Background: The novel concept of guided endodontics has been reported as an effective method to obtain safe and reliable results in root canal treatment.Aim: To evaluate by means of a systematic review the clinical applications, accuracy and limitations of guided endodontic treatment.Data sources: A search of the literature was performed on PubMed, Embase, Web of Science and Cochrane Library databases, until 25 April 2019. No language or year restrictions were applied.Study eligibility criteria: Articles that answered the research question, including case reports, in vitro and ex vivo studies were included. Data extraction was performed independently by two reviewers.Study appraisal: Quality assessment was done using STROBE, CARE and Modified CONSORT guidelines for observational, case reports and pre‐clinical studies, respectively.Results: A total of 22 articles, including fifteen case reports, six pre‐clinical studies (in vitro and ex vivo studies) and one observational study, were included.Limitations and Conclusions: Even though the level of evidence is low, and the methodology described among studies heterogeneous, all articles describe guided access cavity preparation and guided surgery as being highly accurate and successful techniques when comparing the drilled path to the planned treatment. More studies with a larger number of patients are necessary to obtain significant conclusions.

Objective: To identify local radiographic risk factors for Medication‐Related Osteonecrosis of the Jaws (MRONJ) in osteoporotic patients treated with antiresorptive drugs (ARD) and undergoing tooth extraction.Material and Methods: Patients were included in this retrospective, longitudinal, case‐control study, if having at least one administration of ARD, underwent tooth extraction(s), and had pre‐ and post‐operative panoramic radiographs. Additionally, a matched control group was selected. Three calibrated, blinded, and independent observers assessed each tooth extraction site. Statistical analysis compared control against study group, and within the latter, sites MRONJ+ and MRONJ−.Results: In total, 120 patients (99 females/21 males) with 354 tooth extractions were included, from which nine patients (7.5%) and eleven tooth extraction sites (3.1%) developed MRONJ. When comparing control with study group, the latter showed significantly more thickened lamina dura, persistence of the alveolar socket, heterogeneous bone patterns, and sequestrum formation. In the study group, MRONJ developed significantly more in males (19%, p = 0.049), smokers (25%, p = 0.008), in the mandible (82%, p = 0.027), when identifying a radiolucent or sclerotic trabecular pattern (p = 0.004) or when extracting teeth with furcation involvement (p < 0.001), root remnants (p = 0.017), or unrestored caries lesions (p = 0.005).Conclusions: Tooth extraction sites showing radiographic signs of chronic dental infection are prone to MRONJ.