Accuracy and Efficiency of a Dynamic Navigation System for Locating Calcified Canals

Introduction: Calcified canals present a challenge during endodontic treatments. The purpose of this study was to compare the accuracy and efficiency of a dynamic navigation system (DNS) to the freehand (FH) method for locating calcified canals in human teeth. Methods: Sixty human single-rooted teeth with canal obliteration were selected and mounted in dry cadaver jaws. Based on cone-beam computed tomographic scans of the jaws, the drilling path and depth were virtually planned to use X-Guide software (X-Nav Technologies, LLC, Lansdale, PA). Access preparation was made with navigation in the DNS group and without guidance in the FH group by 2 operators with different levels of experience. Postoperative cone-beam computed tomographic scans were taken of all teeth. Linear and angular deviations and reduced dentin thickness at 2 levels were measured. The time for locating the canal, the number of mishaps, and the unsuccessful attempts were determined and analyzed. Results: The mean linear and angular deviations, reduced dentin thickness (at both levels), the time for access cavity preparation, and the number of mishaps in the DNS group were significantly less than the FH group (P<.05). The unsuccessful attempts were not different between the 2 groups (P>.05). The time for access preparation was significantly shorter for the board-certified endodontist in the FH group (P<.05). Conclusions: The DNS was more accurate and more efficient than the FH technique in locating calcified canals in human teeth. This novel DNS can help clinicians avoid catastrophic mishaps during access preparation in calcified teeth.