Guidodontics: A global positioning system (GPS) to surgical Endodontics - A case series

Endodontic treatment is associated with the risk of instrument separation due to multiple factors that create complications not only in further completion of the procedure but also on the final outcome and long-term prognosis of the treatment at times. Separated instrument retrieval is definitely challenging and technique sensitive, requiring a lot of clinical expertise for a successful therapy. All these hurdles make such cases a nightmare to the clinician. This case report presents two clinical cases in which cone-beam computed tomography (CBCT)-guided surgery was used for retrieval of separated instruments extending beyond the confines of root canals in a mandibular molar and maxillary premolar. This novel approach utilizes a customized 3D printed surgical guide fabricated with the help of CBCT, which is stabilized intraorally, helping in predefining the osteotomy site, angulation and depth required for retrieval of separated instruments without performing apicoectomy or root end filling. CBCT also plays an important role in these cases as the actual size, location, and depth of the separated instrument can be appreciated preoperatively. In the present cases, 3D surgical guides helped clinicians to selectively retrieve the separated instruments more conservatively and predictably. Furthermore, complete healing was seen within 3 months in both cases.