Guided endodontic microsurgery in apicoectomy: a review.

The purpose of this review was twofold. The first aim was to show predictable protocols of guided endodontic microsurgery (EMS) and to describe its clinical outcomes. The second aim was to verify the accuracy of this technique compared to the traditional pathway. An electronic search of publications was established from two electronic databases, Cochrane and PubMed, by two independent researchers. The search strategy used a combination of controlled vocabulary and free-text words. Inclusion and exclusion criteria were defined by the authors before the start of the study. Inclusion criteria were: all studies published in English language; studies in vivo on humans; human cadaver studies; studies analyzing guided surgery in apicoectomy. The initial search yielded 67 citations, of which 10 were included. The studies included in this review analysis have shown two different technique both for digitization of dental arch and for surgical procedures too. Guided endodontic micro-surgery is a more predictable technique with less intra-operative and post-operative complications compared to the "freehand" technique and this procedure has shown a greater accuracy.

PRESS and Piezo Microsurgery (Bony Lid): A 7-Year Evolution in a Residency Program-Part 2: PRESS-Defined Site Location.

INTRODUCTION: Treatment of a failing endodontic procedure via microsurgical revision presents better outcomes due, in part, to the integration of the surgical operating microscope and cone-beam computed tomography into clinical practice. However, challenges still remain with respect to the operational locations and the techniques required to address them. Posterior sites, with substantial cortical plate thicknesses and sensitive anatomy, present the dichotomy of visualization versus postsurgical regeneration of bone. The bony lid technique bridges the gap between these 2 concepts, and the application of piezosurgery renders a precise and biocompatible osseous incision. The purpose of this article was to outline through case reports the progression of piezo-guided surgery in a resident setting. METHODS: The first 2 evolutions of the technique used a surgeon-defined method for site location. This third and final evolution uses a digital workflow to virtually plan the surgical procedure, integrating Standard Tessellation Language and Digital Imaging and Communication in Medicine files to create 3-dimensional guides with exacting resection locations, levels, and angles. Export of the virtually planned guide in postproduction generates the precision endodontic surgical stent to accurately define the site location and parameters of the procedure. All surgeries were executed using the piezosurgical method with increasing levels of guidance and precision throughout the evolution process. RESULTS: Each step in the technique implementation enabled the resident to assimilate a new technique and skill set while maintaining bone architecture and minimizing volume loss postoperatively. The patient benefits were an increase in intraoperative safety and postoperative comfort. The resident benefits were accelerated regeneration timetables and increases in the confidence level of the resident and the number of scheduled posterior surgical procedures. CONCLUSIONS: The progression from crude on-site measurements to elegant and precise surgical guides enabled the access and manipulations of difficult surgical sites without compromising visibility, postoperative osseous regeneration, or patient comfort.

PRESS and Piezo Microsurgery (Bony Lid): A 7-Year Evolution in a Residency Program Part 1: Surgeon-defined Site Location.

INTRODUCTION: Treatment of a failing endodontic procedure via microsurgical revision presents better outcomes due, in part, to the integration of the surgical operating microscope (SOM) and cone-beam computed tomography (CBCT) into clinical practice. But challenges still remain with respect to the operational locations and the techniques required to address them. Posterior sites, with substantial cortical plate thicknesses and sensitive anatomy, present the dichotomy of visualization versus postsurgical regeneration of bone. The bony lid technique bridges the gap between these 2 concepts, and the application of piezosurgery renders a precise and biocompatible osseous incision. The purpose of this paper was to outline, through case reports, the progression of piezo-guided surgery in a postgraduate resident setting. METHODS: The primary evolution of the bony lid technique relied on the transfer of measurements from defined landmarks in the CBCT volume to the cortical plate of the surgical site. The secondary evolution used the same measurement protocols transferred to a laboratory model of the patients' arch. A vacuformed stent was fabricated with pertinent fiducial markers in gutta percha defining the surgical site parameters, and a scan exposed with the stent in place. These 2 evolutions are designated as the surgeon-defined site location method and are explained in greater detail in this the first of 2 parts of the topic. All surgeries were executed using the piezosurgical method with increasing levels of guidance and precision throughout the evolution process. RESULTS: Each step in the technique implementation enabled the resident to assimilate a new technique and skill set while maintaining bone architecture and minimizing volume loss postoperatively. The patient benefits were an increase in intraoperative safety and postoperative comfort. The resident benefits were accelerated regeneration timetables, and increase in the confidence level of the resident and number of scheduled posterior surgical procedures. CONCLUSIONS: The progression from crude on-site measurements to elegant and precise surgical guides enabled the access and manipulations of difficult surgical sites without compromising visibility, postoperative osseous regeneration, or patient comfort.

Guided Modern Endodontic Surgery: A Novel Approach for Guided Osteotomy and Root Resection.

INTRODUCTION: Continuous improvements in techniques, instruments, and materials have established modern endodontic microsurgery as a state-of-the-art treatment method. The purpose of this approach was to introduce a new surgical endodontic technique by using a three-dimensional printed template for guided osteotomy and root resection. METHODS: A 38-year-old patient was diagnosed with periapical lesions of teeth #3 and #4 and extruded gutta-percha material. Three-dimensional radiographic and optical scan files were imported into surgical planning software designed for guided implant surgery. Within the adapted software program the periapical lesions and the extruded gutta-percha were visualized and marked. With the aid of virtually positioned surgical pins and piezoelectric instruments, the osteotomy size, the apical resection level, and the bevel angle were defined before treatment. Three-dimensional surgical templates for each tooth were designed within the software program for a guided treatment approach. RESULTS: This approach comprised the treatment of periapical lesions of teeth #3 and #4 with root-end fillings and the detection and complete removal of the extruded gutta-percha material without perforation of sinus membrane. There were no postoperative complications, and clinical and radiologic assessments verified complete healing of the teeth. CONCLUSIONS: The guided microsurgical endodontic treatment presented appears to be a viable technique that allows for predefined osteotomies and root resections.