Endodontic dynamic navigation for precise apical microsurgery: Case report

ABSTRACT Retrieval of separated file at the periapex with minimal intervention is highly demanding. Preserving the remaining healthy periapical bone of a tooth with large lesion to promote healing is the strategic treatment plan. Endodontic DNS (Navident, ClaroNav, Toronto, ON, Canada) was used for precise apical microsurgery in two such clinically complex cases. Scanty literature is available on the use of DNS in apical microsurgery of such similar conditions. Case 1 complained of separated instruments with moderate pain during mastication in root canal treated 14. Two-dimensional (2D) and three-dimensional imaging revealed two separated endodontic files: one in the apical third and another in the periapex of the buccal root. The absence of periapical lesion here demanded minimal ostectomy for surgical removal of separated instruments. Minimal osteotomy, resection of the root tip, and retrieval of the apical separated instrument were achieved with a single precise cut assisted with DNS. During the retro-cavity preparation, the second file was also retrieved atraumatically using ultrasonics. Case 2 complained of moderate pain and mobility in 12. Clinical examination revealed slight discoloration in 12. 2D and 3D imaging revealed a large periapical lesion. Apical microsurgery with endodontic dynamic navigation resulted in the precise, simultaneous location, and resection of the root tip along with the management of the apical pathology with minimal invasion. This was possible only because of DNS. Both cases demonstrated uneventful healing at 1-year review. Periapical radiographs revealed a healthy periapical region in case 1 and healing periapical region in case 2. Key learning points: Endodontic dynamic navigation system enables the clinician to precisely perform a minimally invasive osteotomy and root-end excision in one visit, by guiding the surgical tools in real time with the help of DICOM and STL files of the patient. Dynamic navigation is a technical advance targeting minimally invasive, precise endodontic surgeries with decreased operative mishaps.