Guided Endodontic Access in Maxillary Molars Using Cone-beam Computed Tomography and Computer-aided Design/Computer-aided Manufacturing System: A Case Report
Journal Of Endodontics
Abstract
The
aim of this study was to describe a guided endodontic technique that
facilitates access to root canals of molars presenting with pulp
calcifications. A 61-year-old woman presented to our service with pain
in the upper left molar region. The second and third left molars showed
signs of apical periodontitis confirmed by the cone-beam computed
tomographic (CBCT) scans brought to us by the patient at the initial
appointment. Conventional endodontic treatment was discontinued given
the difficulty in locating the root canals. Intraoral scanning and the
CBCT scans were used to plan the access to the calcified canals by means
of implant planning software. Guides were fabricated through rapid
prototyping and allowed for the correct orientation of a cylindrical
drill used to provide access through the calcifications. Second to that,
the root canals were prepared with reciprocating endodontic instruments
and rested for 2 weeks with intracanal medication. Subsequently, canals
were packed with gutta-percha cones using the hydraulic compression
technique. Permanent restorations of the access cavities were performed.
By comparing the tomographic images, the authors observed a drastic
reduction of the periapical lesions as well as the absence of pain
symptoms after 3 months. This condition was maintained at the 1-year
follow-up. The guided endodontic technique in maxillary molars was shown
to be a fast, safe, and predictable therapy and can be regarded as an
excellent option for the location of calcified root canals, avoiding
failures in complex cases.
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