shortens the operative duration, thus helping clinicians avoid catastrophic accidents [19, 25]. This is the first case report of successful localization of the calcified root canal under the guidance of DNS for complete root canal retreatment and aesthetic restoration after a failed attempt to locate the calcified root canal with a traditional DOM.

The patient was scheduled to undergo root canal retreatment for a labially inclined maxillary central incisor and post-core crown restoration with resin veneers at another hospital, but the calcified root could not be located with a microscope, so the patient was referred to our department. We used DNS for successful positioning and to complete both the root canal retreatment operation and the final aesthetic restoration.

Case presentation

A 43-year-old male patient was referred to the endodontic department at the First Medical Center, Chinese PLA General Hospital, for endodontic retreatment of a calcified root canal in a maxillary central incisor in April 2023.

The patient had undergone root canal treatment and resin veneer restoration of the two maxillary central incisors at another hospital several years prior, and the specific treatment was unknown. A portion of the resin veneer had fell off, which affected the appearance and required aesthetic restoration. One-month prior, the patient underwent root canal retreatment of the left upper central incisor at another hospital. During the treatment, the surgeon noticed that the root canal was calcified and obstructed and decided to stop the treatment.

The labial side of teeth #8 and #9 were resin veneers (Fig. 1a), and the lingual side of teeth #8 and #9 was tooth-coloured fillings, which were partially missing (Fig. 1b). Both teeth #8 and #9 are labial inclinations (Fig. 1c). There was no discomfort on probing or percussion, no loosening, and no abnormalities in the gums. The periapical radiograph revealed a large high-density shadow in the coronal region of teeth #8 and #9, an inadequate and apical underfilling shadow in the root canal of tooth #8, and no obvious root canal in tooth #9 (Fig. 1d). CBCT images revealed complete calcification of the root canal in tooth #9, and a small low-density shadow in 1/3 of the labial and mesial apical roots of this tooth, as well as a drill path deviating to the labial side near the labial root surface from the pulp cavity to the upper middle part of the root in the sagittal view (Fig. 1e).

Fig. 1
figure 1

Clinical examinations and radiographic imaging of patients at initial diagnosis. A The labial sides of teeth #8 and #9 are resin veneers; B The lingual sides of teeth #8 and #9 are tooth-coloured fillings, which partially fall off; C Labial inclination: Teeth #8 and #9; D The periapical radiograph shows that the root canal of tooth #8 has an inadequate and apical underfilling shadow, whereas no obvious root canal image is observed in tooth #9; E The CBCT images show a low-density shadow in the upper 1/3 and complete calcification in the lower 2/3 of the root canal in tooth #9. One-third of the labial and mesial apical root of tooth #9 has a small low-density shadow, and the drill path deviates to the labial side near the labial root surface from the pulp cavity to the upper middle part of the root

Full size image

Clinical diagnosis

  1. 1.

    Tooth #8 was diagnosed with a tooth defect and required post-root canal treatment and underfilling.

  2. 2.

    Tooth #9 was diagnosed with a tooth defect, pulp canal obliteration (PCO) and chronic apical periodontitis.

Treatment options

  1. 1.

    Tooth #8 was scheduled for root canal retreatment.

  2. 2.

    Tooth #9 was scheduled for root canal retreatment, and the calcified root canal was located and dredged under the guidance of DNS.

  3. 3.

    Aesthetic restoration was performed, and the anterior teeth were retracted to improve labial inclination for teeth #8 and #9.

Informed consent

The treatment protocol was approved by the Ethics Committee of the First Medical Center of PLA General Hospital (No. S2023-138-01). Patients were received detailed information about the procedures and risks and signed consent forms before treatment.

Process of treatment

For the application of dynamic navigation, the following 4 steps should be followed:

Preoperative CBCT imaging

Silicone rubber impression material was used to fix a U-shaped tube in the surgical area of the patient’s left upper anterior teeth before treatment. The patient wore the U-shaped tube for CBCT scanning (NewTom VGi, Verona, Italy) with the following parameters: 110 kVp, 3.0 mA, 8 × 8 cm field-of-view, and 0.3 mm voxel size. Digital imaging and communications in medicine (DICOM) data were obtained, and the acquired data were imported into an oral dynamic navigation system software (DCARER, Suzhou, China).

Preoperative plan design

Using the DNS software, and according to the operation steps to determine the drill needle used during the treatment (Fig. 2e) and the three-dimensional direction. The approach was determined according to the principle of centralization, and the initial calcification position was connected to the long axis of tooth #9 in a straight line to ensure the thickness of the dentin on the sidewall of the root canal and avoid lateral perforation. Microadjustments were made in the cross-sectional, sagittal, and coronal planes on the three-dimensional CBCT images (Fig. 2a-d).

Fig. 2
figure 2

The procedures of the dynamic navigation technique. A Locate and identify the target tooth; B-D Coronal, cross-sectional and sagittal views of the designed navigated access; E Spiculate drill used; F Calibration with a round bur; G-H Real-time dynamic navigation; I U-shaped registration device tube was reset to the operative dentition, and a round bur was used to select 6 registration pits and complete the registration process; J DNS displayed the windows when the spiculate drill reached the entry point, real-time presentation of the linear, angular and depth deviations; K DNS displayed the windows when the spiculate drill reached the end point; L DNS displayed the windows when the spiculate drill reached the end point

Full size image

Calibration and registration

A round bur was used to contact the pit on a reference plate at different angles for calibration (Fig. 2f) to determine the relative spatial positions of the handpiece wings and the reference plate. The reference plate was affixed to the left side of the operative area on the same jaw using self-coagulating resin. The registration device, a U-shaped tube, was reset to the operative dentition, and a round bur was used to select 6 registration pits and complete the registration process. After correction and registration, the spatial position between the medical image, the target tooth and the surgical instruments is calculated to guide the treatment in real time (Fig. 2i).

Real-time dynamic navigation

During the operation (Fig. 2g-h), the error control chart and the virtual tooth map were simultaneously displayed on the monitor, including the position, angle, and depth images of the cross-line network (Fig. 2j). The operator drilled at the indicated drilling sites from the specified angles to a depth of 1–2 mm (Fig. 2k). The position and angle windows, which were “microgreen”, indicated that the actual drilling path was within the acceptable range. The depth window was “green”, indicating that the puncture hole was within the predetermined depth range. When the drill was about to reach the premeasured depth, the depth window was yellow, after which the navigation operation was terminated (Fig. 2l).

The subsequent root canal retreatment was performed as previously described.

The root canal of tooth #9 was dredged with an 8# pulp canal reamer, and the lower part to the root tip of the canal was explored. The original filling material was removed, and the shape of the pulp hole of tooth #8 was corrected. The working length of tooth #9 was 19 mm, and that of tooth #8 was 20.5 mm. Postoperative periapical radiographs revealed that the root canals were properly filled (Fig. 3a-b). Three months later, teeth #8 and #9 presented no clinical symptoms. Re-examination of the periapical radiograph revealed that the apical shadow had healed (Fig. 3c). Fiber post-cores and all-ceramic restorations were performed: bonding one post, stacking the resin core, shaping, tooth preparation (Fig. 3d-e) and colour matching (Fig. 3f). Two weeks later, the zirconia all-ceramic crown was fitted with a good margin, retention and shape. The occlusal and contact points were adjusted, polished, and permanently cemented with resin adhesive. The patient was satisfied with the colour and appearance. (Fig. 3g-i). At the 6-month and 12-month follow-ups, no obvious abnormalities were found in the intraoral images (Fig. 4). This case will continue to be subject to long-term review to assess the success rate of treatment and repair and to examine any evidence of inflammatory signs and/or symptoms.

Fig. 3
figure 3

Completion of root canal retreatment and aesthetic restoration. A-B Steps in the root canal retreatment of tooth #9; C Three-month review of radiographic images, in which the root canal retreatment of tooth #8 has also been completed; D-E Steps of fiber post-core bonding and zirconia all-ceramic crown tooth preparation; F Colour matching; G-I Two-week review in which the all-ceramic crowns of teeth #8 and #9 were fit

Full size image
Fig. 4
figure 4

Clinical examinations and radiographic imaging of the patient. A-E 12-month review of the clinical examinations; F-G 6-month and 12-month review of the radiographic imaging

Full size image

Discussion and conclusions

Different studies have shown that the long-term survival of root canal-treated teeth is often associated with major restorations [26, 27]. root canal treatment is not necessary in most PCO cases because they are asymptomatic. PCO is often noticed incidentally by discolouration of the tooth crown or a radiographic examination. Only when clinical symptoms or radiographic periapical lesions occur root canal retreatment is suggested [9]. In addition, when teeth with calcified root canals need to be repaired, such as those with large defects, poor retention, and those requiring a change in the crown shape or angle, preserving a sufficient amount of residual tooth tissue, especially cervical tissue, can effectively reduce pulp-treated tooth breakage; therefore, the accuracy of hole preparation is particularly important [28].

Digital-guided endodontic treatment is more accurate for access cavity preparation, locating calcified root canals, fiber post removal, osteotomy and root-end resection [29]. Several in vitro studies have suggested that the use of dynamic or static navigation systems in endodontic treatment could achieve smaller deviations and higher success rates than freehand manipulations, and no statistically significant differences were found between the two computer-aided navigation techniques. These results suggest that guided endodontics could assist less experienced operators in obtaining highly accurate and precise results [25, 30,31,32]. DNS has shown satisfactory results in studies of the accuracy of calcified root canal localization in vitro. Jain et al. [33] used the Navident DNS to localize and guide the dredging of 138 calcified root canals in 84 3D-printed dental models by comparing the deviation between the planned path of preoperative CBCT and the actual path of postoperative CBCT; the results revealed that the mean operative time was 57.8 s, the mean deviation of the end point was 1.3 mm, and the angle deviation was 1.7°.

Dianat et al. [8] compared the accuracy and efficiency of pulpotomy between X-Guide dynamic navigation and free-hand methods in 60 occluded single root teeth from human cadavers and reported a mean distance deviation between the dynamic navigation group and the free-hand group (buccal‒lingual orientation 0.19 ± 0.21 mm vs. 0.81 ± 0.74 mm; mesio-distally 0.12 ± 0.14 mm vs. 0.31 ± 0.35 mm), angular deviation (2.39° ± 0.85° vs. 7.25° ± 4.2°), dentin thickness (1.06 ± 0.18 mm vs. 1.55 ± 0.55 mm), and operating time (227 ± 97 s vs. 405 ± 246 s) (p < 0.05). However, there was no significant difference in the success rate (96.7% vs. 83.3%) (p > 0.05). Torres et al. [19] applied Navident dynamic navigation to 3D-printed models to evaluate the accuracy and effectiveness of its treatment for severe root canal occlusion, with 3 different experienced operators trained on 28 root canal models under dynamic navigation. Among 168 canals in 132 dental models, 156 canals were successfully established (success rate: 93%), and there was no significant difference between different operators (p < 0.05). In addition, compared with the planned approach, the anterior apical deviation was 0.63 ± 0.35 mm, which was significantly lower than the molar apical deviation (p < 0.05), and the mean angular deviation was 2.81 ± 1.53°. These findings suggest that dynamic navigation is an accurate technique for root canal treatment and has a learning curve effect. In our practice, hand‒eye coordination and control of hand movement stability using DNS require continuous training to ensure both high accuracy and efficiency, so extensive training should be performed before clinical manipulation.

Some case reports also illustrate the precise advantages of dynamic navigation in the treatment of calcified root canals. Dianat et al. [21] applied X-Guide DNS to localize and establish an approach to the calcified root canal in the distal cheek of the right upper first molar in a 63-year-old male patient. After undergoing treatment for prostate cancer with tonsillar metastasis, radiotherapy of the head and neck and treatment with psychotropic drugs, the patient chose a dynamic navigation nonsurgical approach. Villa-Machado et al. [11] reported two cases of endodontically treated upper and lower anterior teeth with discolouration of the crown and extensive occlusion of the root canals due to trauma. The patients had no subjective symptoms, the appearance of the local gingival mucosa was normal, the colour of the crown had no obvious changes, and the periapical structure was intact after 12 months. Wu et al. [13] reported the application of the DHC-ENDO1 DNS in cases of anterior root canal atresia with chronic pulpitis and periapical periodontitis, in which the DHC-ENDO1 DNS was used to successfully locate and unblock the atresia root canal and complete the root canal treatment, resulting in good postoperative recovery.

Compared with the static navigation system and free-hand method, DNS has the following advantages in the treatment of endodontic diseases: (1) significantly higher operative accuracy than the free-hand method [32]; (2) real-time adjustment of the position, angle and depth of drilling during the operation [25]; (3) better adaptability for patients with limited mouth opening, short distances between long jaw teeth, jaw tightness, and severe gag reflex [34]; (4) for patients with severe pain or difficulty in subsequent consultations, DNS can save the steps and costs of making a guide plate, so that these patients can be treated faster on the day [18]; (5) low risk of ineffective cooling of high temperatures generated during drilling [33, 35]; and (6) better manipulation to prevent tooth canal root overlapping [25]. Thus, DNS is more applicable to teeth with multiple canals. On the basis of the above advantages, DNS is optimal for creating a precise and straight path in endodontic treatment and ensuring minimally invasive pulp opening, accurate identification of calcified root canals, atraumatic fibre post removal and precise apical microsurgery [20].

At present, there are still some limitations in the clinical application of DNS of various brands compared with static navigation systems and free-hand operations: (1) the purchase cost of DNS is generally high [21]; (2) the position, angle and depth of the drill needle should be closely observed on the display screen. Therefore, good hand‒eye coordination and a certain amount of pretraining exercise are needed to increase the accuracy and success rate [36, 37]. (3) DNS devices are generally large and have limited portability [11, 35]. (4) the patient still needs to wear a retainer on the dentition that tends to extend out of the mouth through a different shape bracket; therefore, a locator plate identified by a tracer may increase patient discomfort [11, 18]. (5) needle registration must be performed in the patient’s mouth, which can prolong the preoperative preparation time [20]. (6) DNS is mainly based on the CBCT data of the patients. The artefacts produced by high-impedance restorations in patients’ mouths seriously affect the accuracy of locating and selecting reference points, and prepositioning marker plates on the fixator in the patient’s mouth followed by a CBCT scan [38] is needed, which increases patient discomfort and the number and cost of examinations [8]. For now, the application of mixed reality (MR) or augmented reality (AR) techniques and the integration of robotics with DNS in implant placement have been reported [39, 40]. However, only in vitro studies of minimally invasive pulp opening and apical resection based on AR or robotics with DNS in endodontics have been reported [41,42,43]. In addition, superimposing a standard tessellation language (STL) file obtained with an intraoral scan on a CBCT image may increase the accuracy of DNS, especially when radiographic artefacts are present, but more high-quality, large sample size studies are needed to confirm these findings [44].

This case indicates that DNS could be a promising technique to save the teeth when the traditional treatment of calcified root canal approaches failure (lateral perforation), and reduce the risk of iatrogenic errors at the same time. However, there is still a lack of large sample reports on the application of DNS in guiding endodontic therapy, and further prospective clinical studies with larger sample sizes, higher quality and better designs are needed to confirm its accuracy and effectiveness.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

PCO:

Pulp canal occlusion

DOM:

Dental operating microscope

DNS:

Dynamic navigation system

CBCT:

Cone-beam computed tomography

DICOM:

Digital imaging and communications in medicine

MR:

Mixed reality

AR:

Augmented reality

STL:

Standard tessellation language

References

  1. Nikoui M, Kenny DJ, Barrett EJ. Clinical outcomes for permanent incisor luxations in a pediatric population. III. Lateral luxations. Dent Traumatol. 2003;19(5):280–5.

    Article  PubMed  Google Scholar 

  2. Fleig S, Attin T, Jungbluth H. Narrowing of the radicular pulp space in coronally restored teeth. Clin Oral Investig. 2017;21(4):1251–7.

    Article  PubMed  Google Scholar 

  3. Agamy HA, Bakry NS, Mounir MM, Avery DR. Comparison of mineral trioxide aggregate and formocresol as pulp-capping agents in pulpotomized primary teeth. Pediatr Dent. 2004;26(4):302–9.

    PubMed  Google Scholar 

  4. Delivanis HP, Sauer GJ. Incidence of canal calcification in the orthodontic patient. Am J Orthod. 1982;82(1):58–61.

    Article  CAS  PubMed  Google Scholar 

  5. Johnstone M, Parashos P. Endodontics and the ageing patient. Aust Dent J. 2015;60(Suppl 1):20–7.

    Article  PubMed  Google Scholar 

  6. Pettiette MT, Zhong S, Moretti AJ, Khan AA. Potential correlation between statins and pulp chamber calcification. J Endod. 2013;39(9):1119–23.

    Article  PubMed  Google Scholar 

  7. Kuyk JK, Walton RE. Comparison of the radiographic appearance of root canal size to its actual diameter. J Endod. 1990;16(11):528–33.

    Article  CAS  PubMed  Google Scholar 

  8. Dianat O, Nosrat A, Tordik PA, Aldahmash SA, Romberg E, Price JB, Mostoufi B. Accuracy and efficiency of a dynamic Navigation System for locating calcified canals. J Endod. 2020;46(11):1719–25.

    Article  PubMed  Google Scholar 

  9. McCabe PS, Dummer PM. Pulp canal obliteration: an endodontic diagnosis and treatment challenge. Int Endod J. 2012;45(2):177–97.

    Article  CAS  PubMed  Google Scholar 

  10. Lara-Mendes STO, Barbosa CFM, Machado VC, Santa-Rosa CC. A New Approach for minimally Invasive Access to severely calcified Anterior Teeth using the guided endodontics technique. J Endod. 2018;44(10):1578–82.

    Article  PubMed  Google Scholar 

  11. Villa-Machado PA, Restrepo-Restrepo FA, Sousa-Dias H, Tobón-Arroyave SI. Application of computer-assisted dynamic navigation in complex root canal treatments: report of two cases of calcified canals. Aust Endod J. 2022;48(1):187–96.

    Article  PubMed  Google Scholar 

  12. Cohenca N, Shemesh H. Clinical applications of cone beam computed tomography in endodontics: a comprehensive review. Quintessence Int. 2015;46(8):657–68.

    PubMed  Google Scholar 

  13. Wu M, Liu M, Cheng Y, Tang W, Yan P, Jiang H. Treatment of Pulp Canal Obliteration using a dynamic Navigation System: two case reports. J Endod. 2022;48(11):1441–6.

    Article  PubMed  Google Scholar 

  14. Vasudevan A, Santosh SS, Selvakumar RJ, Sampath DT, Natanasabapathy V. Dynamic Navigation in guided endodontics - a systematic review. Eur Endod J. 2022;7(2):81–91.

    PubMed  PubMed Central  Google Scholar 

  15. Llaquet Pujol M, Vidal C, Mercadé M, Muñoz M, Ortolani-Seltenerich S. Guided endodontics for managing severely calcified canals. J Endod. 2021;47(2):315–21.

    Article  PubMed  Google Scholar 

  16. Todd R, Resnick S, Zicarelli T, Linenberg C, Donelson J, Boyd C. Template-guided endodontic access. J Am Dent Assoc. 2021;152(1):65–70.

    Article  PubMed  Google Scholar 

  17. Moreno-Rabié C, Torres A, Lambrechts P, Jacobs R. Clinical applications, accuracy and limitations of guided endodontics: a systematic review. Int Endod J. 2020;53(2):214–31.

    Article  PubMed  Google Scholar 

  18. Connert T, Weiger R, Krastl G. Present status and future directions - guided endodontics. Int Endod J. 2022;55(Suppl 4):995–1002.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Torres A, Boelen GJ, Lambrechts P, Pedano MS, Jacobs R. Dynamic navigation: a laboratory study on the accuracy and potential use of guided root canal treatment. Int Endod J. 2021;54(9):1659–67.

    Article  PubMed  Google Scholar 

  20. Tang WL, Chao XY, Ye Z, Liu MW, Jiang H. The Use of Dynamic Navigation Systems as a Component of DigitalDentistry. J Dent Res. 2024;103(2):119–28.

  21. Dianat O, Gupta S, Price JB, Mostoufi B. Guided Endodontic Access in a Maxillary Molar using a dynamic Navigation System. J Endod. 2021;47(4):658–62.

    Article  PubMed  Google Scholar 

  22. Bardales-Alcocer J, Ramírez-Salomón M, Vega-Lizama E, López-Villanueva M, Alvarado-Cárdenas G, Serota KS, Ramírez-Wong J. Endodontic retreatment using dynamic Navigation: a Case Report. J Endod. 2021;47(6):1007–13.

    Article  PubMed  Google Scholar 

  23. Gambarini G, Galli M, Stefanelli LV, Di Nardo D, Morese A, Seracchiani M, De Angelis F, Di Carlo S, Testarelli L. Endodontic microsurgery using dynamic Navigation System: a Case Report. J Endod. 2019;45(11):1397–e14021396.

    Article  PubMed  Google Scholar 

  24. Qin L, Chen C, Zhang R, Wang Z, Li F, Meng L. Evaluation of a Novel Drilling Approach for dynamic Navigation-aided endodontic microsurgery: a Surgical Simulation Comparison Study. J Endod. 2024;50(7):989–96.

    Article  PubMed  Google Scholar 

  25. Zubizarreta-Macho Á, Muñoz AP, Deglow ER, Agustín-Panadero R, Álvarez JM. Accuracy of computer-aided dynamic Navigation compared to computer-aided Static Procedure for Endodontic Access cavities: an in Vitro Study. J Clin Med 2020;9(1).

  26. Tang W, Wu Y, Smales RJ. Identifying and reducing risks for potential fractures in endodontically treated teeth. J Endod. 2010;36(4):609–17.

    Article  PubMed  Google Scholar 

  27. Landys Borén D, Jonasson P, Kvist T. Long-term survival of endodontically treated teeth at a public dental specialist clinic. J Endod. 2015;41(2):176–81.

    Article  PubMed  Google Scholar 

  28. Schwartz RS, Robbins JW. Post placement and restoration of endodontically treated teeth: a literature review. J Endod. 2004;30(5):289–301.

    Article  PubMed  Google Scholar 

  29. Lima TO, Rocha AO, Dos Anjos LM, Meneses Júnior NS, Hungaro Duarte MA, Alcalde MP, Cardoso M, Vivan RR. A Global overview of guided endodontics: a bibliometric analysis. J Endod. 2024;50(1):10–6.

    Article  PubMed  Google Scholar 

  30. Huth KC, Borkowski L, Liebermann A, Berlinghoff F, Hickel R, Schwendicke F, Reymus M. Comparing accuracy in guided endodontics: dynamic real-time navigation, static guides, and manual approaches for access cavity preparation - an in vitro study using 3D printed teeth. Clin Oral Investig. 2024;28(4):212.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Connert T, Zehnder MS, Weiger R, Kühl S, Krastl G. Microguided endodontics: Accuracy of a miniaturized technique for apically extended Access Cavity Preparation in Anterior Teeth. J Endod. 2017;43(5):787–90.

    Article  PubMed  Google Scholar 

  32. Zubizarreta-Macho Á, Valle Castaño S, Montiel-Company JM, Mena-Álvarez J. Effect of computer-aided Navigation techniques on the Accuracy of Endodontic Access Cavities: a systematic review and Meta-analysis. Biology (Basel) 2021;10(3).

  33. Jain SD, Carrico CK, Bermanis I. 3-Dimensional Accuracy of dynamic Navigation Technology in locating calcified canals. J Endod. 2020;46(6):839–45.

    Article  PubMed  Google Scholar 

  34. Connert T, Krug R, Eggmann F, Emsermann I, ElAyouti A, Weiger R, Kühl S, Krastl G. Guided endodontics versus Conventional Access Cavity Preparation: a comparative study on substance loss using 3-dimensional-printed Teeth. J Endod. 2019;45(3):327–31.

    Article  PubMed  Google Scholar 

  35. Chong BS, Dhesi M, Makdissi J. Computer-aided dynamic navigation: a novel method for guided endodontics. Quintessence Int. 2019;50(3):196–202.

    PubMed  Google Scholar 

  36. Connert T, Leontiev W, Dagassan-Berndt D, Kühl S, ElAyouti A, Krug R, Krastl G, Weiger R. Real-time guided endodontics with a miniaturized dynamic Navigation System Versus Conventional Freehand Endodontic Access Cavity Preparation: substance loss and Procedure Time. J Endod. 2021;47(10):1651–6.

    Article  PubMed  Google Scholar 

  37. Liu SM, Peng L, Zhao YJ, Han B, Wang XY, Wang ZH. The learning curve of a dynamic navigation system used in endodontic apical surgery. J Dent Sci. 2024;19(4):2247–55.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Wei X, Du Y, Zhou X, Yue L, Yu Q, Hou B, Chen Z, Liang J, Chen W, Qiu L, Huang X, Meng L, Huang D, Wang X, Tian Y, Tang Z, Zhang Q, Miao L, Zhao J, Yang D, Yang J, Ling J. Expert consensus on digital guided therapy for endodontic diseases. Int J Oral Sci. 2023;15(1):54.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Shusterman A, Nashef R, Tecco S, Mangano C, Mangano F. Implant placement using mixed reality-based dynamic navigation: a proof of concept. J Dent. 2024;149:105256.

    Article  PubMed  Google Scholar 

  40. Khan M, Javed F, Haji Z, Ghafoor R. Comparison of the positional accuracy of robotic guided dental implant placement with static guided and dynamic navigation systems: A systematic review and meta-analysis. J Prosthet Dent. 2024;132(4):746.e741-746.e748.

  41. Farronato M, Torres A, Pedano MS, Jacobs R. Novel method for augmented reality guided endodontics: an in vitro study. J Dent. 2023;132:104476.

    Article  PubMed  Google Scholar 

  42. Chen Y, Liu L, Qiu S, Hu C, Wang L, Li Y, Tan X, Gao Y, Huang D. Application of real-time augmented reality-guided Osteotomy and Apex Location in Endodontic Microsurgery: A Surgical Simulation Study based on 3D-printed alveolar bone model. J Endod. 2023;49(7):880–8.

    Article  PubMed  Google Scholar 

  43. ChenC, Qin L, Zhang R, Meng L. Comparison of Accuracy and Operation Time inRobotic, Dynamic, and Static-Assisted Endodontic Microsurgery: An In VitroStudy. J Endod. 2024;50(10):1448–54.

  44. Jorba-García A, Ruiz-Romero V, Bara-Casaus JJ, Camps-Font O, Sánchez-Garcés M, Figueiredo R, Valmaseda-Castellón E. The effect on the performance of a dynamic navigation system of superimposing a standard tessellation language (STL) file obtained with an intraoral scan on a cone beam computer tomograph (CBCT). An experimental in vitro study. J Dent. 2024;148:105150.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the patient who consented to the publication of this case report.

Funding

This work was supported by the Youth Independent Innovation Science Fund Project of Chinese PLA General Hospital (grant number: 22QNFC037).

Author information

Author notes

  1. Peng Xue and Qiang Luo contributed equally to this work.

Authors and Affiliations

  1. Department of Stomatology, The First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, 100853, China

    Peng Xue, Qiang Luo, Yang Huang, Meng Xu, Lele Qiu, Jiazhu Wang, Huixia He & Fei Chen

Authors
  1. Peng Xue
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Qiang Luo
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Yang Huang
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Meng Xu
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Lele Qiu
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. Jiazhu Wang
    View author publications

    You can also search for this author inPubMed Google Scholar

  7. Huixia He
    View author publications

    You can also search for this author inPubMed Google Scholar

  8. Fei Chen
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

P.X. and Q.L. helped collect the clinical data and draft and write the manuscript. Y.H. and M.X. helped with clinical data collection and analysis and revised the manuscript. L.Q. and J.W. helped with photography. F.C. designed and implemented the treatment plan and completed the follow-up examinations. H.H. supervised the study and revised the manuscript before submission. All the authors read and approved the final manuscript for publication.

Corresponding authors

Correspondence to Huixia He or Fei Chen.

Ethics declarations

Ethics approval and consent to participate

Ethical approval for this study was obtained from the Ethics Committee of the First Medical Center of PLA General Hospital (No. S2023-138-01). Informed consent was obtained from the patient in written form.

Consent for publication

The patient in this report signed a written informed consent for the publication of clinical details.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Xue, P., Luo, Q., Huang, Y. et al. Retreatment and aesthetic restoration of maxillary incisor with calcified root canal using a dynamic navigation system: a case report. BMC Oral Health 24, 1358 (2024). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12903-024-05118-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12903-024-05118-4

Keywords

BMC Oral Health

ISSN: 1472-6831

Contact us