Guided endodontics. An alternative for high-complexity cases. A systematic narrative review
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Published:
Jun 25, 2025
Keywords:
Guided endodontics, Calcified canals, Static navigation, 3D guides.
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Abstract
Introduction: Guided endodontics has emerged as an innovative technique for managing extraordinarily complex endodontic cases, particularly in teeth with pulp canal obliteration. This approach combines cone-beam computed tomography (CBCT) imaging with intraoral scans and three-dimensional digital planning to create customized guides that enable more precise and conservative access to the pulp chamber. Objective: To critically analyze the scientific evidence regarding the effectiveness of guided endodontics compared to the conventional technique. Methodology: A qualitative study was conducted through a systematic narrative review based on a structured search in indexed databases (PubMed, Scopus, Web of Science, SciELO, and Google Scholar), selecting 28 studies published between 2015 and 2025. Findings were grouped into four thematic areas: diagnostic accuracy, reduction of operator risk, clinical applicability, and educational projection. Results: Most studies agreed that this technique improves canal localization, reduces iatrogenic errors, and shortens operative time, especially among inexperienced operators. However, limitations were identified, particularly regarding technological dependency and methodological heterogeneity among the studies. Conclusion: Guided endodontics represents an effective and safe alternative for complex cases, although its implementation requires a critical evaluation of its clinical, technical, and educational feasibility. General field of study: Health Specific field of study: Dentistry Type of study: Systematic narrative review.
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Pulla Sarmiento, G. M., Rodríguez Reyes , F. G., & Lugo Pinto, M. A. (2025). Guided endodontics. An alternative for high-complexity cases. A systematic narrative review. ConcienciaDigital, 8(2), 65-88. https://doi.org/10.33262/concienciadigital.v8i2.3420
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References
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Banka, A., Patri, G., Pradhan, P. K., & Lath, H. (2024). Comparative evaluation between guided endodontics and conventional techniques for calcific metamorphosis - A systematic review and meta-analysis. Journal of Conservative Dentistry and Endodontics, 27(9), 891–896. https://doi.org/10.4103/JCDE.JCDE_294_24
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Buchgreitz, J., Buchgreitz, M., Mortensen, D., & Bjørndal, L. (2016). Guided access cavity preparation using cone-beam computed tomography and optical surface scans - an ex vivo study. International Endodontic Journal, 49(8), 790–795. https://doi.org/10.1111/iej.12516
Buchgreitz, J., Buchgreitz, M., & Bjørndal, L. (2019). Guided endodontics modified for treating molars by using an intracoronal guide technique. Journal of Endodontics, 45(6), 818–823. https://doi.org/10.1016/j.joen.2019.03.010
Chaniotis, A., & Ordinola-Zapata, R. (2022). Present status and future directions: Management of curved and calcified root canals. International Endodontic Journal, 55(S3), 656–684. https://doi.org/10.1111/iej.13685
Connert, T., Krug, R., Eggmann, F., Emsermann, I., ElAyouti, A., Weiger, R., Kühl, S., & Krastl, G. (2019a). Guided endodontics versus conventional access cavity preparation: A comparative study on substance loss using 3-dimensional-printed teeth. Journal of Endodontics, 45(3), 327–331. https://doi.org/10.1016/j.joen.2018.11.006
Connert, T., Truckenmüller, M., ElAyouti, A., Eggmann, F., Krastl, G., Löst, C., & Weiger, R. (2019b). Changes in periapical status, quality of root fillings and estimated endodontic treatment need in a similar urban German population 20 years later. Clinical Oral Investigations, 23, 1373–1382. https://doi.org/10.1007/s00784-018-2566-z
Connert, T., Weiger, R., & Krastl, G. (2022). Present status and future directions - Guided endodontics. International Endodontic Journal, 55(S4), 995–1002. https://doi.org/10.1111/iej.13687
Dąbrowski, W., Puchalska, W., Ziemlewski, A., & Ordyniec-Kwaśnica, I. (2022). Guided endodontics as a personalized tool for complicated clinical cases. International Journal of Environmental Research and Public Health, 19(16), 9958. https://doi.org/10.3390/ijerph19169958
De Oliveira Neto, R. S., de Souza Lima, L. A., Gomez Titato, P. C., de Andrade, F. B., Vivan, R. R., Alcalde, M. P., & Hungaro Duarte, M. A. (2024). Effectiveness of a new endodontic irrigation system for removing smear layer and dissolving simulated organic matter. Clinical Oral Investigations, 28(10). https://doi.org/10.1007/s00784-023-05418-z
Farajollahi, M., Dianat, O., Gholami, S., & Saber Tahan, S. (2023). Application of an endodontic static guide in fiber post removal from a compromised tooth. Case Reports in Dentistry, 7982368. https://doi.org/10.1155/2023/7982368
Galyamin, K. A., & Gilyazeva, V. V. (2024). Modern aspects of endodontic technologies. "Medical & Pharmaceutical Journal “Pulse,” 26(6), 113–116. https://doi.org/10.26787/nydha-2686-6838-2024-26-6-113-116
Hernández-Vigueras, S., Rosas-Mendez, C., Aravena, P. C., Barría-Rojas, E., & Maldonado-Uribe, J. (2022). Endodoncia guiada estática, una opción para obliteración del canal pulpar. Serie de Casos. International Journal of Morphology, 40(6), 1504–1510. https://doi.org/10.4067/s0717-95022022000601504
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Jain, S. D., Carrico, C. K., & Bermanis, I. (2020). 3-dimensional accuracy of dynamic navigation technology in locating calcified canals. Journal of Endodontics, 46(6), 839–845. https://doi.org/10.1016/j.joen.2020.03.014
Kadrija, V., Hildebrand, H., Leontiev, W., Magni, E., Thieringer, F. M., Weiger, R., & Connert, T. (2025). Effectiveness of a 3D printed training kit for the preparation of access cavities in calcified teeth: A pilot study. European Endodontic Journal, 10(2), 134–141. https://doi.org/10.14744/eej.2024.42275
Kiefner, P., Connert, T., ElAyouti, A., & Weiger, R. (2017). Treatment of calcified root canals in elderly people: a clinical study about accessibility, the time needed and the outcome with a three-year follow-up. Gerodontology, 34(2), 164–170. https://doi.org/10.1111/ger.12238
Kinariwala, N., Buchgreitz, J., Bjørndal, L., Molnár, B., & Ludhwani, S. (2021). Endodontic Guides and Software Planning. En Guided Endodontics. Springer International Publishing. https://doi.org/10.1007/978-3-030-55281-7_4
Krastl, G., Zehnder, M. S., Connert, T., Weiger, R., & Kühl, S. (2016). Guided Endodontics: a novel treatment approach for teeth with pulp canal calcification and apical pathology. Dental Traumatology, 32(3), 240–246. https://doi.org/10.1111/edt.12235
Krug, R., Volland, J., Reich, S., Soliman, S., Connert, T., & Krastl, G. (2020). Guided endodontic treatment of multiple teeth with dentin dysplasia: a case report. Research Square. https://doi.org/10.21203/rs.3.rs-36158/v2
Kulinkovych-Levchuk, K., Pecci-Lloret, M. P., Castelo-Baz, P., Pecci-Lloret, M. R., & Oñate-Sánchez, R. E. (2022). Guided endodontics: A literature review. International Journal of Environmental Research and Public Health, 19(21), 13900. https://doi.org/10.3390/ijerph192113900
La Rosa, G. R. M., Peditto, M., Venticinque, A., Marcianò, A., Bianchi, A., & Pedullà, E. (2024). Advancements in guided surgical endodontics: A scoping review of case report and case series and research implications. Australian Endodontic Journal, 50(2), 397–408. https://doi.org/10.1111/aej.12865
Lara-Mendes, S. T. O., Barbosa, C. de F. M., Machado, V. C., & Santa-Rosa, C. C. (2018). A new approach for minimally invasive access to severely calcified anterior teeth using the guided endodontics technique. Journal of Endodontics, 44(10), 1578–1582. https://doi.org/10.1016/j.joen.2018.07.006
Loureiro, M. A. Z., Silva, J. A., Chaves, G. S., Capeletti, L. R., Estrela, C., & Decurcio, D. A. (2021). Guided endodontics: The impact of new technologies on complex case solutions. Australian Endodontic Journal, 47(3), 664–671. https://doi.org/10.1111/aej.12498
Moreno-Rabié, C., Torres, A., Lambrechts, P., & Jacobs, R. (2020). Clinical applications, accuracy, and limitations of guided endodontics: a systematic review. International Endodontic Journal, 53(2), 214–231. https://doi.org/10.1111/iej.13216
Nasiri, K., & Wrbas, K.-T. (2023). Management of calcified root canal during root canal therapy. Journal of Dental Sciences, 18(4), 1931–1932. https://doi.org/10.1016/j.jds.2023.06.018
Lugo-Pinto, M. A., Martínez-Peraza, V. M., & Cuesta-Durazno, A. P. C. (2024). Tratamiento de conducto como terapia preventiva a la osteonecrosis de los maxilares: reporte de caso clínico. Polo del Conocimiento, 9(8), 3366–3376. https://www.polodelconocimiento.com/ojs/index.php/es/article/view/7886/pdf
Ribeiro, D., Reis, E., Marques, J. A., Falacho, R. I., & Palma, P. J. (2022). Guided endodontics: Static vs. Dynamic computer-aided techniques-A literature review. Journal of Personalized Medicine, 12(9), 1516. https://doi.org/10.3390/jpm12091516
Ricucci, D., Loghin, S., Niu, L.-N., & Tay, F. R. (2018). Changes in the radicular pulp-dentine complex in healthy intact teeth and in response to deep caries or restorations: A histological and histobacteriological study. Journal of Dentistry, 73, 76–90. https://doi.org/10.1016/j.jdent.2018.04.007
Regina Rosselle, V., Wibawa Ongkowijoyo, C., & Setyabudi. (2024). Endodontic treatment of severely curved root canals – A case series. Dental Journal, 57(2), 145–151. https://doi.org/10.20473/j.djmkg.v57.i2.p145-151
Santiago, M. C., Altoe, M. M., de Azevedo Mohamed, C. P., Alves de Oliveira, L., & Salles, L. P. (2022). Guided endodontic treatment in a region of limited mouth opening: a case report of mandibular molar mesial root canals with dystrophic calcification. BMC Oral Health, 22(1), 37. https://doi.org/10.1186/s12903-022-02067-8
Sinha, D., Bali, D., Dhar, V., Arora, E., & Singh, S. (2018). Endodontic retreatment. Santosh University Journal of Health Sciences, 4(1), 17–21. https://doi.org/10.18231/2455-1732.2018.0005
Strbac, G. D., Schnappauf, A., Giannis, K., Moritz, A., & Ulm, C. (2017). Guided modern endodontic surgery: A novel approach for guided osteotomy and root resection. Journal of Endodontics, 43(3), 496–501. https://doi.org/10.1016/j.joen.2016.11.001
Van der Meer, W. J., Vissink, A., Ng, Y. L., & Gulabivala, K. (2016). 3D Computer aided treatment planning in endodontics. Journal of Dentistry, 45, 67–72. https://doi.org/10.1016/j.jdent.2015.11.007
Yan, H., De Deus, G., Kristoffersen, I. M., Wiig, E., Reseland, J. E., Johnsen, G. F., Silva, E. J. N. L., & Haugen, H. J. (2023). Regenerative endodontics by cell homing: A review of recent clinical trials. Journal of Endodontics, 49(1), 4–17. https://doi.org/10.1016/j.joen.2022.09.008
Zehnder, M. S., Connert, T., Weiger, R., Krastl, G., & Kühl, S. (2016). Guided endodontics: accuracy of a novel method for guided access cavity preparation and root canal location. International Endodontic Journal, 49(10), 966–972. https://doi.org/10.1111/iej.12544
Anderson, J., Wealleans, J., & Ray, J. (2018). Endodontic applications of 3D printing. International Endodontic Journal, 51(9), 1005–1018. https://doi.org/10.1111/iej.12917
Banka, A., Patri, G., Pradhan, P. K., & Lath, H. (2024). Comparative evaluation between guided endodontics and conventional techniques for calcific metamorphosis - A systematic review and meta-analysis. Journal of Conservative Dentistry and Endodontics, 27(9), 891–896. https://doi.org/10.4103/JCDE.JCDE_294_24
Braga Diniz, J. M., Diniz Oliveira, H. F., Pinto Coelho, R. C., Manzi, F., Silva, F. E., Carvalho Machado, V., Ribeiro Sobrinho, A. P., & Fonseca Tavares, W. L. (2022). Guided endodontic approach in teeth with pulp canal obliteration and previous iatrogenic deviation: A case series. Iranian Endodontic Journal, 17(2), 78–84. https://doi.org/10.22037/iej.v17i2.36830
Buchgreitz, J., Buchgreitz, M., Mortensen, D., & Bjørndal, L. (2016). Guided access cavity preparation using cone-beam computed tomography and optical surface scans - an ex vivo study. International Endodontic Journal, 49(8), 790–795. https://doi.org/10.1111/iej.12516
Buchgreitz, J., Buchgreitz, M., & Bjørndal, L. (2019). Guided endodontics modified for treating molars by using an intracoronal guide technique. Journal of Endodontics, 45(6), 818–823. https://doi.org/10.1016/j.joen.2019.03.010
Chaniotis, A., & Ordinola-Zapata, R. (2022). Present status and future directions: Management of curved and calcified root canals. International Endodontic Journal, 55(S3), 656–684. https://doi.org/10.1111/iej.13685
Connert, T., Krug, R., Eggmann, F., Emsermann, I., ElAyouti, A., Weiger, R., Kühl, S., & Krastl, G. (2019a). Guided endodontics versus conventional access cavity preparation: A comparative study on substance loss using 3-dimensional-printed teeth. Journal of Endodontics, 45(3), 327–331. https://doi.org/10.1016/j.joen.2018.11.006
Connert, T., Truckenmüller, M., ElAyouti, A., Eggmann, F., Krastl, G., Löst, C., & Weiger, R. (2019b). Changes in periapical status, quality of root fillings and estimated endodontic treatment need in a similar urban German population 20 years later. Clinical Oral Investigations, 23, 1373–1382. https://doi.org/10.1007/s00784-018-2566-z
Connert, T., Weiger, R., & Krastl, G. (2022). Present status and future directions - Guided endodontics. International Endodontic Journal, 55(S4), 995–1002. https://doi.org/10.1111/iej.13687
Dąbrowski, W., Puchalska, W., Ziemlewski, A., & Ordyniec-Kwaśnica, I. (2022). Guided endodontics as a personalized tool for complicated clinical cases. International Journal of Environmental Research and Public Health, 19(16), 9958. https://doi.org/10.3390/ijerph19169958
De Oliveira Neto, R. S., de Souza Lima, L. A., Gomez Titato, P. C., de Andrade, F. B., Vivan, R. R., Alcalde, M. P., & Hungaro Duarte, M. A. (2024). Effectiveness of a new endodontic irrigation system for removing smear layer and dissolving simulated organic matter. Clinical Oral Investigations, 28(10). https://doi.org/10.1007/s00784-023-05418-z
Farajollahi, M., Dianat, O., Gholami, S., & Saber Tahan, S. (2023). Application of an endodontic static guide in fiber post removal from a compromised tooth. Case Reports in Dentistry, 7982368. https://doi.org/10.1155/2023/7982368
Galyamin, K. A., & Gilyazeva, V. V. (2024). Modern aspects of endodontic technologies. "Medical & Pharmaceutical Journal “Pulse,” 26(6), 113–116. https://doi.org/10.26787/nydha-2686-6838-2024-26-6-113-116
Hernández-Vigueras, S., Rosas-Mendez, C., Aravena, P. C., Barría-Rojas, E., & Maldonado-Uribe, J. (2022). Endodoncia guiada estática, una opción para obliteración del canal pulpar. Serie de Casos. International Journal of Morphology, 40(6), 1504–1510. https://doi.org/10.4067/s0717-95022022000601504
Iqbal, A., Sharari, T. A., Khattak, O., Chaudhry, F. A., Bader, A. K., Saleem, M. M., Issrani, R., Almaktoom, I. T., Albalawi, R. F. H., & Alserhani, E. D. M. (2023). Guided endodontic surgery: A narrative review. Medicina, 59(4), 678. https://doi.org/10.3390/medicina59040678
Jain, S. D., Carrico, C. K., & Bermanis, I. (2020). 3-dimensional accuracy of dynamic navigation technology in locating calcified canals. Journal of Endodontics, 46(6), 839–845. https://doi.org/10.1016/j.joen.2020.03.014
Kadrija, V., Hildebrand, H., Leontiev, W., Magni, E., Thieringer, F. M., Weiger, R., & Connert, T. (2025). Effectiveness of a 3D printed training kit for the preparation of access cavities in calcified teeth: A pilot study. European Endodontic Journal, 10(2), 134–141. https://doi.org/10.14744/eej.2024.42275
Kiefner, P., Connert, T., ElAyouti, A., & Weiger, R. (2017). Treatment of calcified root canals in elderly people: a clinical study about accessibility, the time needed and the outcome with a three-year follow-up. Gerodontology, 34(2), 164–170. https://doi.org/10.1111/ger.12238
Kinariwala, N., Buchgreitz, J., Bjørndal, L., Molnár, B., & Ludhwani, S. (2021). Endodontic Guides and Software Planning. En Guided Endodontics. Springer International Publishing. https://doi.org/10.1007/978-3-030-55281-7_4
Krastl, G., Zehnder, M. S., Connert, T., Weiger, R., & Kühl, S. (2016). Guided Endodontics: a novel treatment approach for teeth with pulp canal calcification and apical pathology. Dental Traumatology, 32(3), 240–246. https://doi.org/10.1111/edt.12235
Krug, R., Volland, J., Reich, S., Soliman, S., Connert, T., & Krastl, G. (2020). Guided endodontic treatment of multiple teeth with dentin dysplasia: a case report. Research Square. https://doi.org/10.21203/rs.3.rs-36158/v2
Kulinkovych-Levchuk, K., Pecci-Lloret, M. P., Castelo-Baz, P., Pecci-Lloret, M. R., & Oñate-Sánchez, R. E. (2022). Guided endodontics: A literature review. International Journal of Environmental Research and Public Health, 19(21), 13900. https://doi.org/10.3390/ijerph192113900
La Rosa, G. R. M., Peditto, M., Venticinque, A., Marcianò, A., Bianchi, A., & Pedullà, E. (2024). Advancements in guided surgical endodontics: A scoping review of case report and case series and research implications. Australian Endodontic Journal, 50(2), 397–408. https://doi.org/10.1111/aej.12865
Lara-Mendes, S. T. O., Barbosa, C. de F. M., Machado, V. C., & Santa-Rosa, C. C. (2018). A new approach for minimally invasive access to severely calcified anterior teeth using the guided endodontics technique. Journal of Endodontics, 44(10), 1578–1582. https://doi.org/10.1016/j.joen.2018.07.006
Loureiro, M. A. Z., Silva, J. A., Chaves, G. S., Capeletti, L. R., Estrela, C., & Decurcio, D. A. (2021). Guided endodontics: The impact of new technologies on complex case solutions. Australian Endodontic Journal, 47(3), 664–671. https://doi.org/10.1111/aej.12498
Moreno-Rabié, C., Torres, A., Lambrechts, P., & Jacobs, R. (2020). Clinical applications, accuracy, and limitations of guided endodontics: a systematic review. International Endodontic Journal, 53(2), 214–231. https://doi.org/10.1111/iej.13216
Nasiri, K., & Wrbas, K.-T. (2023). Management of calcified root canal during root canal therapy. Journal of Dental Sciences, 18(4), 1931–1932. https://doi.org/10.1016/j.jds.2023.06.018
Lugo-Pinto, M. A., Martínez-Peraza, V. M., & Cuesta-Durazno, A. P. C. (2024). Tratamiento de conducto como terapia preventiva a la osteonecrosis de los maxilares: reporte de caso clínico. Polo del Conocimiento, 9(8), 3366–3376. https://www.polodelconocimiento.com/ojs/index.php/es/article/view/7886/pdf
Ribeiro, D., Reis, E., Marques, J. A., Falacho, R. I., & Palma, P. J. (2022). Guided endodontics: Static vs. Dynamic computer-aided techniques-A literature review. Journal of Personalized Medicine, 12(9), 1516. https://doi.org/10.3390/jpm12091516
Ricucci, D., Loghin, S., Niu, L.-N., & Tay, F. R. (2018). Changes in the radicular pulp-dentine complex in healthy intact teeth and in response to deep caries or restorations: A histological and histobacteriological study. Journal of Dentistry, 73, 76–90. https://doi.org/10.1016/j.jdent.2018.04.007
Regina Rosselle, V., Wibawa Ongkowijoyo, C., & Setyabudi. (2024). Endodontic treatment of severely curved root canals – A case series. Dental Journal, 57(2), 145–151. https://doi.org/10.20473/j.djmkg.v57.i2.p145-151
Santiago, M. C., Altoe, M. M., de Azevedo Mohamed, C. P., Alves de Oliveira, L., & Salles, L. P. (2022). Guided endodontic treatment in a region of limited mouth opening: a case report of mandibular molar mesial root canals with dystrophic calcification. BMC Oral Health, 22(1), 37. https://doi.org/10.1186/s12903-022-02067-8
Sinha, D., Bali, D., Dhar, V., Arora, E., & Singh, S. (2018). Endodontic retreatment. Santosh University Journal of Health Sciences, 4(1), 17–21. https://doi.org/10.18231/2455-1732.2018.0005
Strbac, G. D., Schnappauf, A., Giannis, K., Moritz, A., & Ulm, C. (2017). Guided modern endodontic surgery: A novel approach for guided osteotomy and root resection. Journal of Endodontics, 43(3), 496–501. https://doi.org/10.1016/j.joen.2016.11.001
Van der Meer, W. J., Vissink, A., Ng, Y. L., & Gulabivala, K. (2016). 3D Computer aided treatment planning in endodontics. Journal of Dentistry, 45, 67–72. https://doi.org/10.1016/j.jdent.2015.11.007
Yan, H., De Deus, G., Kristoffersen, I. M., Wiig, E., Reseland, J. E., Johnsen, G. F., Silva, E. J. N. L., & Haugen, H. J. (2023). Regenerative endodontics by cell homing: A review of recent clinical trials. Journal of Endodontics, 49(1), 4–17. https://doi.org/10.1016/j.joen.2022.09.008
Zehnder, M. S., Connert, T., Weiger, R., Krastl, G., & Kühl, S. (2016). Guided endodontics: accuracy of a novel method for guided access cavity preparation and root canal location. International Endodontic Journal, 49(10), 966–972. https://doi.org/10.1111/iej.12544