Computer-assisted Dynamic Navigation for Localizing Severely Calcified Root Canals: An Analysis of Deviations, Task-focused Performance, and Operator Perception
Pulp canal obliteration (PCO) presents a significant challenge to the endodontist. This study aimed to evaluate deviations, task-focused performance, and operator perceptions during canal orifice localization using computer-assisted dynamic navigation (C-ADN) in tooth replicas with severe PCO, comparing experienced and less experienced operators.
Methods
A total of 120 tooth replicas were assigned to two operators with differing experience levels. To assess variations between planned and actual access preparations, preoperative and postoperative cone-beam computed tomography scans were superimposed using C-ADN software. Operator's task-focused performance and subjective elements resultant from operator's perspective linked to C-ADN were also evaluated. Statistical assessments were conducted using parametric methods, chi-square tests, or Fisher exact tests.
Results
Correlation analysis indicated a positive relationship among PCO depth and drilling time (r = 0.336, P < .001). Although precision measurements, including linear/angular deviations, were statistically similar among the operators (P > .05), the less experienced operator demonstrated significantly greater visuomotor coordination and drilling times, as well as higher proportions of mishaps, leading to a significantly lower task-focused performance (all P < .05). Over successive attempts, both operators showed progressive improvement in visuomotor skills and reported enhanced situational awareness, procedural quality, and safety features of C-ADN. The less experienced operator expressed concerns about workload and usability.
Conclusions
C-ADN systems are promising tools for locating calcified root canals, offering reliable guidance regardless of operators' experience. However, efficiency and mishap rates depend on experience, as mastering the visuomotor skills requires an adequate learning curve. Positive operators’ perception and usability support its integration into endodontics, provided skill development is emphasized to enhance proficiency.
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Section snippets
Study Design and Sample Preparation
This research study was carried out in the Graduate Endodontics Program of the Faculty of Dentistry of the University of Antioquia (Medellín, Colombia) using printed tooth replicas affixed on simulation models (Odontología Didáctica LTDA, Bogotá, Colombia) and coupled in anthropomorphic phantoms without random assignment. Considering a minimum prevalence of PCO following dentoalveolar trauma of 4%2, sample size calculation using an online calculator (//www.calculator.net/sample-size-calculator.html
Outcomes of the Assessment of Quantitative and Qualitative Parameters Related With C-ADN for Canal Location
The results of the bivariate comparisons of the anatomical characteristics assessed in the preoperative CBCT scans according to the experience level of the operators are shown in Table 2. From this table is evident that the results of the canal orifice width at the entry point, axial centering of the canal opening, PCO depth, as well as mesio-distal and bucco-palatal root angulations of the tooth replicas were statistically similar (P > .05, χ2 and unpaired t-test) between for experienced and
Discussion
It has been recognized that the loss of structural integrity associated with access cavity preparation and dentin removal constitute major causes of fracture after root canal treatment26, so that conservative access cavity preparation and root canal location represent a technical challenge in teeth showing PCO. Since its introduction in endodontics, C-ADN has been consolidating as the most accurate technique for locating and negotiating calcified canals27. Nonetheless, yet there continues to be
Declaration of Generative AI and AI-assisted Technologies
During the preparation of this article, the authors used Copilot and Gemini only in the stages of grammar review, typos, and vocabulary to improve language, textual coherence, and readability. Thereafter, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.
CRediT authorship contribution statement
Felipe A. Restrepo-Restrepo: Conceptualization, Resources, Methodology, Investigation, Data curation, Writing – review & editing. Diana P. Cardona-Alzate: Conceptualization, Methodology, Investigation, Data curation, Writing – review & editing. Brayan J. Muriel-Urrego: Conceptualization, Methodology, Investigation, Data curation, Writing – review & editing. Paula A. Villa-Machado: Conceptualization, Resources, Methodology, Validation, Investigation, Validation. Sergio I. Tobón-Arroyave:
Acknowledgment
The study was supported by the Technical Research Council of the Faculty of Dentistry of University of Antioquia (CODI-Code 2023-61270).
The authors deny any conflicts of interest related to this study.