Shiva Tavakkoli Avval

This review evaluates the effectiveness and clinical applicability of guided endodontics (GE) in managing dental anomalies, which present challenges for conventional endodontics. The primary objective is to assess how GE enhances treatment predictability and minimises errors in cases such as dens invaginatus (DI), dentinogenesis imperfecta (DGI), dentinal dysplasia (DD), dens evaginatus (DE) and dental fusion. A narrative review was conducted using a comprehensive search across PubMed/MEDLINE, Scopus, Web of Science, EMBASE and Cochrane Library databases for studies published 2015–2025. Nine studies met the inclusion criteria. GE was found to offer high success rates in the treatment of DI, DGI and DD. The integration of CBCT and 3D‐printed guides allowed for minimally invasive access cavity preparation, reduced iatrogenic complications and improved precision. Despite these advantages, challenges include increased cost, being time‐consuming and limitations in curved canals. Guided endodontics holds promise as a transformative technique in modern endodontic practice.

Performing endodontic treatment on calcified root canals is highly challenging and time‐intensive. Even with the assistance of a dental operating microscope, the probability of iatrogenic errors is high. The aim of this report is to present successful endodontic treatments for severely calcified maxillary anterior teeth using a 3D endodontic sleeveless guide, providing a basis for upcoming validation through more comprehensive research. A 25‐year‐old male patient was referred to the dental office with a chief complaint of pain and swelling of his Tooth 2.2 who explained a previous history of trauma. On clinical examination, periapical swelling was observed, and the tooth demonstrated tenderness to percussion and palpation in the periapical region. Radiographic findings included a severely obliterated pulp chamber and a calcified root canal with periapical radiolucency. In order to perform the root canal treatment with an endodontic guide, an optical impression was carried out using an intraoral scanner. Data from the impression and CBCT files were aligned and sent to the dental laboratory. A virtual copy of a drill was superimposed onto the scans in an optimal position that provided access to the root system, using Exoplan software. A digital model was created and exported as an STL file and transferred to a 3D printer to produce a template. Despite several limitations, successful root canal treatment was conducted. At the 6‐month follow‐up visit, the patient reported no symptoms, and periapical radiography showed a diminished periapical lesion. Static endodontic guidance provides an opportunity to have more reliable and predictable outcomes in treating complex root systems, even in the presence of minor issues such as transportation and file separation.

This systematic review compared the accuracy of guided endodontics with the conventional method in non-surgical endodontic retreatment. Two reviewers conducted a systematic search across PubMed/MEDLINE, Scopus, Embase, and Web of Science databases. Inclusion criteria consisted of all in vitro studies up to October 2024 that documented the application of cone-beam computed tomography in creating a guide for endodontic retreatment cases. The reviewers assessed the quality of the selected studies using the QUIN tool. Data regarding the first author and publication year, sample size, tooth type, retreatment application, computer-aided navigation technique, groups, image acquisition method, outcome measures, guided technique results, conventional technique results, and the main results were extracted using a predefined template. Based on our criteria, seven studies were included in this review. The studies demonstrated variability in the techniques utilized. Iatrogenic errors were less frequent in guided groups, regardless of the operator’s level of experience. Most studies indicated that guided endodontics was more effective than conventional methods, particularly in fiber post-removal and access through MTA, minimizing volumetric loss of tooth structure, and preserving fracture resistance. However, when using guided techniques for removal of separated instruments, more iatrogenic errors occurred, and more time was required compared to the freehand technique. Guided endodontics has shown promise in improving the outcomes of non-surgical retreatment by reducing complications. However, as all included studies were in vitro, clinical evidence is lacking, and the generalization of these results should be done cautiously. Further well-designed clinical studies are required to confirm these findings.