Rehberli Endodonti: Kavramsal Gelişim, Dijital İş Akışı ve Klinik Uygulamalar
Özet
Pulpa kanalı obliterasyonu (PCO), kök kanal tedavisini zorlaştıran ve özellikle dental travma sonrası ortaya çıkabilen klinik bir durumdur. Kalsifiye kanalların lokalizasyonu sırasında perforasyon, aşırı dentin kaybı ve kanalın bulunamaması gibi komplikasyonlar sıklıkla görülebilmektedir. Bu nedenle son yıllarda dijital teknolojilere dayanan kılavuzlu endodonti yaklaşımı geliştirilmiştir. Kılavuzlu endodonti, konik ışınlı bilgisayarlı tomografi (CBCT) verilerinin ağız içi taramalarla birleştirilmesi ve sanal planlama sonucunda oluşturulan yönlendirme sistemleri aracılığıyla kalsifiye kanallara kontrollü erişim sağlamayı amaçlamaktadır. Bu yaklaşım iki temel sistem üzerinden uygulanmaktadır: statik kılavuzlu endodonti ve dinamik navigasyon temelli kılavuzlu endodonti. Bu bölümde kılavuzlu endodontinin dijital iş akışı, klinik endikasyonları, doğruluk ve hassasiyet bulguları ile konvansiyonel yöntemlerle karşılaştırmalı avantajları ele alınmaktadır. Ayrıca tekniğin klinik başarı oranları, olası komplikasyonları ve mevcut sınırlılıkları da güncel literatür ışığında değerlendirilmektedir. Son bölümde ise navigasyon teknolojileri, görüntüleme yöntemleri ve dijital entegrasyon alanındaki gelişmeler doğrultusunda kılavuzlu endodontinin gelecekteki araştırma ve uygulama perspektifleri tartışılmaktadır.
Pulp canal obliteration (PCO) represents a significant clinical challenge in endodontic treatment, particularly due to the difficulty of locating calcified canals and the increased risk of procedural complications such as perforation, excessive dentin removal, and failure to identify the canal. To address these challenges, digitally assisted approaches such as guided endodontics have been introduced in recent years. Guided endodontics relies on the integration of cone-beam computed tomography (CBCT) data with intraoral surface scans, enabling virtual treatment planning and controlled access to calcified canals. Two principal approaches have been developed: static guided endodontics, which utilizes 3D-printed templates, and dynamic guided endodontics, which employs real-time navigation systems. This chapter provides a comprehensive overview of the digital workflow of guided endodontics, including imaging, planning, and clinical implementation. The clinical indications, accuracy, and precision of guided access preparation are reviewed, along with comparisons to conventional freehand techniques. Furthermore, the chapter discusses reported clinical outcomes, potential complications, and current limitations of the technique. Finally, emerging developments in imaging technologies, navigation systems, and digital integration are highlighted to outline future perspectives for guided endodontics in modern endodontic practice.
Referanslar
Andreasen FM, Zhjie Y, Thomsen BL, Andersen PK. Occurrence of pulp canal obliteration after luxation injuries in the permanent dentition. Dental Traumatology. 1987;3(3):103-15.
Nikoui M, Kenny DJ, Barrett EJ. Clinical outcomes for permanent incisor luxations in a pediatric population. III. Lateral luxations. Dental Traumatology. 2003;19(5):280-5.
Mass E, Zilberman U. Long-term radiologic pulp evaluation after partial pulpotomy in young permanent molars. Quintessence International. 2011;42(7).
Fleig S, Attin T, Jungbluth H. Narrowing of the radicular pulp space in coronally restored teeth. Clinical oral investigations. 2017;21(4):1251-7.
Delivanis HP, Sauer GJ. Incidence of canal calcification in the orthodontic patient. American Journal of Orthodontics. 1982;82(1):58-61.
Carvalho TS, Lussi A. Age‐related morphological, histological and functional changes in teeth. Journal of oral rehabilitation. 2017;44(4):291-8.
by: ESoEd, Krastl G, Weiger R, Filippi A, Van Waes H, Ebeleseder K, et al. European Society of Endodontology position statement: endodontic management of traumatized permanent teeth. International Endodontic Journal. 2021;54(9):1473-81.
Krastl G, Weiger R, Filippi A, Van Waes H, Ebeleseder K, Ree M, et al. Endodontic management of traumatized permanent teeth: a comprehensive review. International Endodontic Journal. 2021;54(8):1221-45.
Oginni AO, Adekoya‐Sofowora CA, Kolawole KA. Evaluation of radiographs, clinical signs and symptoms associated with pulp canal obliteration: an aid to treatment decision. Dental Traumatology. 2009;25(6):620-5.
Cvek M, Granath L, Lundberg M. Failures and healing in endodontically treated non-vital anterior teeth with posttraumatically reduced pulpal lumen. Acta Odontologica Scandinavica. 1982;40(4):223-8.
Kiefner P, Connert T, ElAyouti A, Weiger R. Treatment of calcified root canals in elderly people: a clinical study about the accessibility, the time needed and the outcome with a three‐year follow‐up. Gerodontology. 2017;34(2):164-70.
Krastl G, Zehnder MS, Connert T, Weiger R, Kühl S. Guided endodontics: a novel treatment approach for teeth with pulp canal calcification and apical pathology. Dental traumatology. 2016;32(3):240-6.
Zehnder M, Connert T, Weiger R, Krastl G, Kühl S. Guided endodontics: accuracy of a novel method for guided access cavity preparation and root canal location. International endodontic journal. 2016;49(10):966-72.
Buchgreitz J, Buchgreitz M, Mortensen D, Bjørndal L. Guided access cavity preparation using cone‐beam computed tomography and optical surface scans–an ex vivo study. International endodontic journal. 2016;49(8):790-5.
Van Der Meer WJ, Vissink A, Ng YL, Gulabivala K. 3D Computer aided treatment planning in endodontics. Journal of dentistry. 2016;45:67-72.
Wei X, Du Y, Zhou X, Yue L, Yu Q, Hou B, et al. Expert consensus on digital guided therapy for endodontic diseases. International Journal of Oral Science. 2023;15(1):54.
Bun San Chong B, Manpreet Dhesi B, Makdissi J, RCR D. Computer-aided dynamic navigation: a novel method for guided endodontics. Quintessence International. 2019;50(3):196-202.
Dianat O, Gupta S, Price JB, Mostoufi B. Guided endodontic access in a maxillary molar using a dynamic navigation system. Journal of endodontics. 2021;47(4):658-62.
Chen C, Zhang R, Zhang W, Wang F, Wang Z, Qin L, et al. Analysis of the accuracy of a dynamic navigation system in endodontic microsurgery: a prospective case series study. Journal of Dentistry. 2023;134:104534.
Haarmann B, Leontiev W, Magni E, Kühl S, Dagassan-Berndt D, Weiger R, et al. Accuracy of guided endodontics in posterior teeth. Applied Sciences. 2023;13(4):2321.
Jung RE, Schneider D, Ganeles J, Wismeijer D, Zwahlen M, Hammerle C, et al. Computer technology applications in surgical implant dentistry: a systematic review. Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. 2009.
Kühl S, Payer M, Zitzmann NU, Lambrecht JT, Filippi A. Technical Accuracy of Printed Surgical Templates for Guided Implant Surgery with the co D iagnosti X TM Software. Clinical implant dentistry and related research. 2015;17:e177-e82.
Krug R, Reich S, Connert T, Kess S, Soliman S, Reymus M, et al. Guided endodontics: a comparative in vitro study on the accuracy and effort of two different planning workflows. Int J Comput Dent. 2020;23(2):119-28.
Marquardt P, Witkowski S, Strub J. Three-dimensional navigation in implant dentistry. European Journal of Esthetic Dentistry. 2007;2(1).
Block MS, Emery RW, Lank K, Ryan J. Implant Placement Accuracy Using Dynamic Navigation. International Journal of Oral & Maxillofacial Implants. 2017;32(1).
Connert T, Weiger R, Krastl G. Present status and future directions–Guided endodontics. International endodontic journal. 2022;55:995-1002.
LARA-MENDES STdO, Barbosa CdF, Machado VC, Santa-Rosa C. Guided endodontics as an alternative for the treatment of severely calcified root canals. Dental Press Endodontics. 2019;9(1):15-20.
Connert T, Walter E, Benz L, Schwendicke F, Leontiev W. Guided Endodontics—Potential and Limitations. Australian Dental Journal. 2025.
Connert T, Zehnder M, Amato M, Weiger R, Kühl S, Krastl G. Microguided Endodontics: a method to achieve minimally invasive access cavity preparation and root canal location in mandibular incisors using a novel computer‐guided technique. International endodontic journal. 2018;51(2):247-55.
Connert T, Zehnder MS, Weiger R, Kühl S, Krastl G. Microguided endodontics: accuracy of a miniaturized technique for apically extended access cavity preparation in anterior teeth. Journal of endodontics. 2017;43(5):787-90.
Connert T, Krug R, Eggmann F, Emsermann I, ElAyouti A, Weiger R, et al. Guided endodontics versus conventional access cavity preparation: a comparative study on substance loss using 3-dimensional–printed teeth. Journal of endodontics. 2019;45(3):327-31.
Zhang T, Chen D, Miao L-Y, Xie S-J, Tang X-N. Guided endodontic access of calcified root canal by laser melting templates. Hua xi kou Qiang yi xue za zhi= Huaxi Kouqiang Yixue Zazhi= West China Journal of Stomatology. 2020;38(5):525-31.
Torres A, Lerut K, Lambrechts P, Jacobs R. Guided endodontics: use of a sleeveless guide system on an upper premolar with pulp canal obliteration and apical periodontitis. Journal of Endodontics. 2021;47(1):133-9.
Buchgreitz J, Buchgreitz M, Bjørndal L. Guided root canal preparation using cone beam computed tomography and optical surface scans–an observational study of pulp space obliteration and drill path depth in 50 patients. International Endodontic Journal. 2019;52(5):559-68.
Moreno‐Rabié C, Torres A, Lambrechts P, Jacobs R. Clinical applications, accuracy and limitations of guided endodontics: a systematic review. International endodontic journal. 2020;53(2).
Zubizarreta-Macho Á, Valle Castaño S, Montiel-Company JM, Mena-Álvarez J. Effect of computer-aided navigation techniques on the accuracy of endodontic access cavities: a systematic review and meta-analysis. Biology. 2021;10(3):212.
Zubizarreta-Macho Á, de Pedro Muñoz A, Riad Deglow E, Agustín-Panadero R, Mena Álvarez J. Accuracy of computer-aided dynamic navigation compared to computer-aided static procedure for endodontic access cavities: an in vitro study. Journal of clinical medicine. 2020;9(1):129.
Jain SD, Carrico CK, Bermanis I. 3-Dimensional accuracy of dynamic navigation technology in locating calcified canals. Journal of Endodontics. 2020;46(6):839-45.
Gambarini G, Galli M, Morese A, Stefanelli LV, Abduljabbar F, Giovarruscio M, et al. Precision of dynamic navigation to perform endodontic ultraconservative access cavities: a preliminary in vitro analysis. Journal of endodontics. 2020;46(9):1286-90.
Dianat O, Nosrat A, Tordik PA, Aldahmash SA, Romberg E, Price JB, et al. Accuracy and efficiency of a dynamic navigation system for locating calcified canals. Journal of endodontics. 2020;46(11):1719-25.
Jain SD, Saunders MW, Carrico CK, Jadhav A, Deeb JG, Myers GL. Dynamically navigated versus freehand access cavity preparation: a comparative study on substance loss using simulated calcified canals. Journal of endodontics. 2020;46(11):1745-51.
Connert T, Leontiev W, Dagassan-Berndt D, Kühl S, ElAyouti A, Krug R, et al. Real-time guided endodontics with a miniaturized dynamic navigation system versus conventional freehand endodontic access cavity preparation: substance loss and procedure time. Journal of Endodontics. 2021;47(10):1651-6.
Janabi A, Tordik PA, Griffin IL, Mostoufi B, Price JB, Chand P, et al. Accuracy and efficiency of 3-dimensional dynamic navigation system for removal of fiber post from root canal–treated teeth. Journal of endodontics. 2021;47(9):1453-60.
Referanslar
Andreasen FM, Zhjie Y, Thomsen BL, Andersen PK. Occurrence of pulp canal obliteration after luxation injuries in the permanent dentition. Dental Traumatology. 1987;3(3):103-15.
Nikoui M, Kenny DJ, Barrett EJ. Clinical outcomes for permanent incisor luxations in a pediatric population. III. Lateral luxations. Dental Traumatology. 2003;19(5):280-5.
Mass E, Zilberman U. Long-term radiologic pulp evaluation after partial pulpotomy in young permanent molars. Quintessence International. 2011;42(7).
Fleig S, Attin T, Jungbluth H. Narrowing of the radicular pulp space in coronally restored teeth. Clinical oral investigations. 2017;21(4):1251-7.
Delivanis HP, Sauer GJ. Incidence of canal calcification in the orthodontic patient. American Journal of Orthodontics. 1982;82(1):58-61.
Carvalho TS, Lussi A. Age‐related morphological, histological and functional changes in teeth. Journal of oral rehabilitation. 2017;44(4):291-8.
by: ESoEd, Krastl G, Weiger R, Filippi A, Van Waes H, Ebeleseder K, et al. European Society of Endodontology position statement: endodontic management of traumatized permanent teeth. International Endodontic Journal. 2021;54(9):1473-81.
Krastl G, Weiger R, Filippi A, Van Waes H, Ebeleseder K, Ree M, et al. Endodontic management of traumatized permanent teeth: a comprehensive review. International Endodontic Journal. 2021;54(8):1221-45.
Oginni AO, Adekoya‐Sofowora CA, Kolawole KA. Evaluation of radiographs, clinical signs and symptoms associated with pulp canal obliteration: an aid to treatment decision. Dental Traumatology. 2009;25(6):620-5.
Cvek M, Granath L, Lundberg M. Failures and healing in endodontically treated non-vital anterior teeth with posttraumatically reduced pulpal lumen. Acta Odontologica Scandinavica. 1982;40(4):223-8.
Kiefner P, Connert T, ElAyouti A, Weiger R. Treatment of calcified root canals in elderly people: a clinical study about the accessibility, the time needed and the outcome with a three‐year follow‐up. Gerodontology. 2017;34(2):164-70.
Krastl G, Zehnder MS, Connert T, Weiger R, Kühl S. Guided endodontics: a novel treatment approach for teeth with pulp canal calcification and apical pathology. Dental traumatology. 2016;32(3):240-6.
Zehnder M, Connert T, Weiger R, Krastl G, Kühl S. Guided endodontics: accuracy of a novel method for guided access cavity preparation and root canal location. International endodontic journal. 2016;49(10):966-72.
Buchgreitz J, Buchgreitz M, Mortensen D, Bjørndal L. Guided access cavity preparation using cone‐beam computed tomography and optical surface scans–an ex vivo study. International endodontic journal. 2016;49(8):790-5.
Van Der Meer WJ, Vissink A, Ng YL, Gulabivala K. 3D Computer aided treatment planning in endodontics. Journal of dentistry. 2016;45:67-72.
Wei X, Du Y, Zhou X, Yue L, Yu Q, Hou B, et al. Expert consensus on digital guided therapy for endodontic diseases. International Journal of Oral Science. 2023;15(1):54.
Bun San Chong B, Manpreet Dhesi B, Makdissi J, RCR D. Computer-aided dynamic navigation: a novel method for guided endodontics. Quintessence International. 2019;50(3):196-202.
Dianat O, Gupta S, Price JB, Mostoufi B. Guided endodontic access in a maxillary molar using a dynamic navigation system. Journal of endodontics. 2021;47(4):658-62.
Chen C, Zhang R, Zhang W, Wang F, Wang Z, Qin L, et al. Analysis of the accuracy of a dynamic navigation system in endodontic microsurgery: a prospective case series study. Journal of Dentistry. 2023;134:104534.
Haarmann B, Leontiev W, Magni E, Kühl S, Dagassan-Berndt D, Weiger R, et al. Accuracy of guided endodontics in posterior teeth. Applied Sciences. 2023;13(4):2321.
Jung RE, Schneider D, Ganeles J, Wismeijer D, Zwahlen M, Hammerle C, et al. Computer technology applications in surgical implant dentistry: a systematic review. Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. 2009.
Kühl S, Payer M, Zitzmann NU, Lambrecht JT, Filippi A. Technical Accuracy of Printed Surgical Templates for Guided Implant Surgery with the co D iagnosti X TM Software. Clinical implant dentistry and related research. 2015;17:e177-e82.
Krug R, Reich S, Connert T, Kess S, Soliman S, Reymus M, et al. Guided endodontics: a comparative in vitro study on the accuracy and effort of two different planning workflows. Int J Comput Dent. 2020;23(2):119-28.
Marquardt P, Witkowski S, Strub J. Three-dimensional navigation in implant dentistry. European Journal of Esthetic Dentistry. 2007;2(1).
Block MS, Emery RW, Lank K, Ryan J. Implant Placement Accuracy Using Dynamic Navigation. International Journal of Oral & Maxillofacial Implants. 2017;32(1).
Connert T, Weiger R, Krastl G. Present status and future directions–Guided endodontics. International endodontic journal. 2022;55:995-1002.
LARA-MENDES STdO, Barbosa CdF, Machado VC, Santa-Rosa C. Guided endodontics as an alternative for the treatment of severely calcified root canals. Dental Press Endodontics. 2019;9(1):15-20.
Connert T, Walter E, Benz L, Schwendicke F, Leontiev W. Guided Endodontics—Potential and Limitations. Australian Dental Journal. 2025.
Connert T, Zehnder M, Amato M, Weiger R, Kühl S, Krastl G. Microguided Endodontics: a method to achieve minimally invasive access cavity preparation and root canal location in mandibular incisors using a novel computer‐guided technique. International endodontic journal. 2018;51(2):247-55.
Connert T, Zehnder MS, Weiger R, Kühl S, Krastl G. Microguided endodontics: accuracy of a miniaturized technique for apically extended access cavity preparation in anterior teeth. Journal of endodontics. 2017;43(5):787-90.
Connert T, Krug R, Eggmann F, Emsermann I, ElAyouti A, Weiger R, et al. Guided endodontics versus conventional access cavity preparation: a comparative study on substance loss using 3-dimensional–printed teeth. Journal of endodontics. 2019;45(3):327-31.
Zhang T, Chen D, Miao L-Y, Xie S-J, Tang X-N. Guided endodontic access of calcified root canal by laser melting templates. Hua xi kou Qiang yi xue za zhi= Huaxi Kouqiang Yixue Zazhi= West China Journal of Stomatology. 2020;38(5):525-31.
Torres A, Lerut K, Lambrechts P, Jacobs R. Guided endodontics: use of a sleeveless guide system on an upper premolar with pulp canal obliteration and apical periodontitis. Journal of Endodontics. 2021;47(1):133-9.
Buchgreitz J, Buchgreitz M, Bjørndal L. Guided root canal preparation using cone beam computed tomography and optical surface scans–an observational study of pulp space obliteration and drill path depth in 50 patients. International Endodontic Journal. 2019;52(5):559-68.
Moreno‐Rabié C, Torres A, Lambrechts P, Jacobs R. Clinical applications, accuracy and limitations of guided endodontics: a systematic review. International endodontic journal. 2020;53(2).
Zubizarreta-Macho Á, Valle Castaño S, Montiel-Company JM, Mena-Álvarez J. Effect of computer-aided navigation techniques on the accuracy of endodontic access cavities: a systematic review and meta-analysis. Biology. 2021;10(3):212.
Zubizarreta-Macho Á, de Pedro Muñoz A, Riad Deglow E, Agustín-Panadero R, Mena Álvarez J. Accuracy of computer-aided dynamic navigation compared to computer-aided static procedure for endodontic access cavities: an in vitro study. Journal of clinical medicine. 2020;9(1):129.
Jain SD, Carrico CK, Bermanis I. 3-Dimensional accuracy of dynamic navigation technology in locating calcified canals. Journal of Endodontics. 2020;46(6):839-45.
Gambarini G, Galli M, Morese A, Stefanelli LV, Abduljabbar F, Giovarruscio M, et al. Precision of dynamic navigation to perform endodontic ultraconservative access cavities: a preliminary in vitro analysis. Journal of endodontics. 2020;46(9):1286-90.
Dianat O, Nosrat A, Tordik PA, Aldahmash SA, Romberg E, Price JB, et al. Accuracy and efficiency of a dynamic navigation system for locating calcified canals. Journal of endodontics. 2020;46(11):1719-25.
Jain SD, Saunders MW, Carrico CK, Jadhav A, Deeb JG, Myers GL. Dynamically navigated versus freehand access cavity preparation: a comparative study on substance loss using simulated calcified canals. Journal of endodontics. 2020;46(11):1745-51.
Connert T, Leontiev W, Dagassan-Berndt D, Kühl S, ElAyouti A, Krug R, et al. Real-time guided endodontics with a miniaturized dynamic navigation system versus conventional freehand endodontic access cavity preparation: substance loss and procedure time. Journal of Endodontics. 2021;47(10):1651-6.
Janabi A, Tordik PA, Griffin IL, Mostoufi B, Price JB, Chand P, et al. Accuracy and efficiency of 3-dimensional dynamic navigation system for removal of fiber post from root canal–treated teeth. Journal of endodontics. 2021;47(9):1453-60.
