Guided endodontic treatment of multiple teeth with dentin dysplasia: a case report
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CASE REPORT
Open Access
Guided endodontic treatment of multiple teeth with dentin dysplasia: a case report Ralf Krug1* , Julian Volland1, Sebastian Reich1, Sebastian Soliman1, Thomas Connert2 and Gabriel Krastl1
Abstract Background: To report the outcome of guided endodontic treatment (GET) of a case of dentin dysplasia with pulp canal calcification (PCC) and apical periodontitis based on the use of a 3D-printed template designed by merging cone-beam computed tomography (CBCT) and surface scan data. Case presentation: A 12-year old female with radicular dentin dysplasia type I (DD-1) presented for endodontic treatment. Radiography revealed PCC in all teeth and apical radiolucency in seven teeth (12, 15, 26, 31, 32, 36 and 46). Tooth 36 had the most acute symptoms and was thus treated first by conventional access cavity preparation and root canal detection. Despite meticulous technique, the distal and mesiolingual canals were perforated. The perforations were immediately repaired with mineral trioxide aggregate, and the decision was made to switch to guided endodontic treatment for the remaining 6 teeth. CBCT and intraoral surface scans were acquired and matched using coDiagnostix planning software (Dental Wings Inc.), the respective drill positions for root canal location were determined, and templates were virtually designed and 3D-printed. The template was positioned on the respective tooth, and a customized drill was used to penetrate the calcified part of the root canal and perform minimally invasive access cavity preparation up to the apical region. All root canals were rapidly and successfully located with the templates. At 1-year follow-up, clear signs of apical healing were present in all treated teeth. Conclusions: In patients with dentin dysplasia, conventional endodontic therapy is challenging. GET considerably facilitates the root canal treatment of teeth affected by dentin dysplasia. Keywords: Guided endodontics, Pulp canal calcification, Dentin dysplasia, Root canal treatment, Template
Background Endodontic treatment of calcified pulp systems is challenging. Pulp canal calcification (PCC) is reported to occur after various luxation injuries at rates of 15–40% [1, 2]. Chronic irritation (e.g. caries), cervical pulpotomy, or restorative therapies are known to promote the apposition of hard tissues within the root canal [3–5]. It may also occur after orthodontic treatment [6] or in elderly patients with a high rate of physiological apposition of dentin [7]. Specifically, dentin dysplasia (DD), a kind * Correspondence: [email protected] 1 Department of Conservative Dentistry and Periodontology and Center of Dental Traumatology, University Hospital of Würzburg, Würzburg, Pleicherwall 2, 97070 Würzburg, Germany Full list of author information is available at the end of the article
of dentin malformation, also causes accelerated dentinal apposition [8, 9]. DD, a rare disturbance of dentin formation (incidence: 1:100,000), is an autosomal dominant hereditary disease caused by a coding malfunction of the dent
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