Integration of an Ultrasonic Device into Dynamic Navigation System for a Fully Guided Dynamic Endodontic Microsurgery Workflow: An In Vitro Study.

[INTRODUCTION] This study investigates the feasibility of integrating an ultrasonic (US) device into a dynamic navigation system (DNS) for a fully guided dynamic endodontic microsurgery (EMS) workflow. It compares the accuracy and efficiency of fully guided dynamic US + DNS to US + freehand (FH) workflow.

[METHODS] Thirty-eight mandibular molars were divided into 2 groups: US + DNS (n = 19) and US + FH (n = 19). Cone-beam computed tomography scans were taken pre- and postoperatively. Bone window cut (BWC), root-end resection (RER), root-end cavity preparation (RECP), and root-end filling (REF) were planned in the X-guide. BWC, RER, RECP, and REF were all conducted under dynamic navigation. Three-dimensional deviations were measured for BWC. Resected root length and resection angle were calculated for the RER. Frequency long-axis deviation was recorded for RECP, and REF depth was measured. Total operating time was recorded.

[RESULTS] The fully guided US + DNS was more accurate than US + FH, showing lesser 3-dimensional deviations for BWC (P < .0001). The resected root length was ∼3 mm (P > .05). The RER angle was lower in US + DNS (P < .0001). RECP long-axis deviations were lesser in US + DNS (P < .05). The REF depth average was 3 mm for US + DNS and 2.78 mm for US + FH (P < .05). Both EMS workflows were time efficient for EMS, with US + FH taking less time (P < .05).

[CONCLUSIONS] Within the limitations of this study, it is feasible to integrate US into a DNS for a fully guided dynamic EMS workflow. Fully guided dynamic EMS workflow improved overall EMS accuracy.