Background: To compare the outcomes of conventional access cavity preparation (CONV) versus guided endodontics (GE) for access cavity preparation in anterior teeth with pulp canal calcification (PCC) regarding root canal detection, substance loss, procedural time, and need for additional radiographs. Methods: Extracted, sound human teeth with PCC (n = 108) were matched in pairs, divided into two groups and used to produce 18 models. An independent endodontist and a general dentist performed access cavity preparation under simulated clinical conditions on nine models each (54 teeth). The endodontist used the conventional technique and the general dentist GE. Time needed to access the root canals and the number of additional radiographs were recorded. Pre- and postoperative cone-beam computed tomography scans were obtained to measure substance loss. Statistical significance was tested by examining the overlap of 95% confidence intervals (CIs) between the groups. Results: All root canals were successfully accessed by both methods. There were no significant differences in substance loss (CI: CONV 15.9–29.6 mm³ vs. GE 17.6-27.5mm³) or procedural time (CI: CONV 163.3-248.5 s vs. GE 231.9-326.8 s). However, 31 additional radiographs were required for GE compared to none for CONV. Conclusions: For access cavity preparation in teeth with PCC, both CONV by a specialist and GE by a general dentist produce good results in terms of substance loss and time requirements.

Objectives: This study compared conventional access cavity preparation (CONV) and real-time guided endodontics (RTGE) in teeth with pulp canal calcification (PCC) regarding the rate of detected root canals, substance loss and procedural time. Materials and methods: A total of 72 extracted, sound human teeth (48 incisors, 24 canines) with PCC were matched in pairs, divided into two groups of 36 teeth each. An endodontic specialist performed CONV, while a general dentist not specialized in endodontics utilized RTGE on six models each, under simulated clinical conditions. The operators recorded the time to access the calcified root canals. Pre- and postoperative cone-beam computed tomography (CBCT) scans were obtained to measure substance loss. Statistical significance was tested by examining the overlap of 95% confidence intervals (CIs) and Fisher’s exact test. Results: RTGE had a marginally higher success rate (34/36) in detecting root canals compared to CONV (32/36) (p =.67). While RTGE resulted in less substance loss (CI: 9–14.3 mm³ vs. 15–24.2 mm³), it required more procedural time than CONV (CI: 11.6–17.8 min vs. 1.4–2.5 min). Conclusions: Both CONV by a specialist and RTGE by a general dentist achieved a high detection rate of root canals, with RTGE resulting in superior tooth substance preservation but at the expense of longer operation times. Clinical relevance: RTGE can be considered as an alternative technique for non-specialists when treating teeth with PCC, emphasizing procedural safety and effective canal detection.

This study aimed to evaluate the use of a dynamic navigation system for endodontic access cavity preparation (EACP) in posterior teeth. Partially calcified posterior teeth replicas were 3D printed to generate 24 maxillary and mandibular models. Preoperative cone-beam computed tomographic (CBCT) scans were performed for all models. After digital planning of access cavities for dynamic navigation, two operators (operator 1 with seven years of experience and limited to endodontics vs. operator 2 with three years of experience working as a general dentist) received twelve models with a total of 96 teeth each and performed EACP under simulated clinical conditions. Four weeks after performing EACP using a dynamic navigation system (DNS), EACP was performed using a conventional freehand approach (CONV). Postoperative CBCT scans were performed for all models, and substance loss determination was conducted by registering pre- and postoperative CBCT scans. The overall substance loss was significantly lower using the DNS compared to CONV in molars (29.6 mm³ vs. 82.6 mm³; p<0.001) and premolars (11.8 mm³ vs. 25.3 mm³; p<0.001). No significant differences in substance loss between operators 1 and 2 were observed when using a DNS. Operator 1 significantly reduced substance loss only in molars, but not in premolars, when using a DNS. Dynamic navigation for EACP is a reliable method in posterior teeth and results in tooth substance preservation. When used by a less experienced general dentist, dynamic navigation can raise the level of performance to that of an experienced endodontist.

Die Gestaltung der Zugangskavität ist der erste invasive Schritt jeder Wurzelkanalbehandlung. Ziel ist es, eine möglichst substanzschonende, aber gleichzeitig funktionell optimale Zugangskavität zu schaffen, die eine sichere und effiziente Durchführung einer Wurzelkanalbehandlung erlaubt. Teil 1 dieses Beitrags beleuchtet zunächst Grundlagen und Prinzipien der Zugangskavität. Article published online: 30 September 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bei jeder Wurzelkanalbehandlung ist es das Ziel, eine möglichst substanzschonende, aber gleichzeitig funktionell optimale Zugangskavität zu schaffen. Durch den Einsatz von Operationsmikroskopen und modernen, hochleistungsfähigen Instrumenten sind immer präzisere Zugangskavitäten möglich und eröffnen neue Perspektiven in der Herangehensweise. Teil 2 dieses Beitrags gibt praxisrelevante Empfehlungen für die Umsetzung am Patienten. Article published online: 30 September 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany