Real-time guided endodontics versus conventional freehand access cavity preparation by a specialist– an ex vivo comparative study

Abstract

Objectives: This study compared conventional access cavity preparation (CONV) and real-time guided endodontics (RTGE) in teeth with pulp canal calcification (PCC) regarding the rate of detected root canals, substance loss and procedural time. Materials and methods: A total of 72 extracted, sound human teeth (48 incisors, 24 canines) with PCC were matched in pairs, divided into two groups of 36 teeth each. An endodontic specialist performed CONV, while a general dentist not specialized in endodontics utilized RTGE on six models each, under simulated clinical conditions. The operators recorded the time to access the calcified root canals. Pre- and postoperative cone-beam computed tomography (CBCT) scans were obtained to measure substance loss. Statistical significance was tested by examining the overlap of 95% confidence intervals (CIs) and Fisher’s exact test. Results: RTGE had a marginally higher success rate (34/36) in detecting root canals compared to CONV (32/36) (p =.67). While RTGE resulted in less substance loss (CI: 9–14.3 mm3 vs. 15–24.2 mm3), it required more procedural time than CONV (CI: 11.6–17.8 min vs. 1.4–2.5 min). Conclusions: Both CONV by a specialist and RTGE by a general dentist achieved a high detection rate of root canals, with RTGE resulting in superior tooth substance preservation but at the expense of longer operation times. Clinical relevance: RTGE can be considered as an alternative technique for non-specialists when treating teeth with PCC, emphasizing procedural safety and effective canal detection.