Dynamic Navigation in Endodontics: Scope, Benefits, and Challenges - A Systematic Review.

[INTRODUCTION] Teeth exhibiting pulp canal calcification or obliteration, requiring retreatment and microsurgery, present significant challenges and necessitate clinical expertise to negate iatrogenic errors and ensure a successful outcome. Dynamic navigation system (DNS) is a recently emerged technology increasingly utilized in such complex endodontic treatments. The present review consolidates the available information about the application, advantages, disadvantages, and complications of DNS in endodontics.

[METHODS] An electronic search was performed on PubMed, Cochrane Library, Semantic Scholar, and Google Scholar databases till April 2024. Studies that performed endodontic procedures utilizing the DNS on humans were included. A risk of bias assessment was done using the Joanna Briggs Institute critical appraisal checklists. Data extraction included type of DNS, application including the teeth treated, advantages, disadvantages, and complications.

[RESULTS] Fourteen articles (12 case reports and 2 case series) were included in the review. DNS was used for endodontic surgery (78.3%, n = 7), negotiation of calcified canals (20.5%, n = 6), and endodontic retreatment (1.2%, n = 1). The Navigation systems used were Navident, DHC-ENDO1, and X-guide. The mean follow-up (n = 12) was 9.9 months (range: 1-24 months).

[CONCLUSIONS] DNS proves to be a reliable solution for complex endodontic scenarios such as endodontic microsurgery, negotiation of obliterated pulp canals, and endodontic retreatment However, the high initial investment and steep learning curve hinder widespread adoption. Future randomized controlled trials comparing different systems are warranted to further validate the effectiveness.