A novel anatomical ceramic root canal simulator for endodontic training

Introduction: Endodontic therapy is often complicated and technically demanding. The aim of this study was to develop a reproducible biomimetic root canal model for pre-clinical and postgraduate endodontic training. Material and Methods: A specific ceramic shaping technique (3D printing and slip casting of a root canal mould) was developed to reproduce canal systems with the desired shape and complexity using a microporous hydroxyapatite (HAp)-based matrix. The microstructural morphology, pore size and porosity, as well as the Vickers microhardness of the ceramic simulators (CS) were assessed and were compared with natural dentin and commercial resin blocks. The reproducibility of the root canal shapes was assessed using the Dice-Sorensen similarity index. Endodontic treatments, from refitting the access cavity to obturation, were performed on the CS. Each step was controlled by radiography. Results: Many properties of the CS were similar to those of natural dental roots, including the mineral component (HAp), porosity (20%, porous CS), pore size (3.4 +/- 2.6 mu m) and hardness (120.3 +/- 18.4 HV). Discussion: We showed that it is possible to reproduce the radio-opacity of a tooth and variations in root canal morphology. The endodontic treatments confirmed that the CS provided good tactile sensation during instrumentation and displayed suitable radiological behaviour. Conclusions: This novel anatomic root canal simulator is well suited for training undergraduate and postgraduate students in endodontic procedures.