Endodontic Treatment of an Anomalous Anterior Tooth with the Aid of a 3-dimensional Printed Physical Tooth Model

Abstract

Endodontic treatment of tooth formation anomalies is a challenge to clinicians and as such requires a complete understanding of the aberrant root canal anatomy followed by careful root canal disinfection and obturation. Here, we report the use of a 3-dimensional (3D) printed physical tooth model including internal root canal structures for the endodontic treatment of a challenging tooth anomaly. A 12-year-old boy was referred for endodontic treatment of tooth #8. The tooth showed class II mobility with swelling and a sinus tract in the buccal mucosa and periapical radiolucency. The tooth presented a very narrow structure between the crown and root by distal concavity and a severely dilacerated root. Moreover, a perforation site with bleeding and another ditching site were identified around the cervical area in the access cavity. A translucent physical tooth model carrying the information on internal root canal structures was built through a 3-step process: data acquisition by cone-beam computed tomographic scanning, virtual modeling by image processing, and manufacturing by 3D printing. A custom-made guide jig was then fabricated to achieve a safe and precise working path to the root canal. Endodontic procedures including access cavity preparation were performed using the physical tooth model and the guide jig. At the 7-month follow-up, the endodontically treated tooth showed complete periapical healing with no clinical signs and symptoms. This case report describes a novel method of endodontic treatment of an anomalous maxillary central incisor with the aid of a physical tooth model and a custom-made guide jig via 3D printing technique.