Guided Endodontics: a novel treatment approach for teeth with pulp canal calcification and apical pathology

Abstract Aim To present a new treatment approach for teeth with pulp canal calcification ( PCC ) which require root canal treatment. Case A 15‐year‐old male patient presented with pain of his upper right central incisor. The tooth showed signs of apical periodontitis. Due to PCC , location of the root canal was judged to be difficult and associated with a high risk of perforation. A cone beam computed tomography ( CBCT ) and an intra‐oral surface scan were performed and matched using software for virtual implant planning. After planning the position of the drill for root canal location, a virtual template was designed, and the data were exported as an STL file and sent to a 3D printer for template fabrication. The template was positioned on the anterior maxillary teeth. A specific drill was used to penetrate through the obliterated part of the root canal and obtain minimally invasive access to the apical part. The root canal was accessible at 9 mm distance from the apex. Further root canal preparation was carried out using an endodontic rotary instrumentation system. After an interappointment dressing for 4 weeks, the root canal was filled with vertically condensed gutta‐percha using an epoxy sealer. The access cavity was restored with a composite material. After 15 months, the patient was clinically asymptomatic with no pain on percussion. The radiograph showed no apical pathology. Conclusions The presented guided endodontic approach seems to be a safe, clinically feasible method to locate root canals and prevent root perforation in teeth with PCC .