(TC01) 3D Guided Access in Endodontics

Introduction: 3D guided access in endodontics is a contentious topic. In specific scenarios it is a useful tool in obtaining a minimally invasive access into the pulp chamber, such as calcified teeth and variable anatomy. It is not a panacea in endodontic accessing, and drawbacks include discrepancies between the guide and the location of the chamber as well as difficulty in properly disinfecting, obturating and restorating the tooth. The purpose of this literature review is to compare the benefits and shortcomings of the 3D guided technique. Materials and Methodology: We conducted a literature review using three online databases and found 11 articles discussing the uses and limitations of 3D guided access.

Results: There is not sufficient evidence to suggest that 3D guides should be used in every case, but it can be a useful tool with the proper case selection. Compared to free-handed access, 3D guided provides a more precise and accurate access cavity that allows the preservation of periradicular dentin, which studies have shown is critical in reducing fracture risk of the tooth and improves the odds for successful restoration. 3D guided access has been shown to be particularly beneficial in narrow teeth, such as mandibular incisors, as they have less radicular dentin and are more difficult to restore. With calcified pulp chambers, a 3D guide can preserve dentin and save the provider and patient time. Limitations include the necessity of a CBCT scan, 3D printer and proper armamentarium. Case selection is key in the outcome of endodontic treatment.