Preservation of dentin structure with guided versus conventional accesses in calcified canals: In vitro study

Introduction: Guided endodontic access has emerged as a highly precise approach, utilizing cone beam computed tomography (CBCT) imaging and three-dimensional (3D)-printed guides to navigate calcified canals while minimizing unnecessary dentin removal. This study aimed to compare the preservation of dentin structure and enough time for localization of root canals with conventional technique and a guided endodontics approach in calcified canals in vitro . Materials and Methods: This in vitro study used 16 digitally modified, 3D-printed teeth (eight maxillary and eight mandibular incisors) simulating calcified canals embedded in cadaver jaws. Two groups were formed: One for guided access and one for conventional access. Pre- and postoperative CBCT scans were used to measure dentin structure loss, and clinical time was recorded for each procedure. Statistical analysis was performed using independent t -tests, with significance set at P < 0.05. Results: Guided access resulted in significantly less dentin loss (6.4 mm 3 , standard deviation SD = 0.5) compared to conventional access (67.5 mm 3 , SD = 11.9, P < 0.001). The clinical time required was also significantly shorter for guided access (5.05 min, SD = 1.1) versus conventional access (22.76 min, SD = 7.6, P < 0.001). In addition, guided access is located in 50% of canals, whereas conventional access is located in only 25%. Conclusions: Guided access significantly reduced dentin loss, required less clinical time, and achieved higher canal localization rates compared to conventional access, supporting its use as a more conservative and efficient approach for managing calcified canals.