Modern Endodontic Access Cavity Preparation

Abstract

Aim: This narrative review aimed to assess the actual benefits of minimally invasive endodontic access cavities compared to traditional endodontic access cavities. Additionally, to assess the precision, clinical application and limitations of non- surgical computer-aided endodontic access cavities. Methodology: A literature search was performed via electronic database up to December 2020, added by Google Scholar search. Moreover, a hand search of the references was carried out, in addition to the Open Grey database. Only articles that answered the research aim were assessed, including clinical, ex vivo and in vitro studies. Results: A total of 69 studies were included in this narrative review. Pre-clinical studies on the utility of minimally invasive and computer-aided endodontic access cavities were critically analysed. The literature search revealed case reports, and one observational study related to non-surgical treatment using the computer-aided guided endodontic approach. The computer-aided dynamic navigation system was more recently utilised to perform orthograde endodontic treatment in one case report. Conclusion: Many pre-clinical studies have been reported on the minimally invasive access cavities, and there is an increased interest in such an approach. The literature had methodological heterogeneity and presented inconclusive results. There is a lack of clinical data to introduce these conservative cavities in everyday endodontic treatment. Overall, the studies regarding computer-aided endodontics had significant methodological draw backs and low-quality evidence, represented in experimental research and case reports. Long-term clinical studies with a large number of teeth need to be conducted to evaluate the outcome of endodontic treatment using the computer-aided endodontic technique. Smaller access cavity can hinder proper disinfection of the root canal system and may result in difficulties filling the root canal and placement of the coronal restoration. Traditional endodontic access remains the golden standard in root canal treatment. The development in endodontic armamentarium alongside magnification grant minimal hard tissue loss without compromising the treatment success.