Real-time 3-dimensional Dynamic Navigation System in Endodontic Microsurgery: A Cadaver Study

Sara A Aldahmash; Jeffery B Price; Behzad Mostoufi; Ina L Griffin; Omid Dianat; Patricia A Tordik; Frederico C Martinho

doi:10.1016/j.joen.2022.04.012

Real-time 3-dimensional Dynamic Navigation System in Endodontic Microsurgery: A Cadaver Study

J Endod. 2022 Jul;48(7):922-929. doi: 10.1016/j.joen.2022.04.012. Epub 2022 Apr 28.

Authors

Sara A Aldahmash¹, Jeffery B Price², Behzad Mostoufi³, Ina L Griffin⁴, Omid Dianat⁵, Patricia A Tordik⁴, Frederico C Martinho⁶

Affiliations

¹ Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD; College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.
² Department of Oncology and Diagnostic Sciences, School of Dentistry, University of Maryland, Baltimore, MD.
³ Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, MD.
⁴ Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD.
⁵ Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD; Centreville Endodontics, Centreville, VA.
⁶ Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD. Electronic address: fmartinho@umaryland.edu.

PMID: 35489425
DOI: 10.1016/j.joen.2022.04.012

Abstract

Introduction: This study evaluated the accuracy and efficiency of the 3-dimensional dynamic navigation system (3D-DNS) to perform minimally invasive osteotomy (MIO) and root end resection (RER) in endodontic microsurgery (EMS) and investigated the viability of root end cavity preparation (RECP) and root end fill (REF) in MIO.

Methods: Forty-eight tooth roots were divided in cadaver heads into 2 groups: 3D-DNS (n = 24) and freehand (n = 24). Cone-beam computed tomographic scans were taken before and after surgery. First, virtual 3D-DNS accuracy was verified using 3 outcome measures: 2-dimensional and 3-dimensional virtual deviations and angular deflection. Second, the accuracy of 3D-DNS for performing MIO was investigated in 2 outcome measures: osteotomy size and volume. Third, the 3D-DNS accuracy was determined for RER in 3 outcomes: resected root length, root length after resection, and resection angle. The viability of RECP and REF was investigated and REF depth and volume measured as well, and procedural time and the number of mishaps were recorded.

Results: Two- and 3-dimensional virtual deviations and the angular deflection were lower in the 3D-DNS group than the freehand group (P < .05). Osteotomy height, length, and volume were all reduced when using 3D-DNS (P < .05). The resection angle was lower for 3D-DNS (P < .05). RECP and REF were completed in 100% of the roots. The REF depth achieved was ∼3 mm. Osteotomy time, RER time, and the total procedure time were all significantly shortened using 3D-DNS (P < .05).

Conclusions: 3D-DNS enabled our surgeon to perform accurate and efficient EMS with minimally invasive osteotomy and RER. The surgeon was also able to conduct RECP with adequate REF in minimally invasive osteotomy performed using 3D-DNS guidance.

Keywords: Dynamic navigation system; endodontic microsurgery; image guided; root-end surgery; technology.

MeSH terms

Apicoectomy
Cadaver
Cone-Beam Computed Tomography
Humans
Microsurgery* / methods
Tooth*