A Fully In‐House Digital Workflow for Static Guided Endodontic Access in Post‐Traumatic Pulp Canal Obliteration

ABSTRACT

Pulp canal obliteration is a recognized sequela of traumatic dental injury and may represent a reparative pulpal response. Although pulp canal obliteration itself does not indicate endodontic treatment, pulp necrosis and apical periodontitis may subsequently develop, creating a technically challenging access problem in severely obliterated canals. Static guided endodontics provides a means of transferring a virtually planned access trajectory to the clinical setting. This article reviews the biological and clinical considerations of post‐traumatic pulp canal obliteration and the development of static guided endodontics, and describes a fully in‐house digital workflow integrating commercially available dental design applications with general‐purpose three‐dimensional mesh‐editing software. The workflow is clinically illustrated in a 57‐year‐old woman with a maxillary right central incisor (Tooth 11) showing post‐traumatic pulp canal obliteration, pulp necrosis, asymptomatic apical periodontitis, and crown discoloration approximately 50 years after the original injury. The geometry of the actual small‐diameter endodontic bur was directly measured and reproduced virtually for patient‐specific trajectory and guide design. Two sequential guides were fabricated in‐house and used to access the residual canal, followed by root canal treatment and internal bleaching. This approach illustrates how established digital concepts can be integrated into a clinician‐directed, fully in‐house workflow for managing technically challenging endodontic access in post‐traumatic pulp canal obliteration.