A Narrative Review on Guided Endodontics: Novel Treatment Approach for Teeth with Pulp Canal Calcification

Abstract

Pulp canal calcification (PCC), also referred to as pulp canal obliteration or calcific metamorphosis, represents one of the most formidable challenges in contemporary endodontic practice. The progressive deposition of mineralised tissue within the root canal system renders conventional access cavity preparation and canal negotiation technically demanding, time-consuming, and associated with an elevated risk of iatrogenic complications, including root perforation. Guided endodontics has emerged as an innovative digital workflow that integrates cone beam computed tomography (CBCT) data with digital surface scanning to fabricate patient-specific drill guides, enabling precise and minimally invasive access to calcified root canals. This narrative review comprehensively evaluates the current evidence base for guided endodontics, encompassing its conceptual framework, digital workflow, technical execution, clinical accuracy, dentinal substance preservation, and the inherent limitations of the technique. A structured search of major electronic databases was conducted, incorporating studies published between 2005 and 2026, supplemented by seminal older literature. The review examines the aetiology and pathophysiology of PCC, outlines diagnostic challenges, and critically appraises both static guide-based and dynamic real-time navigation modalities of guided access. Evidence indicates that guided endodontics affords significantly improved accuracy of canal location and substantially reduced iatrogenic dentinal removal compared with conventional approaches, particularly in severely calcified anterior teeth. Nevertheless, the technique demands a sophisticated digital infrastructure, carries cumulative procedural errors from each step of the workflow, and is associated with higher costs and a considerable learning curve. Future developments integrating artificial intelligence-assisted planning, augmented reality navigation, and refined guide fabrication materials hold considerable promise for broader clinical application. Overall, guided endodontics represents a paradigm shift in the management of calcified root canals, with growing evidence supporting its role as a reliable, tooth-conserving treatment modality.