(TC43) Application of Innovative Design 3D Printed Access Guide with CBCT in Pulp Canal Obliteration Endodontics Treatment

An accurate 3D access guide helps clinicians overcome difficulties treating pulp canal obliteration. The previous literature in guided endodontics mostly utilized a combination of an intraoral scanner and cone beam computed tomography (CBCT) to create an access guide, which may increase treatment time and cost. As a result, its utilization outside of academia has been limited. The purpose of this table clinic is to provide a procedural demonstration on the application of an access guide utilizing a CBCT scan, only. Unlike previous guides, this new guide is designed to be placed on a single tooth with a maximum interproximal clearance of 3 mm above the CEJ to avoid obstruction of the adjacent dentition. This results in easier use of the guide under rubber dam isolation. To accommodate an accessing bur without damaging the guide, a combination of a 1.8 mm access hole with a metal internal sleeve and angulation rods were placed. After conversion of CBCT images to stereolithography (STL) files, the guide design was outsourced to a 3D-printing laboratory. The performance evaluation of the guide was performed on extracted molars and pre-molars with severe pulp obliteration. Following ex-vivo performance tests, an in-vivo application of the guide was performed by a resident in postgraduate endodontics clinic at UCSF. The procedure video allows for analysis of time, shape, and a clinical comparison. Computational simulation has shown great potential with this design. Further ex vivo and in vivo investigations are projected to provide analogous accuracy and performance.