Accuracy and Tooth Structure Preservation of Static and Dynamic Guided Endodontics in Teeth with Pulp Canal Obliteration: A Systematic Review

Background/Objectives: Pulp canal obliteration (PCO) complicates endodontic access and increases the risk of procedural errors. This systematic review evaluated the accuracy and tooth-structure preservation of static-guided endodontics and dynamic navigation in teeth with PCO. Methods: This PRISMA 2020-compliant review was registered in PROSPERO (CRD420261403200) after review activities had begun. CENTRAL, Embase, MEDLINE, PubMed, and Scopus were searched from inception to 17 July 2026. Clinical and experimental studies of either technique in permanent human teeth with PCO or calcified canals were eligible; artificial or simulated tooth models were excluded. Risk of bias was assessed with design-specific tools (RoB 2, ROBINS-I, JBI, QUIN). Because designs, comparators, and outcome measures were not sufficiently comparable for pooling, findings were synthesized narratively. Results: Of 490 records identified, 56 studies were included. Guided approaches generally improved canal localization and trajectory accuracy and tended to reduce tooth-structure loss and procedural complications, particularly perforations, although structural preservation was not consistently superior. Procedure-time findings were heterogeneous. Conclusions: Static-guided endodontics and dynamic navigation improve the technical accuracy of access in teeth with PCO and may reduce measured tooth-structure removal and complications. Current evidence does not establish universal superiority over expert conventional access, and standardized long-term clinical trials are needed.