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

Robert P. Bethea

Third Advisor

Zachary Evans

Abstract

Introduction: one of the most common challenging scenarios that a clinician faces on a regular basis is the treatment of a calcified tooth. Using CBCT to identify canals is becoming the standard of care and a tremendous help to clinicians. More recently, Dynamic guidance is becoming a popular among clinicians for dealing with challenging cases such as calcification. Objective: The aim of this study was to evaluate the accuracy of endodontic access of calcified anterior mandibular and maxillary teeth using dynamic guidance. Material and Method: 42 extracted calcified human mandibular and maxillary anterior teeth were selected. Rubber model former mold was used to mount the extracted teeth in the proper position to mimic the human jaw, and CBCT images were captured. Preoperative CBCT scans were transferred to the Dynamic Guidance system software for planning of endodontic access. To simulate a clinical scenario, the dentoforms were mounted to a manikin and placed on an operatory chair. Post-removal burs were used to gain access to the canal after calibration was completed. Once the proper depth was reached, the software prompted the operator to stop. The procedure was terminated at this point, regardless of the success of the operator to locate the canals or not. After completion, the access was evaluated by the passive placement of a #6 C file in the canal to ensure access/patency of the canal. A post-operative CBCT with and without the file in the access was taken. The teeth were then decoronated at the cementoenamel junction to remove any obstruction that would potentially deflect the file, and a file was placed in the canal and a CBCT was taken with the file. All images were assessed for access deviation and accuracy, followed by comparative statistics. Results: Of the 32 included in this study, 28 (87.5%) canals were successfully located. The angular deviation was calculated after superimposing the pre-op CBCT over the post-op CBCT by measuring the angle between the file and the natural path of the physical canal. The average angular deviation was 4.69 degrees, the average platform buccolingual deviation was 0.38 mm, the average platform mesiodistal direction was 0.23 mm, the average of non-depth deviation (deviation in any direction other than apico-coronally) was 0.99 mm, and the average of apical non-depth deviation at the apical extent of the file trajectory was 0.70 mm Conclusion: Calcified canals were located by an inexperienced operator in 87.5% of the time with an angular deviation of 4.69 degrees which confirms that dynamic guide system

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