Date of Award

2022

Embargo Period

7-29-2022

Document Type

Thesis

Degree Name

Master of Science in Dentistry

College

College of Dental Medicine

First Advisor

Theodore D. Ravenel

Second Advisor

J. Wade Nichols

Third Advisor

Pinar Emecen-Huja

Abstract

Introduction: The initial step of root canal therapy consists of access preparation. Access preparation can be difficult, due to pulpal calcifications, misaligned teeth, and full coverage restorations that obscure the canal morphology. Recent trends involve static or dynamic guides to help the operator to locate the canals. Both systems have limitations. A robot with haptic guidance has been developed for implant surgeries, however, no studies have evaluated its possible use in endodontics. The purpose of this study was to determine whether the volume of tooth structure removed, and time required for access preparation in calcified anterior teeth differed between a robot-guided approach compared to freehand access. Methods: Forty-eight maxillary and mandibular anterior teeth with calcified canals were randomly divided into 3 groups (by number allocation). Teeth were mounted and a preoperative CBCT taken. Access cavity preparation was performed with robot-guided approach after planning the procedure in group 1 (robot-guided by a second-year endodontic resident), and freehand in groups 2 (experienced endodontist) and 3 (second-year endodontic resident). Time in seconds was recorded and a postoperative CBCT was obtained. Digital Imaging and Communications in Medicine (DICOM) images were transferred to ITK-SNAP software (an application used to segment structures in 3D medical images) to evaluate the percentage volume of tooth structure removed. Statistical analyses consisted of independent samples t-tests and one-way Analysis of Variance (ANOVA). Results: Forty teeth were used for final analyses. Seven teeth were excluded from the analysis due to gouging, perforation or broken bur in robot-guided group and one tooth was excluded from endodontic resident freehand group due to perforation. Regarding time, mean measures for group 1, 2 and 3 were 74.3, 144.9 and 219.9 seconds, respectively. There is a significant difference between group 1 and group 2 (p0.05). Mean percentages for volume of tooth structure removal in mm3 were 3.7, 8.1 and 9.5, for groups 1, 2 and 3 respectively. Significant differences are observed between group 1 and group 2 (p0.05). Conclusions: Robot-guided navigation can be an efficient alternative for accessing calcified teeth if procedure is planned accurately. More research is needed in the future for better results.

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