02 March 2023

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The guided dynamic navigation technique and its use in endodontics

By Arianna Bianchi

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The use of surgical templates is now widespread in the implant field, allowing the execution of even complex rehabilitation treatments in a simpler and more predictable way. But is it possible to extend the use of these methods in endodontics?

Materials, methods

This question was precisely the topic of an in vitro study, published in 2022 in the Journal of Endodontics. The aim of the study was to evaluate the use of guided dynamic navigation for the endodontic treatment of teeth that presented obliteration of the pulp canal. Researchers then compared it with the traditional freehand technique for opening the chamber.

To conduct the study, the authors created – using a 3D printer – 40 lower and upper incisors simulating the obliteration of the root canal system.

All the conditions were then reproduced to create a correct simulation of an endodontic treatment, including the use of a rubber dam.

Clinicians opened the pulp chambers. For freehand access, the authors had CBCT and microscope scans available.

To create the chamber opening with the dynamic navigation technique, however, the Navident system (ClaroNav) was used, which involved scanning, planning, tracking and positioning processes. For both methods, the time for chamber opening and finding the root apex was evaluated, observed through a periapical radiograph with the aid of a #15 K-File.

Results

Fourteen articles, including three case reports and 11 in-vitro studies, met the eligibility criteria and were included in the study. The quality assessment revealed a minimal risk of bias, with mean scores of 83.3% for case reports and 84.1% for in-vitro studies. 

DNS was used for various clinical applications such as access cavity preparation, pulp canal obliteration, endodontic retreatment and microsurgery. The DNS brands used were Navident, X-guide, ImplaNav and DENACAM. Due to the nature of the component studies, meta-analysis was not possible.

Conclusions

The authors concluded that challenging clinical situations like pulp canal obliteration, conservative access preparation, endodontic retreatment and microsurgery can be managed efficiently with fewer iatrogenic errors in a shorter time using DNS. However, this systematic review’s evidence is low since the included articles are either case reports or in-vitro studies. Clinical studies are needed to test DNS efficacy among operators, including those who are less proficient and compare the accuracy of currently available systems.

For more information: "Dynamic Navigation in Guided Endodontics – A Systematic Review."