By Ane Poly, DDS, MSc, PhD
As we navigate the rapidly evolving landscape of dental education, exploring how digital technologies can enhance current teaching methods and improve student learning is paramount. Endodontic access preparation (EAP) represents the critical first phase in non-surgical root canal treatment. Its primary objectives, such as conserving sound tooth structure, unroofing the pulp chamber, and establishing direct-line access to canal orifices, lay the foundation for clinical success.
Traditionally, preclinical courses rely on visual inspection by calibrated faculty members to grade student EAP. However, extensive literature shows that visual inspection is inherently subjective, leading to a lack of interrater reliability among faculty in the evaluation process.
Standard visual inspection also leaves students with limited, qualitative feedback. While an instructor can observe that an access cavity is overextended or off-center, students often struggle to visualize the exact three-dimensional volumetric defect or millimeter deviations from ideal dimensions. Because self-assessment is a crucial lifelong skill predoctoral students must develop to refine their hand-skills and work independently, establishing objective standards for error detection is essential.
Adapting 3D Comparison Software for Endodontics
To bridge this gap, CAD/CAM technology widely used in fixed prosthodontics to evaluate crown preparations (Planmeca Romexis Compare, formerly E4D Compare) was adapted for endodontic education to evaluate student EAPs three-dimensionally against standardized ideal master models.1
Students start by using intraoral scanners to scan their EAPs and upload the 3D file into the software. Then, they trace the access perimeter as an “Axial Base” and follow the board licensure landmarks (ADEX criteria2) to trace the “Margin”. High-resolution surface scanning superimposes the student model onto a faculty-determined ideal model, and the existing software tools are used to measure internal wall dimensions and outline extents:
- Compute Difference: Quantifies volumetric alignment via 3D heat maps, highlighting overextended areas in red, underextended areas in blue, and acceptable areas in yellow. (Figure 1)
Figure 1: Compute difference tool showing (A) the ideal model, (B) the S2 model, and (C) the two models overlapped. Red areas indicate overextension; blue areas indicate underextension; yellow areas fall within the tolerance range. The black rectangle highlights the quantitative data.
- Slice Plane & Distance Tools: Provide cross-sectional views at various depth levels, enabling specific millimeter measurements between internal preparation walls. (Figure 2)
Figure 2: Ideal and student models overlapped with the slice plane tool showing a qualitative comparison of the internal form. Three measurements are shown in specific areas, illustrating the distance tool being used to measure the distance between models.
- Shoulder Width: Measures circumferential boundary distances to verify adherence to licensure safety margins.2 (Figure 3)
Figure 3: Shoulder width tool shows the student model where the red areas indicate the distance is > 2.0 mm, blue areas < 1.0 mm, and yellow areas between 1 and 2 mm.
Practical Insights from Preclinical Implementation
The viability and impact of this digital methodology were evaluated with a randomized controlled trial.3 Sixty second-year dental students performed EAPs on #14 acrylic teeth (RTE #14 With Insert; Acadental, Lenexa, KS) following the ADEX criteria2. Students were assigned either to a control group using traditional visual assessment or an experimental group combining traditional self-assessment with 3D software evaluation.
The trial revealed significant findings regarding student self-perception and critical evaluation. While both groups experienced an increase in clinical confidence, students relying solely on traditional visual assessment significantly overestimated their performance improvements. Conversely, students equipped with 3D digital feedback examined their work far more critically and accurately.
This outcome highlights the Dunning-Kruger effect, a cognitive bias where individuals with lower competence overestimate their abilities due to a lack of detailed feedback. The 3D comparison software serves as a “digital magnifying glass,” exposing minor over-extensions, wall gouging, and lack of straight-line access. By removing visual ambiguity, the software tempers unearned overconfidence and fosters genuine self-awareness.
Looking Ahead: Impact on Dental Curriculum and Faculty Workflow
Student acceptance has been positive. In our randomized trial, 96.7% of students who used the 3D method agreed that 3D evaluation should be permanently incorporated into preclinical endodontic training and licensure exam preparation.
Beyond student self-evaluation, integrating 3D evaluation software into preclinical simulation laboratory training helps address a broader institutional challenge: faculty shortages and calibration. With vacant budgeted faculty positions in U.S. dental schools reaching record highs, digital evaluation provides an objective, standardized baseline for instruction.
Ultimately, this precise and immediate feedback empowers students to critically analyze their work and build the lifelong self-assessment capabilities necessary for modern endodontic practice. Furthermore, by providing round-the-clock feedback, the software mitigates faculty workload, allowing instructors to redirect their time toward targeted, high-level clinical coaching.
Note: Generative AI was used as an editorial aid to assist with grammar, clarity, phrasing, and organization. The ideas, opinions, and final wording of the content are solely those of the author.
Ane Poly, DDS, MSc, PhD, is a Clinical Assistant Professor in the Department of Endodontics at the University of Florida College of Dentistry.
References
- Poly A, Burnett JE, Buie CA, Schweitzer JL. Three-dimensional software adapted to evaluate endodontic access cavity preparation. J Dent Educ. 2023;87(suppl 3):1848-1851.
- CDCA-WREB-CITA. ADEX Dental Exam Series: Endodontic Criteria. 2026 Candidate Manual. Anterior Endo Procedure: https://adextesting.org/wp-content/uploads/2026/05/2026.8-DEN-ENDO-Anterior_20260521.pdf Posterior Endo Procedure: https://adextesting.org/wp-content/uploads/2026/05/2026.8-DEN-ENDO-Posterior_20260521.pdf
- Poly A, Harness C, Vu E, Biradar A, Buie CA, Burnett JE, Schweitzer JL. Integrating digital technology in endodontic education: A randomized controlled trial evaluating student self-assessment and perspectives. J Dent Educ. 2025 Aug;89(8):1294-1302.
Disclaimer
The views and opinions expressed by authors are solely those of the authors and do not necessarily reflect the official policy or position of the American Association of Endodontists (AAE). Publication of these views does not imply endorsement by the AAE.
Compiled by Dr. Blake Clarke
Dr. Jan Groth is a resident at The University of Minnesota. Here, Dr. Blake Clarke catches up with him and learns more about his journey to endo.
Dr. Blake Clarke: Dr. Groth, thank you for taking the time to speak with us. Could you begin by telling us a little about yourself and your background?
Dr. Jan Groth: Thanks for having me! I’m an endodontics resident at the University of Minnesota.
Before returning for residency, I spent several years in private practice as a general dentist in Minneapolis and Miami Beach. Over time, I noticed that the days I went home feeling most fulfilled were the ones when someone arrived miserable from a severe toothache and left comfortable, often surprised that the root canal was not the horror story they had imagined. I genuinely enjoy the psychological side of what we do: caring for someone who is terrified by the words ‘root canal,’ earning that patient’s trust, keeping them comfortable, and turning the experience into a positive one.
Outside dentistry, I enjoy staying active and exploring. I love snowboarding and taking on major treks through different landscapes, whether on high-altitude trails or in remote terrain. I also enjoy deep conversations, learning about space, caring for plants, and working with my hands on design and woodworking projects. I believe in making time to enjoy life and finding meaningful ways to give back to the community around me.
Dr. Clarke: You practiced as a general dentist for several years after graduation. When did you decide to pursue endodontics, and what led you to that decision?
Dr. Groth: Practicing as a general dentist gave me the opportunity to explore a broad scope of care while navigating different practice cultures, patient communities, and procedures. Although I have always loved dentistry, consecutive years of undergraduate education, research, and dental school had absorbed a significant chapter of my life. After graduation, I felt it was important to step away from academia, gain real-world perspective, and reconnect with life and the community around me. I always had an eye on endodontics, but working as a general dentist first gave me invaluable clinical perspective and personal balance.
About four years into practice, I reached a transitional point in my life and knew I would be moving. That gave me space to step back and reevaluate what truly drove me. I realized I wanted deeper knowledge and the opportunity to refine my skills in the areas where I felt the greatest passion and natural strengths: saving teeth and helping patients manage anxiety. With that clarity, returning to specialize felt like the right decision.
Dr. Clarke: You mentioned that finding meaningful ways to give back is important to you. How do you hope to carry that into your career after residency?
Dr. Groth: Growing up with Mexican and German heritage, connecting across different cultures has always felt natural to me. Serving on dental brigades abroad, including in Guatemala, showed me how powerful those connections can be. Using my native Spanish to communicate directly with patients allowed me to address some of the fear that often surrounds dental care.
Long term, I hope to establish a sustainable brigade in Latin America that provides free specialty dental care while partnering with the local community to support its growth beyond the dental chair.
Many patients arrive for endodontic treatment already anxious about the procedure. What have you learned about earning their trust and helping them feel more comfortable?
Most patients don’t come in with only a painful tooth. They also bring years of accumulated dental anxiety and secondhand horror stories, all while being asked to put themselves in a vulnerable position. I’ve learned that earning their trust begins with genuine empathy.
Before I recline the chair or pick up a mirror, I make a point of connecting with them on a human level. I meet them eye-to-eye, validate their apprehension, and make sure they retain a sense of control.
When patients realize that you see them first and their root canal second, their anxiety often begins to ease. Turning an appointment someone has dreaded for weeks into a comfortable, almost anticlimactic part of the day is one of the most rewarding aspects of this specialty.
Dr. Clarke: That is an excellent approach to caring for patients with dental anxiety. For our final question, what is one piece of advice you would give to dental students or general dentists who are considering a career in endodontics?
Dr. Groth: My advice would be to give yourself grace and move with intention rather than simply following momentum. Whether you are accepted directly out of dental school or spend valuable years in general practice, both paths have real advantages. What matters most is giving yourself the space to step back and reconnect with what truly motivates you. It is easy to get caught up in academic milestones, but when you pursue endodontics out of a genuine passion for saving teeth and relieving pain, the demands of the profession feel worthwhile.
Dr. Blake Clarke is a member of the AAE’s Resident & New Practitioner Committee.
By: Dr. Jessica Hwang
This August, endodontic residents from across the country came together in St. Louis for the annual APICES conference, and the weekend was a great reminder that some of the most valuable parts of residency happen outside of the clinic.
Held August 14–15 at the Hyatt Regency St. Louis at the Arch, APICES brought residents together for two days of education, career development, networking, and plenty of opportunities to have some fun along the way. The program covered many of the questions residents are already thinking about as they prepare for life after training. Dr. Gordon Lai kicked things off with Things I Wish I Knew in Residency, sharing invaluable advice ranging from patient management and optimizing resident workflows to the practical clinical tips he is well known for.
Another crowd favorite was Dr. Monica Estes’ presentation, Beyond the Percentage: Understanding Endodontic Compensation in Today’s Market. Dr. Estes walked residents through real-world compensation scenarios, common contract considerations and potential red flags, and how to more thoughtfully evaluate employment opportunities. Residents also heard from Dr. Rene Chu on life after residency, a topic everyone in training is eager to think about! On the clinical side, Dr. Adham Azim delivered an engaging surgical lecture on the diagnosis and management of cervical root resorption, while Dr. Rob Roda shared plenty of wisdom and a few cautionary lessons in 10 Ways to Lose a Referral. Residents also heard from leadership across the AAE, AAE Foundation, and ABE College of Diplomates during the annual Get to Know Your Specialty session.
Beyond the lecture hall, the exhibit hall stayed busy throughout the weekend, with industry partners showcasing new technology, answering questions, and keeping things lively with giveaways and raffles. It gave residents an opportunity not only to learn about products and resources they may encounter in practice, but also to connect directly with the companies and organizations supporting the specialty.
APICES also provided an opportunity to give back. Before the meeting began, members of the Foundation Resident Expert Advisory Council (REACH) volunteered with Give Kids a Smile St. Louis, helping prepare dental supplies for the organization’s biannual open clinic in October. It was a meaningful way for residents to contribute to the local community while representing the Foundation for Endodontics and the specialty.
One of the weekend’s special moments was recognizing the 2026 recipients of the Foundation for Endodontics and Dentsply Sirona Freedom Scholarship. Each year, three residents receive a $50,000 award designed to help offset the significant financial investment of postgraduate endodontic training. This year’s recipients were Dr. Luc de la Villefromoy, Dr. Anas Akhras, and Dr. Sierra Nunn. The scholarship is another meaningful example of the support being invested in the next generation of endodontists.
Of course, APICES would not be APICES without the social side of the weekend. Corporate partners Specialized Dental Partners and Specialty1 Partners hosted events throughout St. Louis, giving residents a chance to step away from lectures, enjoy stunning views of the Gateway Arch, and connect in a more relaxed setting. Between the receptions, exhibit hall conversations, and catching up with residents from programs across the country, there was no shortage of opportunities to make new connections.
That may ultimately be what makes APICES so memorable. Residency can be intense, and it is easy to become absorbed in the day-to-day routine of patients, seminars, research, and requirements. APICES gives residents a chance to look beyond their own programs and realize just how large and welcoming the endodontic community really is. Hopefully, residents walked away with new knowledge, new friends, and a stronger sense that they have found their place in the specialty.
Until next year, APICES!
Dr. Jessica Hwang is a member of the AAE’s Resident & New Practitioner Committee.
It’s hard to believe we’re already heading into fall! The excitement of July and a new academic year has begun to settle, and by now, most of our first-year residents have made the transition into clinic. The days are getting busier, the cases more interesting, and hopefully the view through the microscope is starting to feel a little more familiar.
For our first-year residents, this is often when residency starts to feel real. You’re putting what you’ve learned into practice, developing your own routines, and realizing just how much there
still is to learn. Give yourself grace. Speed and confidence will come with experience. Focus on building good habits, asking questions, and learning something from every case.
For our returning residents, take a moment to recognize how far you’ve come. When a first-year asks you a question you remember asking yourself, embrace the opportunity to be a mentor.
Some of the most valuable lessons in residency come from the co-residents beside you.
August also brought us together in St. Louis for APICES 2026, and what an incredible weekend it was! We had an amazing turnout and were fortunate to learn from a truly gifted and knowledgeable group of speakers. Thank you to everyone who joined us and helped make the meeting such a success. I hope you returned to your programs with new knowledge, new connections, and renewed excitement for our specialty. We hope to see many of you again at APICES 2027, August 20-21 in New Orleans!
As we head into fall, remember that your endodontic community extends far beyond your residency program or practice. Stay connected, seek mentorship, support one another, and continue finding opportunities to learn. For our new practitioners especially, graduation didn’t mark the end of that journey, it simply changed where and how the learning happens.
As always, the Resident and New Practitioner Committee is here to support you. If there’s something you’d like to see in PaperPoint, something you’d like to contribute, or an idea for how the RNPC can better serve our residents and new practitioners, I’d love to hear from you at PCarpenter.DDS@gmail.com.
Here’s to a productive fall, continued growth, and finding a little more confidence each time you sit down at the microscope.
Until next time,
Priscilla L. Carpenter, D.D.S., M.S.
Resident and New Practitioner Committee Chair Diplomate, American Board of Endodontics
By Dr. Gordon Lai
This past August at APICES, I had the honor of speaking to AAE residents about some of the lessons that have stayed with me since residency. For those who were unable to attend-and for recent graduates-I wanted to share a few of those ideas here. When I entered endodontic residency, I assumed success would be defined mostly by clinical skill: finding MB2s, negotiating calcified canals, and producing beautiful obturations. Those things matter. But over time, I have come to believe that the residents who grow the most are distinguished just as much by their mindset: humility, curiosity, preparation, adaptability, and knowing what to prioritize at each stage of training.
One thing I have come to appreciate is that residency is not designed to make you an “expert” endodontist. Its job is to make you “competent” as a specialist and give you the foundation to keep improving after graduation. Expertise comes later, through years of repetition, reflection, mistakes, and real-world experience. Understanding that should make it easier to say, “I don’t know,” ask for help, and accept criticism. Humility and teachability are among the most valuable qualities I believe a resident can bring to training.
That also means learning from every faculty member, including those whose style differs from yours or who challenge you the most. It is natural to gravitate toward instructors who are easygoing or whose techniques resemble your own, but I’ve learned that some of the greatest growth can come from faculty who question your decisions or approach a case differently. You do not have to adopt every technique you are shown, but you should understand why it works before deciding whether it belongs in your own clinical toolbox.
Along with being humble, be hungry. Residency is a rare opportunity to encounter difficult cases with a safety net around you. Do not spend those years trying to make every day comfortable. Seek out the difficult retreatment. Take the calcified canal. Volunteer for procedures you have not experienced. Keep a wishlist of cases and techniques you want exposure to before graduation.
Learning to manage your own complications is also part of the learning process. Files may separate. Perforations may occur. Cases may not go according to plan. The goal should not be to graduate having avoided every complication. The goal is to understand why complications happen, how to prevent them when possible, and how to manage them appropriately.
At the same time, do not confuse ambition with rushing. Early in residency, it is easy to become overly focused on finishing cases faster to meet requirements. I think that priority is often backwards. The first year should be about mastering the fundamentals: diagnosis, radiographic and CBCT interpretation, access design, hand filing, WL control, anesthesia, and restoration of the endodontically treated tooth. Once you have spent that first year building those fundamentals, then you can start focusing more on speed and efficiency.
One of the best ways to improve both quality and efficiency is to come prepared. Show up early. Review the imaging. Think through the anatomy you expect to encounter. Have a game plan in mind, but also have a backup plan. The resident who knows only one way to remove gutta-percha or a Thermafil carrier, obturate a large canal, or remove a metal post will eventually encounter a case where that approach does not work.
That is where adaptability becomes essential. Dental school often teaches dentistry as a sequence of steps just like a recipe. Residency is where you learn that complex cases do not always follow the recipe. A good endodontist needs more than one way to solve a problem. If Plan A is not working, you need a Plan B and sometimes even a Plan C. Without those backup approaches, it is easy to become flustered when a case stops following the expected path.
Residency is also the best time to experiment deliberately. Try different file systems, obturation techniques, irrigation methods, and workflows. Learn how they work, where they fail, and what fits your hands. Do not graduate as a miniature version of your program director-or any single faculty member. Develop your own clinical style while staying grounded in sound principles and evidence. Technology will continue to change, and your workflow should be able to evolve with it.
For recent graduates, that same mindset should continue beyond residency. Training gives you competence; continued learning moves you toward expertise. Find lifelong mentors. Stay curious. Never stop learning. Consider teaching. I have found that teaching residents forces me to examine my own clinical habits, stay current with the evidence, and be able to explain not just what I do, but why I do it.
Most importantly, accept that endodontics will continue to humble you. Even years into practice, difficult cases will remind you how much there still is to learn. The best residents I have taught are not necessarily the fastest, the most technically gifted, or the ones who make the fewest mistakes. They are the ones who remain curious, accept feedback, challenge their own assumptions, seek out difficult experiences, and learn to adapt. That mindset will serve you long after residency is over.
Dr. Gordon Lai received his DDS degree from University of California San Francisco School of Dentistry in 2006 and subsequently completed a one year GPR at the VA Palo Alto. While serving as the associate dental director at a community clinic in the SF Bay Area for 10 years, he was also active in mentoring residents for the UCSF/NYU Langone AEGD residency program. He subsequently completed his endodontics specialty training at University of Pacific Arthur A. Dugoni School of Dentistry in 2020 and is currently teaching part time as an assistant professor at UOP as well as working in private practice. One of his main areas of research interest is finding innovative ways to incorporate 3D printing, Virtual Reality, and Augmented Reality into clinical practice as well as educating dental students.
Each August, the AAE, with the generous support of the Foundation for Endodontics, hosts APICES, our annual meeting for residents in conjunction with the AAE Educator Workshop. This weekend is affectionately known as “Endopalooza”, and each year it is eagerly anticipated by residents and educators alike. This year, the city of St. Louis was our host for the event, and despite near record heat – not to mention humidity, a great time was had by all.
Each year the Educator Workshop rotates between Department Chairs, Graduate Program Directors, and Pre-doctoral Directors. This summer the focus was on our Graduate Program Directors, and it was very well attended with more than 40 directors making the trip. The presentation topics were devoted to the application process, including the usefulness and relevance of the ADAT exam as well as the competitive and increasingly chaotic interview and offer process. Despite efforts in the past to establish some structure to the process of interviewing and selecting residents, it remains unorganized, and from the perspective of the applicant, unfair. We were treated to a presentation on the Match, which is used by all of the other dental specialties, Endodontics being the only holdout, and the information presented was detailed and comprehensive. Whether we will garner enough support among the programs to make a move in that direction remains to be seen, but productive discussions were part of our meeting as well. This feedback will provide the Educational Affairs Committee with valuable insight with which to formulate recommendations for some change and structure to improve the selection of residents going forward.
The program for the APICES portion of the weekend included a wide variety of presentations, beginning with the traditional “Get to Know Your Specialty”. This session includes the Presidents of the AAE, the American Board of Endodontics, the Foundation for Endodontics, and the College of Diplomates, and is intended to acquaint residents with the organizations that helped establish and maintain our specialty and the roles that each play in that critical support structure. By highlighting the benefits of AAE membership, such as advocacy, continuing education, publications, and much more, we hope to encourage our residents to continue their membership not only after their program ends, but for the duration of their careers. Other lectures included such topics as “Things I Wish I Knew in Residency”, Compensation for Endodontic procedures, Post-graduate life, “Ten Ways to Lose a Referral”, and just to make sure we had some scientific clinical information, Dr. Azim presented on the topic of Cervical Root Resorption.
Although these two meetings are held concurrently, the lectures are separate, given the two different audiences. That is not to say that there is no opportunity for interaction. A robust exhibit “hall” populated with a variety of vendors is open to both groups, and a lot of mingling occurred during the lunch break. There were also evening social events that provided ample opportunity to catch up with old friends as well as make new acquaintances, and some bonding time over a mechanical bull …
APICES was the first of its kind – a meeting for residents, planned by residents, and it has been emulated by other specialties since its inception, but it has never been surpassed in its longevity or its impact on our resident community. Even more remarkable is that attendance at this meeting is almost entirely subsidized by support from the Foundation for Endodontics. The hotel accommodations and a significant amount toward airfare is provided for each of the residents in attendance – dependent upon their attending each of the lectures of course. The value and importance of this early engagement extend far beyond the dollar investment required to make it happen. By demonstrating the value of membership in the AAE as well as the philanthropy of the Foundation , we hope to inspire life-long participation and advocacy on behalf of our specialty and dentistry in general. If you are eligible to attend either event, I would encourage you to do so as it is both informative and inspiring. If you are not eligible to attend, you can still support this effort by making a contribution to the Foundation for Endodontics in appreciation for their support of “Endopalooza” Next year’s host city will be New Orleans where we will undoubtedly “Laissez les Bon Temps Roulez”. I hope that you can join us if possible.
Root canal misinformation isn’t going away—but the evidence against it continues to grow stronger.
The AAE has updated its Root Canal Safety Fact Sheet(opens in new tab), giving members a timely, evidence-based resource to help address patient questions and misinformation about the safety of endodontic treatment.
The updated fact sheet reinforces decades of research contradicting the long-discredited “focal infection theory” and addresses the continued spread of root canal misinformation on social media. It also expands the conversation with emerging research examining the relationship between endodontic infection, treatment and systemic health.
What’s new?
The updated resource incorporates recent research, including a landmark two-year longitudinal study from researchers at King’s College London(opens in new tab) examining patients following successful root canal treatment. The study found significant changes in glucose and lipid metabolism and systemic inflammatory markers following treatment—adding to emerging evidence about the relationship between chronic oral infection and overall health.
The fact sheet also includes:
- New guidance for discussing root canal safety and misinformation with patients
- Emerging evidence related to endodontic treatment and systemic metabolic and inflammatory health
- Greater emphasis on collaboration between dental and medical professionals
- Updated research and references, including recent studies examining apical periodontitis and systemic health
- Practical resources members can share with patients who have questions or concerns
While emerging research continues to develop, the message remains clear: there is no valid scientific evidence linking endodontically treated teeth with systemic disease.
We encourage you to review the updated fact sheet and keep it handy as a resource for conversations with patients, referring dentists and other health professionals.
VIEW THE UPDATED ROOT CANAL SAFETY FACT SHEET(opens in new tab)
Together, we can help patients separate fact from misinformation—and reinforce the value of evidence-based endodontic care and preserving the natural tooth.
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 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.
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’s anatomy and is a step forward in endodontics ongoing commitment to preserving natural teeth through precise, predictive and conservative treatment.
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.
Supporting the AAE Mission of Saving Natural Teeth:
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.
Non-Surgical Application:
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.
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 (1).
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. (Fig.1)
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’s 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’s planned CBCT image volume. (E) Final radiograph following non-surgical endodontic therapies.
Surgical Applications:
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 (2). It was concluded 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.
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. (Fig.2)
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.
Evidence and Future Directions:
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 (3, 4). 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 (4, 5, 6, 7, 8). Clinical case reports and emerging studies continue to demonstrate promising results across a variety of non-surgical and surgical applications.
Fig. 3. Tooth #19 presented for guided surgery. (a) Attachment of the Fotona H14 handpiece to the Navident handpiece tracker (“Rocket”). (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.
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.
Looking Ahead:
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 (9). (Fig.3 and Fig.4)
Conclusion:
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.
Through precision-guided treatment and minimally invasive care, dynamic navigation presents how technological advancement can further the specialty’s commitment to saving teeth and improving patient’s oral health and quality of life.
References:
- Jain SD, Carrico CK, Bermanis I. 3-dimensional accuracy of dynamic navigation technology in locating calcified canals. J Endod. 2020;46(6):839-845.
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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.
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.
The American Association of Endodontists (AAE), in partnership with the Organized Dental Coalition (ODC) and more than 70 national health professional and patient advocacy organizations, recently urged Congress to advance the Ensuring Lasting Smiles Act (ELSA) (S. 1677/H.R. 3277). Through a coalition letter sent to leaders of the Senate Committee on Health, Education, Labor, and Pensions and the House Committee on Energy and Commerce, the organizations called on Congress to schedule committee markups and move this bipartisan legislation forward before the end of the 119th Congress.
The Ensuring Lasting Smiles Act addresses a longstanding gap in private health insurance coverage for children born with congenital anomalies affecting the eyes, ears, teeth, mouth, or jaw. Although many health plans indicate they cover congenital anomalies, families frequently encounter coverage denials when follow-up or reconstructive care is needed. Medically necessary services—including dental implants, prosthodontic treatment, orthodontics, and other restorative procedures—are often classified as cosmetic or shifted to supplemental dental or vision plans, leaving families responsible for significant out-of-pocket costs.
For children with craniofacial conditions such as cleft lip and palate, ectodermal dysplasia, hypodontia, and other congenital anomalies, access to timely multidisciplinary care is critical. Treatment often spans several years and involves coordination among medical and dental specialists to restore normal function as a child grows and develops. Delays in care can affect speech, nutrition, breathing, oral function, and overall quality of life while creating unnecessary financial and emotional burdens for families.
ELSA would help ensure that private group and individual health plans provide coverage for medically necessary services needed to improve, repair, or restore normal function for patients with qualifying congenital anomalies. The legislation is carefully tailored to address functional reconstructive care and does not require coverage for procedures performed solely for cosmetic purposes. Previous Congressional Budget Office analyses have estimated that the legislation would have a minimal impact on insurance premiums while helping families avoid costly delays in treatment.
The legislation continues to receive strong bipartisan support in both chambers of Congress and is championed by Senators Tammy Baldwin (D-WI) and Joni Ernst (R-IA), along with Representatives Neal Dunn, D.M.D. (R-FL) and Kim Schrier, M.D. (D-WA). The broad coalition supporting ELSA reflects a shared commitment among healthcare providers and patient advocacy organizations to ensure children with congenital anomalies have access to medically necessary care without unnecessary insurance barriers.
The AAE is proud to stand alongside the Organized Dental Coalition and its healthcare partners in advocating for policies that improve patient access to essential oral healthcare. As part of its broader advocacy efforts, the Association will continue working with Congress, coalition partners, and policymakers to advance practical solutions that remove barriers to care, strengthen insurance coverage for medically necessary treatment, and improve outcomes for patients and their families.
The American Association of Endodontists (AAE), in collaboration with the American Dental Association (ADA), the Organized Dental Coalition (ODC), and other national dental organizations, recently expressed its support for the Ensuring Kids Have Access to Medically Necessary Dental Care Act. In a coalition letter sent to Senator Angela Alsobrooks (D-MD) and Representative Nanette Barragán (D-CA), the organizations thanked the lawmakers for introducing the legislation and reaffirmed their commitment to advancing policies that improve children’s access to essential oral healthcare.
The proposed legislation would strengthen dental coverage under the Children’s Health Insurance Program (CHIP) by prohibiting lifetime and annual dollar limits on dental benefits and requiring dental-only wraparound coverage for certain children whose existing health plans do not provide adequate dental benefits. These changes would help ensure that children enrolled in CHIP can receive medically necessary dental care without facing arbitrary financial limitations that may interrupt treatment or place additional financial burdens on families.
Although CHIP has played a critical role in expanding access to healthcare for millions of children, gaps in dental coverage continue to create barriers for many families. Annual and lifetime benefit caps can leave children without coverage in the middle of treatment, forcing parents to delay care, pay significant out-of-pocket costs, or forgo treatment altogether. The coalition emphasized that oral health is a fundamental component of overall health and that children should have access to comprehensive dental care throughout their development.
Routine preventive care and timely treatment help reduce the risk of dental disease, pain, infection, and costly emergency care while supporting healthy nutrition, speech development, learning, and overall well-being. Ensuring continuous access to dental services also helps providers deliver appropriate care without unnecessary interruptions caused by insurance limitations. Strengthening CHIP’s dental benefits would improve continuity of care while helping families better manage the financial challenges associated with ongoing treatment.
By supporting this coalition effort, the AAE continues to advance its commitment to improving access to quality oral healthcare through federal advocacy. Working alongside the ADA, the Organized Dental Coalition (ODC), and other national dental organizations, the Association remains engaged in efforts to reduce barriers to medically necessary dental care, strengthen insurance coverage for patients, and promote policies that improve oral health outcomes for children and families across the country.