Guided Endodontics for a Tooth with Root Fracture: A Case Report

Background: A 19-year-old female patient reported to the Department of Conservative Dentistry, Medical University of Gdańsk, with pain in the left lateral incisor. During the attempt to perform root canal treatment on tooth 22, we encountered difficulties in locating the canal opening, which resulted in treatment failure. Radiographic examinations revealed Pulp Canal Obliteration and a root fracture with a double fracture line, resulting in two root fragments. The prognosis for this tooth was poor, with extraction being the most likely outcome. Methods: To provide effective therapy, a 3D-printed endodontic guide was utilized, allowing for more precise localization of the canal in a tooth with a calcified root canal and complex fracture morphology. An intraoral scan and cone-beam computed tomography (CBCT) were performed, followed by the design of the guide. This facilitated accurate planning of the entry path for endodontic instruments, promoting minimally invasive treatment and reducing the loss of tooth structure. Results: Through navigated endodontics, the treatment became more predictable, and the risk of iatrogenic complications was minimized, significantly improving the prognosis of the therapy. Clinical and radiological examinations conducted after 12 months demonstrated successful treatment and preservation of the tooth in the oral cavity. Conclusions: The obtained results suggest that the use of guided endodontics can improve outcomes in cases with pulp canal obliteration and complex fractures, offering a minimally invasive and predictable approach.