Real-Time Three-dimensional Dynamic Navigation for Post Space Preparation in Root Canal-Treated Teeth: An In vitro Study

Frederico C Martinho; Syed J Qadir; Jeffery B Price; Patricia A Tordik; Ricardo A Bernardes; Ina L Griffin

doi:10.1016/j.joen.2024.03.006

Real-Time Three-dimensional Dynamic Navigation for Post Space Preparation in Root Canal-Treated Teeth: An In vitro Study

J Endod. 2024 Mar 22:S0099-2399(24)00166-3. doi: 10.1016/j.joen.2024.03.006. Online ahead of print.

Authors

Frederico C Martinho¹, Syed J Qadir², Jeffery B Price³, Patricia A Tordik², Ricardo A Bernardes², Ina L Griffin²

Affiliations

¹ Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland. Electronic address: fmartinho@umaryland.edu.
² Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland.
³ Division of Oral Radiology, Department of Oncology and Diagnostic Sciences, University of Maryland, School of Dentistry, Baltimore, Maryland.

PMID: 38522577
DOI: 10.1016/j.joen.2024.03.006

Abstract

Introduction: The aim of this study was to investigate the feasibility of a real-time three-dimensional dynamic navigation system (3D-DNS) for post space preparation (PSP) in root canal-treated teeth and to compare the accuracy and efficiency of 3D-DNS to freehand (FH) for PSP.

Methods: Fifty-four maxillary molars were divided into two groups: 3D-DNS (n = 27) and FH group (n = 27). Cone beam computed tomography (CBCT) scans were taken preoperatively and postoperatively. The drilling path for the PSP was virtually planned in the preoperative CBCT scan in the X-guide software (X-Nav Technologies, Lansdale, PA). For the 3D-DNS group, the PSP drilling was conducted under dynamic navigation. The 3D deviations and angular deflections were calculated. The residual dentin thickness (RDT) was determined after PSP. The operation time and the total number of mishaps were recorded. Shapiro-Wilk, t-test or Mann-Whitney rank sum, weighted Cohen's kappa, and Fisher exact tests were used (P < .05).

Results: The PSP was completed in all samples (54/54). The 3D-DNS was more accurate than the FH, with significantly fewer 3D deviations and angular deflections (all, P < .05). The 3D-DNS required less operating time than the FH (P < .05). For the 3D-DNS, no teeth had RDT < 1 mm, whereas 6/27 in the FH showed RDT < 1 mm after the PSP. There was no difference in the total number of mishaps (P > .05).

Conclusion: Within the limitations of this in vitro study, the 3D-DNS is feasible for PSP. The 3D-DNS improved the accuracy and efficiency of PSP. The dynamic navigation system can potentially become a safe and reliable technology for PSP.

Keywords: Dynamic navigation system; endodontics; post space; preparation; technology.