{"id":31274,"date":"2026-08-28T13:35:17","date_gmt":"2026-08-28T18:35:17","guid":{"rendered":"https:\/\/www.aae.org\/specialty\/?p=31274"},"modified":"2026-08-31T13:01:23","modified_gmt":"2026-08-31T18:01:23","slug":"dynamic-navigation-in-endodontics-advancing-precision-and-preserving-natural-teeth","status":"publish","type":"post","link":"https:\/\/www.aae.org\/specialty\/dynamic-navigation-in-endodontics-advancing-precision-and-preserving-natural-teeth\/","title":{"rendered":"Dynamic Navigation in Endodontics: Advancing Precision and Preserving Natural Teeth"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-31291\" src=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/SeptFeatureStory.jpg\" alt=\"\" width=\"1583\" height=\"626\" srcset=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/SeptFeatureStory.jpg 1583w, https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/SeptFeatureStory-300x119.jpg 300w, https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/SeptFeatureStory-1024x405.jpg 1024w, https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/SeptFeatureStory-1536x607.jpg 1536w, https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/SeptFeatureStory-150x59.jpg 150w, https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/SeptFeatureStory-300x119@2x.jpg 600w\" sizes=\"auto, (max-width: 1583px) 100vw, 1583px\" \/><\/p>\n<p><em>By Mohamed I. Fayad, D.D.S., M.S., Ph.D. and Jaime J. Silberman, D.D.S., M.S.<\/em><\/p>\n<p>The preservation of natural teeth is the cornerstone of Endodontic care. Technology continues to evolve and endodontists are more equipped with innovative tools that enhance precision and support minimally invasive approaches. Among the most significant advancements is dynamic navigation, a real-time computer assisted guidance technology.<\/p>\n<p>Dynamic navigation combines three-dimensional imaging, digital treatment planning and optical tracking technology to guide clinicians during non-surgical and surgical treatment. It allows clinicians to visualize the position of their instruments in real time relative to a patient\u2019s anatomy and is a step forward in endodontics ongoing commitment to preserving natural teeth through precise, predictive and conservative treatment.<\/p>\n<p>Dynamic navigation utilizes cone-beam computed tomography (CBCT) imaging, specialized software, and tracking devices to create a virtual treatment plan before a non-surgical or surgical procedure. During treatment the clinician receives real-time feedback on instrument position, angulation and depth, enabling precise execution of the planned treatment.<\/p>\n<h3><strong>Supporting the AAE Mission of Saving Natural Teeth:<\/strong><\/h3>\n<p>The American Association of Endodontists has always championed the importance of saving natural teeth. Dynamic navigation aligns with this mission as precision-guided treatment allows clinicians to remove less healthy tooth structure thus supporting the biological and functional preservation of natural dentition.<\/p>\n<h3><strong>Non-Surgical Application: <\/strong><\/h3>\n<p>One of the most common applications of dynamic navigation is the management of calcified canals and pulp canal obliteration. Traditional approaches often require extensive exploration and may increase the risk of perforation or excessive removal of tooth structure.<\/p>\n<p>Dynamic navigation enables clinicians to preplan a precise pathway to the canal space and follow that pathway in real time. This guided approach can significantly improve efficiency while preserving surrounding dentin and reducing iatrogenic complications. Several studies compared navigated and freehand access cavity preparation by evaluating tooth substance loss. It was concluded that navigated access cavity preparations resulted in significantly less mean substance loss with optimal and efficient precision in locating calcified root canals in comparison with freehand access preparations <strong>(1).<\/strong><\/p>\n<p>Dynamic navigation also offers advantages in endodontic retreatment, cases involving complex root canal anatomy, developmental anomalies, or unusual configuration. Dynamic navigation can assist clinicians in identifying optimal access trajectories while minimizing or disrupting the existing restorations. <strong>(Fig.1)<\/strong><\/p>\n<div id=\"attachment_31275\" style=\"width: 945px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-31275\" class=\"wp-image-31275 size-full\" src=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/SeptFig1.png\" alt=\"\" width=\"935\" height=\"772\" srcset=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/SeptFig1.png 935w, https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/SeptFig1-300x248.png 300w, https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/SeptFig1-150x124.png 150w, https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/SeptFig1-300x248@2x.png 600w\" sizes=\"auto, (max-width: 935px) 100vw, 935px\" \/><p id=\"caption-attachment-31275\" class=\"wp-caption-text\">Fig 1. Non-Surgical Application Case. (A) Initial radiograph of the lower central incisors (# 24 and # 25) showing coronal and mid-root pulp canal obliterations, respectively. (B) The 3D-DNS main components are: 1) The tracking system-Stereoscopic cameras (red arrow); 2) The tracking markers (green arrow); and 3) The navigation software and display (yellow arrow). (C) Motion tracking accessories are attached to the high-speed handpiece and to the patient\u2019s jaw during the procedure. (D) In the operative field, the computer-assisted system uses a pre-acquired CBCT scan. Through optical technology, it provides the clinician with real-time guidance of the surgical bur relative to the patient\u2019s planned CBCT image volume. (E) Final radiograph following non-surgical endodontic therapies.<\/p><\/div>\n<h3><strong>Surgical Applications:<\/strong><\/h3>\n<p>Surgical procedures often require precise localization of the root apices and careful management of surrounding anatomical structures. Using dynamic navigation, clinicians can accurately plan osteotomy location, size, and surgical pathways and root resection level and angulation prior to surgical treatment. This can reduce unnecessary bone removal and support minimally invasive surgical access. The accuracy and efficiency of three- dimensional dynamic navigation system (3D-DNS) for performing minimally invasive osteotomy and root end resection as well as the viability of root end cavity preparation (RECP) and root end fill (REF) in endodontic microsurgery (EMS) was evaluated <strong>(2).<\/strong> It was \u00a0concluded that 3D-DNS enabled clinicians to perform EMS with high precision and efficiency while facilitating minimally invasive osteotomy and precise root end resection. The surgeon was able to perform RECP with adequate REF in minimally invasive osteotomy utilizing 3D-DNS.<\/p>\n<p>Dynamic navigation is specifically beneficial when treating cases involving proximity to the critical anatomical structures such as maxillary sinus, inferior alveolar nerve, mental foramen, or adjacent tooth roots. Enhanced spatial awareness allows clinicians to approach these cases with greater confidence and predictability. By minimizing the extent of surgical intervention, navigation-assisted procedures may contribute to improved patient experience, reduced postoperative discomfort and preservation of healthy bone structures. <strong>(Fig.2)<\/strong><\/p>\n<div id=\"attachment_31276\" style=\"width: 928px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-31276\" class=\"wp-image-31276 size-full\" src=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/SeptFig2.png\" alt=\"\" width=\"918\" height=\"867\" srcset=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/SeptFig2.png 918w, https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/SeptFig2-300x283.png 300w, https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/SeptFig2-150x142.png 150w, https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/SeptFig2-300x283@2x.png 600w\" sizes=\"auto, (max-width: 918px) 100vw, 918px\" \/><p id=\"caption-attachment-31276\" class=\"wp-caption-text\">Fig 2. Surgical Application Case. Cone-beam computed tomography scan. (A) Sagittal view, (B) Coronal view and (C) Axial view of an endodontically treated mandibular molar (Tooth # 19) with a low density image periapically in the mesial root. (D) Dynamic navigation technology was utilized to surgically manage the case using the cortical bony lid technique. (E) The fully guided procedure allowed the clinicians to perform the osteotomy, root-end resection, and biopsy simultaneously. (F) Reposition of the cortical bony lid. (G-I) Thirteen-month postoperative cone-beam computed tomography scan demonstrating satisfactory bone healing of the surgical defect.<\/p><\/div>\n<h3><strong>Evidence and Future Directions:<\/strong><\/h3>\n<p>A growing body of research supports the accuracy and clinical benefit of dynamic navigation in non-surgical and surgical endodontics. A systemic review evaluating the application, accuracy, advantage and limitations of dynamic navigation systems (DNS) in endodontics concluded that the DNS enables efficient management of complex clinical scenarios, including pulp canal obliteration, conservative access cavity preparation, endodontic retreatment, and endodontic microsurgery <strong>(3, 4). <\/strong>The use of DNS was associated with fewer iatrogenic errors and reduced operative time compared with conventional techniques. Laboratory investigations have demonstrated high levels of precision in accessing calcified canals and performing guided osteotomies <strong>(4, 5, 6, 7, 8).<\/strong> Clinical case reports and emerging studies continue to demonstrate promising results across a variety of non-surgical and surgical applications.<\/p>\n<div id=\"attachment_31283\" style=\"width: 2570px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-31283\" class=\"wp-image-31283 size-full\" src=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/Figure-3_Sept-scaled.jpg\" alt=\"\" width=\"2560\" height=\"1205\" srcset=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/Figure-3_Sept-scaled.jpg 2560w, https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/Figure-3_Sept-300x141.jpg 300w, https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/Figure-3_Sept-1024x482.jpg 1024w, https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/Figure-3_Sept-1536x723.jpg 1536w, https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/Figure-3_Sept-2048x964.jpg 2048w, https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/Figure-3_Sept-150x71.jpg 150w, https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/Figure-3_Sept-300x141@2x.jpg 600w\" sizes=\"auto, (max-width: 2560px) 100vw, 2560px\" \/><p id=\"caption-attachment-31283\" class=\"wp-caption-text\">Fig. 3. Tooth #19 presented for guided surgery. (a) Attachment of the Fotona H14 handpiece to the Navident handpiece tracker (&#8220;Rocket&#8221;). (b) Axial view. (c, d) Coronal and 3D rendering views demonstrating the thick cortical bone and the mental nerve exit. (e) Low-density area associated with the distal root.<\/p><\/div>\n<div id=\"attachment_31282\" style=\"width: 2570px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-31282\" class=\"wp-image-31282 size-full\" src=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/Figure-4_Sept-scaled.jpg\" alt=\"\" width=\"2560\" height=\"1517\" srcset=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/Figure-4_Sept-scaled.jpg 2560w, https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/Figure-4_Sept-300x178.jpg 300w, https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/Figure-4_Sept-1024x607.jpg 1024w, https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/Figure-4_Sept-1536x910.jpg 1536w, https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/Figure-4_Sept-2048x1213.jpg 2048w, https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/Figure-4_Sept-150x89.jpg 150w, https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/Figure-4_Sept-300x178@2x.jpg 600w\" sizes=\"auto, (max-width: 2560px) 100vw, 2560px\" \/><p id=\"caption-attachment-31282\" class=\"wp-caption-text\">Fig. 4. Top left: Navident treatment planning demonstrating the buccal lid osteotomy and root-end resection. Real-time dynamic navigation was used throughout the procedure. (a) Buccal lid osteotomy performed under real-time dynamic navigation using the Fotona H14 handpiece and the chisel laser tip after calibration and accuracy verification. (b) Buccal lid following retrieval. (c) Immediate postoperative CBCT demonstrating repositioning of the buccal lid. (d) One-year follow-up CBCT demonstrating complete bone remodeling.<\/p><\/div>\n<p><a href=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/Figure-3_Sept.tiff\"><img decoding=\"async\" class=\"aligncenter size-full wp-image-31277\" src=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2026\/08\/Figure-3_Sept.tiff\" alt=\"\" \/><\/a><\/p>\n<h3><strong>Looking Ahead:<\/strong><\/h3>\n<p>Recently, the integration of dynamic navigation with Er:YAG laser technology has emerged as a promising advancement in guided dental surgery. This combined approach leverages the strengths of both technologies, providing the high level of precision and minimally invasive capabilities of dynamic navigation together with the favorable biological effects of Er:YAG lasers as preservation of osteoblast viability, reduces thermal damage to surrounding bone. The use of Er:YAG lasers has been associated with decreased postoperative pain, swelling and patient discomfort <strong>(9). (Fig.3 and Fig.4)<\/strong><\/p>\n<h3><strong>Conclusion:<\/strong><\/h3>\n<p>The educational value of dynamic navigation should not be overlooked. Real-time visualization of the instrument movement within three-dimensional anatomy provides a powerful learning experience for residents and practicing clinicians.<\/p>\n<p>Through precision-guided treatment and minimally invasive care, dynamic navigation presents how technological advancement can further the specialty\u2019s commitment to saving teeth and improving patient\u2019s oral health and quality of life.<\/p>\n<p>References:<\/p>\n<ol>\n<li>Jain SD, Carrico CK, Bermanis I. 3-dimensional accuracy of dynamic navigation technology in locating calcified canals. J Endod. 2020;46(6):839-845.<\/li>\n<li>Aldahmash SA, Price JB, Mostoufi B, Griffin IL, Dianat O, Tordik PA, Martinho FC. Real-time 3-dimensional dynamic navigation system in endodontic microsurgery: A cadaver study. J Endod. 2022;48(7):922-929.<\/li>\n<li>Vasudevan A, Santosh SS, Selvakumar RJ, Sampath DT, Natanasabapathy V. Dynamic navigation in guided endodontics: A systematic review. Eur Endod J. 2022;7(2):81-91.<\/li>\n<li>Kapoor A, Alagarsamy R, Lal B, Rana AS, Kaur A, Sharma S, Logani A. Dynamic navigation in endodontics: Scope, benefits, and challenges\u2014A systematic review. J Endod. 2025;51(7):879-889.<\/li>\n<li>Hirt L, Hildebrand H, Weiger R, Thieringer FM, Connert T, Leontiev W. Real-time guided endodontics with a miniaturized dynamic navigation system in calcified posterior teeth: Performance in regard to the operator&#8217;s level of experience. J Endod. 2025;51(11):1637-1643.<\/li>\n<li>Dianat O, Nosrat A, Tordik PA, Aldahmash SA, Romberg E, Price JB, Mostoufi B. Accuracy and efficiency of a dynamic navigation system for locating calcified canals. J Endod. 2020;46(11):1719-1725.<\/li>\n<li>Connert T, Weiger R, Krastl G. Present status and future directions\u2014Guided endodontics. Int Endod J. 2022;55(Suppl 4):995-1002.<\/li>\n<li>Wei X, Du Y, Zhou X, Yue L, Yu Q, Hou B, Chen Z, Liang J, Chen W, Qiu L, Huang X, Meng L, Huang D, Wang X, Tian Y, Tang Z, Zhang Q, Miao L, Zhao J, Yang D, Yang J, Ling J. Expert consensus on digital guided therapy for endodontic diseases. Int J Oral Sci. 2023;15(1):54.<\/li>\n<li>Gen\u00e7 BG\u00c7, Orhan K, Or S. A clinical comparison of Er:YAG laser, piezosurgery, and conventional bur methods in impacted third molar surgery. Photobiomodul Photomed Laser Surg. 2023;41(6):283-290.<\/li>\n<\/ol>\n<p><em>Mohamed I. Fayad D.D.S., M.S., Ph.D. (Main Author), Endodontics LTD Private Practice, Chicago, is affiliated with the Department of Endodontics, University of Illinois Chicago.\u00a0<\/em><\/p>\n<p><em>Jaime J. Silberman D.D.S., M.S. (Co-Author), Silberman Endodontics, of Boynton Beach, Fla., is affiliated with the Department of Endodontics, Nova Southeastern University, Davie, Fla.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>By Mohamed I. Fayad, D.D.S., M.S., Ph.D. and Jaime J. Silberman, D.D.S., M.S. The preservation of natural teeth is the cornerstone of Endodontic care. Technology continues to evolve and endodontists&hellip;<\/p>\n","protected":false},"author":12,"featured_media":31291,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"content-type":"","_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[215],"tags":[],"feature":[202],"class_list":["post-31274","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-future-trends","feature-communique"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Dynamic Navigation in Endodontics: Advancing Precision and Preserving Natural Teeth - American Association of Endodontists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.aae.org\/specialty\/dynamic-navigation-in-endodontics-advancing-precision-and-preserving-natural-teeth\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Dynamic Navigation in Endodontics: Advancing Precision and Preserving Natural Teeth - American Association of Endodontists\" \/>\n<meta property=\"og:description\" content=\"By Mohamed I. 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