Guided Endodontics: A novel treatment approach for the management of teeth with root canal obliteration-Case Series

To present a novel minimally invasive treatment approach to create a 3D-printed guide to obtain patency to obliterated root canal on the basis of CBCT data & surface scan. A 38 year old female presented with diffuse pain on her upper right front teeth area. On clinical examination tooth number # 11,12,21 and 22 were tender on percussion and was giving a negative response with cold test and EPT. IOPA with tooth number # 11 showed completely obliterated root canal. In CBCT the radiographic evidence of the root canal was traced only at the apical third of tooth number # 11. So guided endodontic treatment was chosen for attaining the patency of the root canal. Surface scan was obtained from the cast of the patient. Both details were superimposed on a software and a virtual template was prepared using a 3D printer with the guiding sleeve attached. After positioning the template over the teeth, precision microendodontic bur was used to gain the access to the root canal with minimal invasion to obtain the patency of the root canal. After biomechanical preparation with rotary instruments an intra canal medicament was given in the root canal for 4 weeks, following which the root canal was obturated with thermoplasticized gutta-percha obturation technique and access cavity was restored with composite. After 3 months the patient was asymptomatic and had no pain on percussion. Another case of a 35 year old female patient with completely obliterated tooth number # 21 was also treated with guided endodontic treatment modality. Novelty of the case report is that we could use a micro precision bur Endo guide EG 5 for the guided endodontic treatment for the first time, which was supported by thorough literature search. Guided endodontics is a relatively safe and feasible treatment modality for teeth with calcification and periapical pathology which reduces the incidence of perforation and deviation of root canal geometry, a common complication of its conventional counterpart. Key Words: Guided endodontic treatment, Maxillary central incisor, Micro precision endodontic access bur, Root canal obliteration