A Fully In-House Digital Workflow for Static Guided Endodontic Access in Post-Traumatic Pulp Canal Obliteration

Pulp canal obliteration is a recognized sequela of traumatic dental injury and may represent a reparative pulpal response. Although pulp canal obliteration itself does not indicate endodontic treatment, pulp necrosis and apical periodontitis may subsequently develop, creating a technically challenging access problem in severely obliterated canals. Static guided endodontics provides a means of transferring a virtually planned access trajectory to the clinical setting. This article reviews the biological and clinical considerations of post-traumatic pulp canal obliteration and the development of static guided endodontics, and describes a fully in-house digital workflow integrating commercially available dental design applications with general-purpose three-dimensional mesh-editing software. The workflow is clinically illustrated in a 57-year-old woman with a maxillary right central incisor (Tooth 11) showing post-traumatic pulp canal obliteration, pulp necrosis, asymptomatic apical periodontitis, and crown discoloration approximately 50 years after the original injury. The geometry of the actual small-diameter endodontic bur was directly measured and reproduced virtually for patient-specific trajectory and guide design. Two sequential guides were fabricated in-house and used to access the residual canal, followed by root canal treatment and internal bleaching. This approach illustrates how established digital concepts can be integrated into a clinician-directed, fully in-house workflow for managing technically challenging endodontic access in post-traumatic pulp canal obliteration.