18 October 2023

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How to manage iatrogenic root canal ledges with the support of Come Beam

Lara Figini

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Successful endodontic treatment is achieved through correct shaping and disinfection of the root canal system, however anatomical variations of the canals, the angle of canal curvature, the radius of curvature and the position of the curvature can influence the disinfection effectiveness of the system root canal and endodontic success. Mechanical preparation is an important and critical step in the disinfection process and complex root canal systems can represent a challenge for the endodontist with the risk of iatrogenic errors. Among these procedural errors we can list iatrogenic obstructions due to accumulation of dentin mud, perforations, transport of the apical portion etc., all conditions that can compromise disinfection, jeopardizing the apical seal and predisposing to periapical pathologies. Ledges formation can be defined as “an irregular iatrogenic product, having the shape of a platform in the root canal wall, which makes access to the apical foramen difficult or even impossible”. It has been reported by various authors in the literature that the formation of iatrogenic ledges increases significantly with root curvatures greater than 20 degrees. Defined protocols are therefore necessary to fully understand the internal structures of the root canals and to develop a pre-procedural simulation in order to facilitate the endodontist in the management of complex endodontic cases, such as those sent by colleagues with iatrigenic ledges  that prevented the achievement correct apical. The advanced segmentation method combined with Cone Beam (CBCT) can be useful for this purpose.

Materials and methods

In a study published in Journal of Endodontics, the authors proposed an innovative method combined with CBCT to successfully complete difficult root canal treatments with iatrogenic dentinal ledges within one or more canals. The authors illustrated the clinical case of a patient who came to them after an unsuccessful root canal treatment due to dentinal obstruction of the left mandibular first molar. A CBCT was performed and the images were imported into segmentation-ready software (Mimics®, Materialise™). The canal was isolated and segmentation was performed together with the other tooth structures. A 3D representation of the canal and internal canal structures was exported from the software and additively produced. This was used as a preclinical guide to simulate the procedure, pre-curve the files appropriately and manage the root canal treatment more easily.

Conclusions

From the data of this study, which must be confirmed in other similar studies, it can be concluded that this new technique, which uses virtual processing from CBCT data after the formation of iatrogenic root canal ledges, allows for more effective and rapid management of dental elements. with these problems.

Bibliography: CBCT segmentation and additive manufacturing for the management of root canals with ledges: A case report and technique. Andrew B. Cameron, Hadeel M.H. A.S. Abdelhamid, B.D.S,, Roy George.

Journal of Endodontics DOI: https://doi.org/10.1016/j.joen.2023.08.002