Accuracy of Static Guided Endodontic Access in Pulp Canal Obliteration: Influence of Sleeve Design on Clinical Precision

OBJECTIVES: Pulp canal obliteration (PCO) presents a major challenge in endodontic treatment due to canal calcification, which complicates canal localization and increases the risk of errors during freehand access (FHA). Static guided endodontic access (SGEA) has been introduced to improve accuracy; however, the influence of guide sleeve design, particularly material and height, remains unclear. METHODS: This in vitro study used 48 standardized 3D-printed maxillary central incisors with simulated PCO. Tooth-supported guides with titanium, cobalt-chromium (CoCr), and zirconia sleeves at heights of 3, 5, and 7 mm were evaluated, with FHA as control. Pre- and post-operative CBCT scans were superimposed to measure coronal and apical deviation and access cavity volume. Data were analysed using 1-way ANOVA with Bonferroni post hoc tests (α = 0.05). RESULTS: Guided access showed significantly lower coronal and apical deviations than FHA, especially in labial-lingual directions (p < .001). Increased sleeve height improved directional control, with 7 mm sleeves showing the lowest deviations. Sleeve material showed no consistent effect. Guided techniques also enabled more controlled dentin removal. CONCLUSIONS: SGEA improves accuracy and procedural control compared with FHA in simulated PCO. Sleeve height plays a more critical role than material. CLINICAL RELEVANCE: Guided endodontics enhances precision, supports conservative dentin removal, and reduces iatrogenic risk, with sleeve height as a key factor.