Treatment of obliterated root canals using various guided endodontic techniques

Objective: This article reports on four endodontic treatments of obliterated teeth using a static guided endodontic (GE) technique. The aim is to demonstrate the benefits and limits of static guided endodontics. Cases: The four patients were referred for endodontic treatment of an obliterated tooth. The teeth did not respond to pulp vitality test. Periapical X-rays and cone-beam computed tomography (CBCT) revealed the presence of a periapical lesion and root canal obliteration. Patients' consent was obtained to perform GE orthograde treatment. The clinical cases were treated by GE using different static fixed guides depending on the case: a closed guide and a metal sleeve and a open guide with a system guiding the head of the contra-angle. Treatment planning and guide manufacture were achieved by means of software programs initially designed for implantology, but which can also be used by endodontists. Root canal patency was obtained in all patients. In each of the four cases, drilling was done using a small diameter (0.75 mm) cylindrical drill (FFDM Pneumat Tivoly; Bourges; France). Once canal patency was obtained using a manual file, classic endodontic treatment could be performed. Conclusions: Static GE assists endodontists in the management of complex cases by enabling centered drilling of the canal with minimum risk of deviating from the virtually planned path. The novel choice of a small-diameter drill (0.75 mm) helps maximize the preservation of the dental tissues.