Dynamic navigation for endodontic access in calcified maxillary molars

Bradley, Hannah (2025) Dynamic navigation for endodontic access in calcified maxillary molars. MSc(R) thesis, University of Glasgow.

Abstract

Rationale.

Endodontic access on teeth with calcified canals is challenging, time consuming and requires significant expertise. Dynamic navigation (DN) is a recent advancement within endodontics that provides real-time guidance during endodontic access. Dynamic navigation may improve the accuracy of canal location in teeth with calcified canals compared to freehand (FH) access.

Aim 1.
To carry out a systematic review of existing literature to assess the accuracy of canal location using DN in teeth with pulp canal obliteration when compared to FH and static navigation (SN) and to inform the design of an in vitro study.

Methods 1.
The systematic review eligibility criteria included 3D-printed or human teeth with pulp canal obliteration (PCO), endodontic access performed using DN and comparison to FH and/or SN. Embase, MEDLINE and CENTRAL and clinical trial registries were last searched on 31 March 2023. Additional searches included leading endodontic journals, conference proceedings and contact with manufacturers. The risk of bias was assessed using a modified Joanna Briggs Institute (JBI) checklist. Study characteristics and outcomes were tabulated and outcomes were explored as a narrative synthesis.

Results 1.
Systematic review identified three eligible articles for inclusion with a total of 172 teeth. All studies were of in vitro design on human and 3D-printed anterior and premolar teeth with varying levels of PCO. No studies included teeth with multiple canals or roots. The overall risk of bias was low in two studies and moderate in one study. Meta-analysis was not performed due to heterogeneity and the results presented as a narrative synthesis. Dynamic navigation improved accuracy of canal location in teeth with PCO in all three studies when compared
to FH access. No studies compared DN to SN.

Aim 2.
To perform an in vitro study to compare the tooth volume loss following DN and FH endodontic access in anatomically accurate 3D-printed maxillary molars with simulated calcified canals, performed by two operators with differing levels of experience.

Methods 2.
The in vitro study utilised a custom 3D-printed, anatomically accurate maxillary molar with four simulated calcified canals. A total of 40 identical teeth were accessed, 20 using the Navident Dynamic Navigation System (ClaroNav, Toronto, Canada) and 20 FH, by two operators with different levels of endodontic experience. The primary outcome measure was total tooth volume loss, while secondary outcome measures included the incidence of successful canal location, incidence of perforation and procedural time. Volume loss was assessed using pre- and post-operative cone-beam computer tomography, automatic segmentation and volume analysis software.

Results 2.
There was no significant difference in tooth volume loss between DN and FH endodontic access in 3D-printed maxillary molars with simulated calcified canals (53.824 vs. 48.144mm3, p=0.085). However, DN significantly reduced the median procedural time (6 minutes 52 seconds vs. 21 minutes 56 seconds, p<0.05)

Conclusions.
The systematic review suggested that DN may increase the accuracy of canal location in teeth with PCO when compared to FH access. However, the findings should be interpreted with caution due to the small number of included studies, all of which were of in vitro design.

The in vitro study was the first to compare endodontic access of multiple canals using DN and FH methods. It demonstrated that while DN does not significantly impact tooth volume loss in 3D-printed maxillary molars with simulated canal calcification, it significantly reduces procedural time and enhances consistency.

Further research should involve a range of multi-rooted teeth to validate the findings of the current in vitro study, as well as clinical studies to evaluate the clinical application of DN and address the inherent limitations of in vitro and ex vivo study designs.

• Item Type: Thesis (MSc(R))
• Qualification Level: Masters
• Subjects: R Medicine > RK Dentistry
• Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Dental School
• Supervisor's Name: Robertson, Mr. Douglas and McLean, Professor William
• Date of Award: 2025
• Depositing User: Theses Team
• Unique ID: glathesis:2025-85484
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 01 Oct 2025 16:07
• Last Modified: 01 Oct 2025 16:09
• Thesis DOI: 10.5525/gla.thesis.85484
• URI: https://theses.gla.ac.uk/id/eprint/85484