Locating a root canal in a severely calcified tooth can be a delicate balancing act. Remove too little dentine, and the canal may remain elusive. Remove too much, and the clinician risks weakening the tooth or creating an unwanted deviation. In these cases, cone-beam computed tomography (CBCT)-based guided endodontics offers a more planned route to the canal—but how much difference does it make compared with conventional access?
A systematic review published in BMC Oral Health on 15 October 2026 has examined the evidence behind guided endodontic access, assessing its accuracy, efficiency, safety and ability to preserve tooth structure. The findings favour static guidance for several technical outcomes.
What does the evidence show?
The review searched PubMed/MEDLINE, Scopus, Web of Science Core Collection and Embase from their inception to 15 August 2026. The researchers included 79 eligible reports: 32 reports representing independent analytical studies and 47 contextual clinical or safety reports.
An important distinction emerged from this classification. Of the 32 analytical studies, 25 were non-clinical. The primary meta-analyses focused on static guidance, in which a digitally planned access path is transferred to the tooth using a physical guide. Evidence concerning dynamic navigation and robotic or haptic guidance was considerably more limited.
Static guidance was associated with less tooth-structure removal than conventional access. The pooled mean difference was −35.29 mm³, with a 95% confidence interval of −62.24 to −8.33 mm³. This suggests that guided access can help conserve dentine under the conditions studied.
The technique was also associated with shorter measured access or procedure time, with a pooled mean difference of −13.72 minutes (95% confidence interval −18.88 to −8.55 minutes).
Both findings are promising, but they require careful interpretation. Heterogeneity was very high for tooth-structure loss (I² = 98.2%) and moderate for procedure time (I² = 59.4%). The results therefore varied substantially across studies, and the pooled estimates should not be treated as guaranteed benefits in everyday practice.
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