Decision Support for Removing Fractured Endodontic Instruments: A Patient-Specific Approach
The instrumental fracture is a common endodontic complication that is treated by surgical or non-surgical removal approaches. However, no tool exists to help the clinician to choose between available strategies, and decision-making is mostly based on clinical judgment. Digital solutions, such as Fin...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-03-01
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| Series: | Applied Sciences |
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| Online Access: | https://www.mdpi.com/2076-3417/11/6/2602 |
| _version_ | 1797541367600119808 |
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| author | Raphaël Richert Jean-Christophe Farges Cyril Villat Sébastien Valette Philippe Boisse Maxime Ducret |
| author_facet | Raphaël Richert Jean-Christophe Farges Cyril Villat Sébastien Valette Philippe Boisse Maxime Ducret |
| author_sort | Raphaël Richert |
| collection | DOAJ |
| description | The instrumental fracture is a common endodontic complication that is treated by surgical or non-surgical removal approaches. However, no tool exists to help the clinician to choose between available strategies, and decision-making is mostly based on clinical judgment. Digital solutions, such as Finite Element Analysis (FEA) and Virtual Treatment Planning (VTP), were recently proposed in maxillofacial surgery. The aim of the current study is to present a digital tool to help decide between non-surgical and surgical strategies in a clinical situation of a fractured instrument. Five models have been created: the initial state of the patient, two non-surgical removal strategies using a low or high root canal enlargement, and two surgical removal strategies using a 3- or 6-mm apicoectomy. Results of the VTP found a risk of perforation for the non-surgical strategies and sinus proximity for surgical ones. FEA showed the lowest mechanical risk for the apicoectomy strategy. A 3-mm apicoectomy approach was finally chosen and performed. In conclusion, this digital approach could offer a promising decision support for instrument removal by planning the treatment and predicting the mechanical impact of each strategy, but further investigations are required to confirm its relevance in endodontic practice. |
| first_indexed | 2024-03-10T13:15:00Z |
| format | Article |
| id | doaj.art-e8f898a348644cf8b8e48e136036a124 |
| institution | Directory Open Access Journal |
| issn | 2076-3417 |
| language | English |
| last_indexed | 2024-03-10T13:15:00Z |
| publishDate | 2021-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Applied Sciences |
| spelling | doaj.art-e8f898a348644cf8b8e48e136036a1242023-11-21T10:31:37ZengMDPI AGApplied Sciences2076-34172021-03-01116260210.3390/app11062602Decision Support for Removing Fractured Endodontic Instruments: A Patient-Specific ApproachRaphaël Richert0Jean-Christophe Farges1Cyril Villat2Sébastien Valette3Philippe Boisse4Maxime Ducret5Hospices Civils de Lyon, PAM Odontologie, 69007 Lyon, FranceHospices Civils de Lyon, PAM Odontologie, 69007 Lyon, FranceHospices Civils de Lyon, PAM Odontologie, 69007 Lyon, FranceHospices Civils de Lyon, PAM Odontologie, 69007 Lyon, FranceLaboratoire de Mécanique des Contacts et Structures, UMR 5259 CNRS/INSA/Univ Lyon, 69100 Villeurbanne, FranceHospices Civils de Lyon, PAM Odontologie, 69007 Lyon, FranceThe instrumental fracture is a common endodontic complication that is treated by surgical or non-surgical removal approaches. However, no tool exists to help the clinician to choose between available strategies, and decision-making is mostly based on clinical judgment. Digital solutions, such as Finite Element Analysis (FEA) and Virtual Treatment Planning (VTP), were recently proposed in maxillofacial surgery. The aim of the current study is to present a digital tool to help decide between non-surgical and surgical strategies in a clinical situation of a fractured instrument. Five models have been created: the initial state of the patient, two non-surgical removal strategies using a low or high root canal enlargement, and two surgical removal strategies using a 3- or 6-mm apicoectomy. Results of the VTP found a risk of perforation for the non-surgical strategies and sinus proximity for surgical ones. FEA showed the lowest mechanical risk for the apicoectomy strategy. A 3-mm apicoectomy approach was finally chosen and performed. In conclusion, this digital approach could offer a promising decision support for instrument removal by planning the treatment and predicting the mechanical impact of each strategy, but further investigations are required to confirm its relevance in endodontic practice.https://www.mdpi.com/2076-3417/11/6/2602finite element analysisvirtual treatment planningendodonticsapicoectomyInstrument removaldecision-making |
| spellingShingle | Raphaël Richert Jean-Christophe Farges Cyril Villat Sébastien Valette Philippe Boisse Maxime Ducret Decision Support for Removing Fractured Endodontic Instruments: A Patient-Specific Approach Applied Sciences finite element analysis virtual treatment planning endodontics apicoectomy Instrument removal decision-making |
| title | Decision Support for Removing Fractured Endodontic Instruments: A Patient-Specific Approach |
| title_full | Decision Support for Removing Fractured Endodontic Instruments: A Patient-Specific Approach |
| title_fullStr | Decision Support for Removing Fractured Endodontic Instruments: A Patient-Specific Approach |
| title_full_unstemmed | Decision Support for Removing Fractured Endodontic Instruments: A Patient-Specific Approach |
| title_short | Decision Support for Removing Fractured Endodontic Instruments: A Patient-Specific Approach |
| title_sort | decision support for removing fractured endodontic instruments a patient specific approach |
| topic | finite element analysis virtual treatment planning endodontics apicoectomy Instrument removal decision-making |
| url | https://www.mdpi.com/2076-3417/11/6/2602 |
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