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Advanced dentistry · Endodontics
Guided endodontics is a way of locating a root canal that has narrowed or calcified so far that it cannot be found by conventional means. At Sardinia House in Holborn, Dr Spencer Richman plans the path to the canal on a CBCT scan, and a 3D-printed guide made in-house directs the drill along it. It can save a tooth that would otherwise be extracted. Consultation £150.
Consultation
£150, including imaging
Treatment
Complex root canal from £1,250
Visits
Usually two: planning, then treatment
Made with
CBCT scan and SprintRay 3D printing
Who it is for
After a knock, years of wear or a previous restoration, a tooth can lay down hard tissue inside its canal until the space all but disappears on an X-ray. The nerve inside may still become infected and need treating.
Teeth are sometimes declared untreatable because the canal cannot be found, leaving extraction as the only option offered. A guide planned from a 3D scan can locate what the naked eye, and even the microscope, could not.
Front teeth injured in childhood often calcify and darken decades later. Because the guide follows a precise path, the opening is small and the tooth keeps its strength, which matters when it is on show.
Searching for a calcified canal freehand risks drilling through the side of the root. If a previous attempt has stalled, a guided approach can reach the canal along the one safe route that remains.
The difference
A CBCT scan shows where the remaining canal space lies within the root, even when it is a fraction of a millimetre wide. The intra-oral scan of your tooth is merged with it, so the plan sits exactly on your anatomy.
The planned drill path is designed on screen and turned into a guide that seats over your teeth. It is printed on our SprintRay printers in-house, so the time between planning and treatment is short.
The guide holds the drill at the planned angle and depth, so the access cavity is narrow and the healthy tooth around it is left alone. The tooth is weakened far less than it would be by searching freehand.
Once the canal has been reached, Dr Richman continues under the operating microscope to clean, shape and fill it as he would any root canal. The guide gets us to the canal; the microscope finishes the job.
The process
We examine the tooth, then take a CBCT image and a digital scan. If a canal is calcified and a guided approach is suitable, you receive a written plan with the fee before anything else is booked.
The two scans are merged and Dr Richman plans a drill path on screen from the surface of the tooth to the remaining canal, checking the angle and depth from every direction before it is approved.
The guide is printed on our SprintRay printer and checked against a printed model of your teeth, so that it seats firmly and does not move during treatment.
With the tooth numbed and isolated, the guide is seated and a fine drill follows the planned path to the canal. It usually takes a few minutes to reach what might otherwise have taken an hour, or not been possible at all.
The guide is removed and the treatment continues under the microscope: cleaning, shaping, filling and sealing. The tooth is then restored, often with a crown milled the same day on CEREC here.
Afterwards
Expect the tooth to be tender for a few days, as after any root canal treatment, and manage it with ordinary painkillers. Avoid hard chewing on the tooth until the final filling or crown is in place. Keep cleaning around it as normal. We review the tooth at your next check-up and, with an X-ray, check that the area around the root is healing.
Guide fees
Guide fees. Nothing is started until your plan, with every fee written down, is in your hands. See all fees
Who provides it
Good to know
It is root canal treatment in which a 3D-printed guide, planned from a CBCT scan, directs the drill to a canal that has narrowed or calcified. It uses the same principle as guided implant surgery, applied to finding a canal rather than placing an implant.
The consultation is £150 and includes the imaging. Treatment is quoted as a complex root canal, from £1,250, with any crown afterwards quoted separately. You receive the exact fee in writing once the scan has been assessed.
No more than conventional root canal treatment. The tooth is numbed and isolated before the guide is seated. Because the access is smaller and quicker, many people find it a shorter and less tiring appointment than a long search for the canal.
General dentists refer calcified canals when they cannot be located safely with conventional methods. Dr Richman's practice is limited to endodontics, and the CBCT scanner, microscope and 3D printers are all under one roof in Holborn, which is what makes a guided approach possible.
Not every one. The remaining canal needs to be visible on the CBCT scan, and there must be a safe straight path to it. If the scan shows that is not the case, we will say so and discuss the alternatives, which may include extraction.
Usually two. The first is the consultation and scans, after which the guide is designed and printed. The second is the treatment itself. If the tooth needs a crown, it can often be made and fitted on the same day as the treatment.
It is uncommon when the planning shows a clear path, but it can happen. The options are then surgical root canal treatment, which treats the root from its tip, or removing the tooth. We discuss these before treatment so there are no surprises.
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