Computer aided-dynamic navigation technology for efficient single visit endodontic treatment of pulp canal obliteration: A case report
Article Sidebar
Main Article Content
Abstract
Dental trauma causes a variety of issues and perplexes practitioners. One of the consequences of trauma is pulp canal obliteration (PCO), which presents a challenge in treatment due to the high likelihood of procedural errors and complications. To overcome these challenges, Guided endodontics was introduced using personalised 3D guides by overlaying DICOM and STL files (Static navigation) or real-time navigation (Dynamic navigation) of the patient. A dynamic navigation system (DNS) is a computer‑aided navigation technology analogous to the Global Positioning System (GPS) navigation. Dynamic navigation provides real-time, precise guidance using 3D imaging, helping practitioners accurately navigate and treat calcified canals by visualising and accessing challenging areas without damaging tooth structure. The current case report describes the management of pulp canal obliteration using the dynamic navigation system in a single visit. A 30-year-old female complained of pain in the upper front teeth region for the past two months, with a history of trauma 10 years ago. The clinical examination revealed no caries, cracks, or discolouration. Tooth 12 was sensitive to percussion. Pulp sensibility tests were negative. On radiographic examination, the pulp canal was partially obliterated until the middle third. Tooth 12 was diagnosed as necrotic pulp with symptomatic apical periodontitis. After reviewing options, the case was root canal treated using a dynamic navigation system. A successful negotiation of the canal was done followed by completion of root canal treatment. The patient was asymptomatic with intact periapical structures at the 1-year follow-up period. Computer-aided dynamic navigation proved to be safe, fast, and predictable for negotiating calcified canals with minimal risk of errors in a single visit.
Article Details
Section
This work is licensed under a Creative Commons Attribution 4.0 International License.
This work is licensed under a Creative Commons Attribution 4.0 International License.
How to Cite
References
1. Jain SD, Carrico CK, Bermanis I. 3-Dimensional accuracy of dynamic navigation technology in locating calcified canals. J Endod. 2020;46(6):839-45. https://doi.org/10.1016/j.joen.2020.03.014
2. McCabe PS, Dummer PM. Pulp canal obliteration: an endodontic diagnosis and treatment challenge. Int Endod J. 2012;45(2):177-97. https://doi.org/10.1111/j.1365-2591.2011.01963.x
3. Krastl G, Weiger R, Filippi A, Van Waes H, Ebeleseder K, Ree M, Connert T, Widbiller M, Tjäderhane L, Dummer PMH, Galler K. Endodontic management of traumatized permanent teeth: a comprehensive review. Int Endod J. 2021;54(8):1221-45. https://doi.org/10.1111/iej.13508
4. Yu CY, Abbott PV. Responses of the pulp, periradicular and soft tissues following trauma to the permanent teeth. Aust Dent J. 2016;61 Suppl 1:39-58. https://doi.org/10.1111/adj.12397
5. Doranala S, Vemisetty H, Punna R, Alwala AM. Endodontic Management of Canal Calcification in Maxillary Central Incisor Using 3D Prototyping Technique: A Case Report. J Adv Oral Res. 2020;11(1):93-96. https://doi.org/10.1177/2320206820901651
6. Yang X, Zhang Y, Chen X, Huang L, Qiu X. Limitations and management of dynamic navigation system for locating calcified canals failure. J Endod. 2023 Oct 25: S0099-2399(23)00655-6. https://doi.org/10.1016/j.joen.2023.10.010
7. Lang H, Korkmaz Y, Schneider K, Raab WM. Impact of endodontic treatments on the rigidity of the root. J Dent Res. 2006 Apr;85(4):364-8. https://doi.org/10.1177/154405910608500416
8. Vasudevan A, Santosh SS, Selvakumar RJ, Sampath DT, Natanasabapathy V. Dynamic Navigation in Guided Endodontics - A Systematic Review. Eur Endod J. 2022;7(2):81-91. https://doi.org/10.14744/eej.2022.96168
9. Chong BS, Dhesi M, Makdissi J. Computer-aided dynamic navigation: a novel method for guided endodontics. Quintessence Int. 2019;50(3):196-202.
10. Hildebrand H, Krug R, Leontiev W, et al. Real-time guided endodontics versus conventional freehand access cavity preparation by a specialist- an ex vivo comparative study. Clin Oral Investig. 2025;29(5):232. https://doi.org/10.1007/s00784-025-06310-8
11. Panithini DB, Sajjan GS, Kinariwala N, Medicharla UD, Varma KM, Kallepalli M. Real-time guided endodontics: A case report of maxillary central incisor with calcific metamorphosis. J Conserv Dent. 2023;26(1):113-117. https://doi.org/10.4103/jcd.jcd_506_22
12. Manishaa B, Sajjan GS, Kinariwala N, Varma KM, Ponnada N, Bagu SV. Endodontic dynamic navigation for precise apical microsurgery: Case report. Endodontology. 2024;36(2):181-7. https://doi.org/10.4103/endo.endo_133_23
13. Janabi A, Tordik PA, Griffin IL, et al. Accuracy and efficiency of 3-dimensional dynamic navigation system for removal of fiber post from root canal-treated teeth. J Endod. 2021;47(9):1453-60. https://doi.org/10.1016/j.joen.2021.07.002
14. Kulvitit S, Eamtanaporn T, Sinpitaksakul P, Promoppatum P, Khrueaduangkham S, Porntaveetus T. The effects of combined dynamic navigation system and dental operating microscope on the accuracy and efficiency of fiber post removal: an in vitro study. BMC Oral Health. 2025;25(1):482. https://doi.org/10.1186/s12903-025-05887-6.
15. Jain SD, Carrico CK, Bermanis I, Rehil S. Intraosseous anesthesia using dynamic navigation technology. J Endod. 2020;46(12):1894-900. https://doi.org/10.1016/j.joen.2020.09.001
16. Mekhdieva E, Del Fabbro M, Alovisi M, et al. Dynamic Navigation System vs. Free-Hand Approach in Microsurgical and Non-Surgical Endodontics: A Systematic Review and Meta-Analysis of Experimental Studies. J Clin Med. 2023;12(18):5845. https://doi.org/10.3390/jcm12185845
17. Nasiri K, Wrbas KT. Management of calcified root canal during root canal therapy. J Dent Sci. 2023;18(4):1931-1932. https://doi.org/10.1016/j.jds.2023.06.018
18. Hegde SG, Tawani G, Warhadpande M, Raut A, Dakshindas D, Wankhade S. Guided endodontic therapy: Management of pulp canal obliteration in the maxillary central incisor. J Conserv Dent. 2019;22(6):607-611. https://doi.org/10.4103/JCD.JCD_21_20
19. American Association of Endodontists AAE Endodontic Case Difficulty Assessment Form and Guidelines.
20. Connert T, Weiger R, Krastl G. Present status and future directions - Guided endodontics. Int Endod J. 2022;55 (Suppl 4):995-1002. https://doi.org/10.1111/iej.13687
21. Ribeiro D, Reis E, Marques JA, Falacho RI, Palma PJ. Guided Endodontics: Static vs. Dynamic Computer-Aided Techniques-A Literature Review. J Pers Med. 2022;12(9):1516. https://doi.org/10.3390/jpm12091516
22. Lakshmi Durga IS, Varma KM, Sajjan GS, Satish RK, Praveen G. Comparative evaluation of the effect of adhesive restorative composite resins on the reinforcement of peri-cervical dentin: An in vitro study. J Conserv Dent. 2022;25(2):151-155. https://doi.org/10.4103/jcd.jcd_487_21
23. Dianat O, Nosrat A, Tordik PA, Aldahmash SA, Romberg E, Price JB, Mostoufi B. Accuracy and Efficiency of a Dynamic Navigation System for Locating Calcified Canals. J Endod. 2020;46(11):1719-1725. https://doi.org/10.1016/j.joen.2020.07.014