Date of Award

2020

Document Type

Thesis

Degree Name

Master of Science in Dentistry

Department

Oral Rehabilitation

College

College of Dental Medicine

First Advisor

Theodore D. Ravenel V

Second Advisor

Zachary Evans

Third Advisor

Robert P. Bethea

Abstract

Introduction: Dynamic guidance is a technology that uses CBCT images and an array of cameras & sensors to guide the operator’s dental handpiece along a pre-determined path in real-time. It has been used in implant surgery, non-surgical endodontics, as well as in a few reported clinical cases of endodontic microsurgery to improve the accuracy of these procedures. However, no study has been published which quantitatively evaluates its ability to improve accuracy and reduce osteotomy size in endodontic microsurgery. Therefore, the aim of this in-vitro study was to compare dynamically guided endodontic microsurgery to freehand surgery in terms of osteotomy window, osteotomy volume, apical bevel, apical resection length and depth of osteotomy past the target root. Materials and Methods: Thirty-six human mandibular posterior teeth were cast into stone models containing three teeth each (one premolar, two molars), and those models were subsequently divided equally into freehand and guided groups. In the freehand group, an experienced operator performed osteotomies and root-end resections. In the guided group, the X-Guide System was used to assist in the execution of similar osteotomies and resections. Post-operative CBCT images were taken of both groups and the aforementioned parameters were evaluated using software native to the imaging system. Results: Significant differences were found between the freehand and guided groups in terms of osteotomy window area, osteotomy volume, depth of osteotomy past the target root and amount of resection. Most notably, the window area in the guided group (15.7mm2 ± 3.85) was significantly (p<0.05) smaller than in the freehand group (37.6mm2 ± 5.02), and the osteotomy volume in the guided group (0.111cm3 ± 0.04) was significantly (p<0.05) smaller than in the freehand group (0.226cm3 ± 0.05). Conclusions: The results of this study show that implementing dynamic guidance in endodontic microsurgery has the potential to significantly reduce the osteotomy window area and osteotomy volume as compared to freehand surgery, which subsequently can result in improved healing. It can also ensure that critical structures such as adjacent non-target roots and the mandibular canal are avoided while attempting to locate the target root.

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