Effect of Computer-Aided Navigation Techniques on the Accuracy of Endodontic Access Cavities: A Systematic Review and Meta-Analysis

SIMPLE SUMMARY: The endodontic access cavity is an essential step in the root canal treatment allowing the access and location of the root canal system. The inaccuracy during the endodontic access cavitie can lead to intraoperative complications such as missed root canals or root perforations, and hence affect the prognosis of the root canal treatment. The development of computer-aided static and dynamic navigation techniques has improved the accuracy of endodontic access cavities and root canal location; however, it is necessary a comparative analysis to clarify which of the computer-aided navigation system is more accurate. This systematic review and meta-analysis aims to clarify the root canal success rate using static and/or dynamic navigation systems compared to freehand accesses. ABSTRACT: The present systematic review and meta-analysis aims to determine the effect of computer-aided navigation techniques on the accuracy of endodontic access cavities. Materials and methods: A systematic literature review and meta-analysis of clinical studies, based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, was performed that evaluated the root canal location rate of computer-aided navigation techniques applied to endodontic access cavities. Four different databases were used to consult the literature: PubMed-Medline, Scopus, Cochrane, and Web of Science. After discarding duplicate articles and applying inclusion criteria, 14 articles were selected for qualitative analysis and 13 for quantitative analysis. Results: the root canal location success rate started at 98.1% (CI: 95.7–100%) of the cases performed through a computer-aided navigation technique. The prediction interval ranged from 93.3% to 100%. The meta-analysis did not detect heterogeneity between the combined studies (Q-test = 17.3; p = 0.185; I(2) = 25%). No statistically significant differences were found between computer-aided static navigation techniques (success rate: 98.5%) and computer-aided dynamic navigation techniques (success rate: 94.5%) (Q test = 0.57; p = 0.451), nor between in vitro studies (success rate: 96.2%) and in vivo studies (success rate: 100%) (Q test = 2.53; p-value = 0.112). An odds success ratio of 13.1 (CI: 95%; 3.48, 49.1) encourages the use of computer-aided navigation techniques over conventional endodontic access cavity procedures. Conclusions: the endodontic access cavities created using static and dynamic computer-aided navigation techniques are highly accurate in locating the root canal system.