Date of Award

2019

Document Type

Thesis

Degree Name

Master of Science (MS)

Department

Oral Rehabilitation

College

College of Dental Medicine

First Advisor

Theodore D. Ravenel

Second Advisor

Zachary P. Evans

Third Advisor

Robert G. Gellin

Abstract

Aim: To measure the accuracy, we will be evaluating the position deviations and angular deviations of endodontic access preparations compared with the digital file plan for the guided access. Material and Methods: 24 extracted human anterior teeth (4 maxillary canines, 4 mandibular canines, 8 mandibular incisors, and 8 maxillary incisors) were mounted into acrylic resin to mimic the position in the human jaw. Pre-op CBCT images of the models were acquired and imported into the X-Nav system software. Virtual endodontic files were custom created in the software by adjusting the diameter of the “implant” to 0.5 mm, with lengths ranging from 7-14 mm to allow virtual placement with coronal termination of the file near the natural tooth occlusal surface. The enamel of the path of the access is first removed using a high-speed drill and a #4 round bur and subsequently 34mm size #1 Munce with the 1:1 dental surgical electric handpiece was used to drill through the designed access in the proper orientation. Post-op CBCT images were taken and evaluated for angular deviation via access design and endodontic file placement deviations. Results: Subjective analysis confirmed passive straight line access with a #8 K-file through the access for all canals and CBCT images were captured. Images were repeated with files in the canal after decoronation of teeth. No significant difference was found in file angular deviations. Overall files angular deviation was 2.75 ± 2.21 degrees. There was a significant difference found among maxillary canine vs mandibular canines (1.34 ± 1.32 degrees and 5.61 ± 1.63 degrees, respectively) with a p-value=0.0064. A significant difference was found among each tooth type when comparing the drill depth needed to achieve passive access with endodontic files. There was significant difference found when comparing maxillary canines to mandibular incisors. The average drill depth for maxillary canines was 12.75 ± 2.06mm, maxillary incisors was 12 ± 1.93mm, and mandibular incisors 8.05 ± 0.97mm. Conclusion: The dynamic guide system proved to be highly accurate in accessing root canals of anterior teeth while creating a highly conservative access design. The accuracy was consistent among all anterior teeth without any significant difference. All canals were located after the endodontic access was completed using the software. Further research will be needed to study the practicality of the system in a clinical setting. The system does have a learning curve of 3-4 teeth and the system can be very useful in situations with highly calcified teeth where deep access will be required to locate canals.

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