Date of Award

2022

Embargo Period

7-29-2022

Document Type

Thesis

Degree Name

Master of Science in Dentistry

Department

Oral Rehabilitation

College

College of Dental Medicine

First Advisor

Theodore D. Ravenel

Second Advisor

J. Wade Nichols

Third Advisor

Pinar Emecen-Huja

Abstract

Introduction: Fiber posts are frequently used for the restoration of endodontically treated teeth. Such posts are typically bonded to the tooth using a composite resin system. These posts often need to be removed during endodontic retreatment. While there are many techniques to remove fiber posts, most include drilling through the post itself which can be challenging and result in a perforation or excessive tooth structure being removed. Static and dynamic guided endodontic techniques have been proposed to safely remove fiber posts. Yomi (Neocis, Inc, Miami, FL) is a haptic robot guidance system has been FDA approved to assist in placing dental implants and may be able to be used for endodontic applications. This system combines the advantages of both static and dynamic guidance. The purpose of this study was to investigate the ability and efficiency of a robot-assisted haptic guidance system to remove bonded fiber posts in endodontically treated teeth. Methods: Forty-six natural extracted single-rooted maxillary anterior teeth with straight canals were selected and endodontically treated. Following obturation, a post space was created, and fiber posts placed and bonded with resin. The teeth were then mounted in acrylic blocks simulating a maxillary arch form. Preoperative CBCT volumes were acquired. The teeth were divided into 3 groups for fiber post removal. In Group 1 the fiber posts were removed by an endodontic resident using robot-assisted haptic guidance. In Group 2 the fiber posts were removed by an experienced endodontist using a freehand technique. In Group 3 the fiber posts were removed by the endodontic resident using a freehand technique. The volume of removed tooth structure was measured and time to remove the fiber posts recorded. Post-operative CBCT volumes were acquired. ITK-SNAP semiautomatic segmentation software was used to compare pre- and post-operative CBCT images for volumetric analysis in determining the amount of tooth structure removal. The data was statistically analyzed using independent samples t-tests, one-way ANOVA, and the Tukey post-hoc procedure. Results: All teeth were included for final analyses. The mean time to remove a post in Group 1 was 33.3 seconds, Group 2 was 446.2 seconds, and Group 3 was 607.2 seconds. There was a significant difference between each group regarding the time to remove the fiber post. The mean volume of tooth structure removed in Group 1 was 10.9 mm3, Group 2 was 15.6 mm3, and Group 3 was 24.3 mm3. The difference in volume of tooth structure removed was significant between Group 1 and the two other groups. Conclusions: The removal of resin bonded fiber posts in single canal maxillary teeth is possible using a robot-assisted haptic guidance system. The robot guided system is more time efficient and results in less volume removed when removing fiber posts compared to freehand techniques. An experienced endodontist is more conservative in removing a fiber post than an endodontic resident when considering the amount of tooth structure removed.

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