Background and Overview
Endodontics is a rewarding and challenging profession. The tasks of negotiating, cleaning,
and shaping canals can frustrate even the most talented clinicians, particularly if
the canals are blocked by calcifications. Circumventing these obstructions can be
a slow, tedious process, and at times it is not possible. Various techniques have
been developed to assist with this problem but have met with limited success. Given
that the success of endodontic treatment is dependent on the elimination or reduction
of bacterial influences on periapical tissues, this is a critical issue.
A new application of an existing technology is available. This technique uses 3-dimensional
(3D) radiography (cone-beam computed tomography) and 3D intraoral imaging. Through
the integration of the data sets, pathways are planned to locate blocked canals. Templates
can be designed and fabricated on 3D printers that fit intimately on the dentition.
Special drills are selected that fit through the sleeves embedded in the template.
These pathways align the drill and guide the depth of the access. Once the canals
are accessed, conventional root canal treatment is possible.
Conclusions and Practical Implications
This case report reviews a new technique for treating a necrotic calcified root canal.
The canal was identified in the apical one-third of the root. A pathway was planned
to negotiate the canal using digital technology. The blockage was bypassed, and the
root canal was successfully treated using a “template-guided access technique” with
minimal tooth loss.