Restorative Dentistry and Endodontics

The Korean Academy of Conservative Dentistry (대한치과보존학회)
권호 표지
DOI QR코드

DOI QR Code

The application of "bone window technique" using piezoelectric saws and a CAD/CAM-guided surgical stent in endodontic microsurgery on a mandibular molar case

  • Kim, Ukseong (Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry) ;
  • Kim, Sunil (Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry) ;
  • Kim, Euiseong (Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry)
  • Received : 2019.12.02
  • Accepted : 2020.02.25
  • Published : 2020.08.31
Download PDF
⟨ Previous Next ⟩

Abstract

Apical surgery for a mandibular molar is still challenging for many reasons. This report describes the applications of computer-guided cortical 'bone-window technique' using piezoelectric saws that prevented any nerve damage in performing endodontic microsurgery of a mandibular molar. A 49-year-old woman presented with gumboil on tooth #36 (previously endodontically treated tooth) and was diagnosed with chronic apical abscess. Periapical lesions were confirmed using cone-beam computed tomography (CBCT). Endodontic microsurgery for the mesial and distal roots of tooth #36 was planned. Following the transfer of data of the CBCT images and the scanned cast to an implant surgical planning program, data from both devices were merged. A surgical stent was designed, on the superimposed three-dimensional model, to guide the preparation of a cortical window on the buccal side of tooth #36. Endodontic microsurgery was performed with a printed surgical template. Minimal osteotomy was required and preservation of the buccal cortical plate rendered this endodontic surgery less traumatic. No postoperative complications such as mental nerve damage were reported. Window technique guided by a computer-aided design/computer-aided manufacture based surgical template can be considerably useful in endodontic microsurgery in complicated cases.

Keywords

References

  1. Kang M, Jung HI, Song M, Kim SY, Kim HC, Kim E. Outcome of nonsurgical retreatment and endodontic microsurgery: a meta-analysis. Clin Oral Investig 2015;19:569-582. https://doi.org/10.1007/s00784-015-1398-3
  2. Gorni FG, Gagliani MM. The outcome of endodontic retreatment: a 2-yr follow-up. J Endod 2004;30:1-4. https://doi.org/10.1097/00004770-200401000-00001
  3. Setzer FC, Shah SB, Kohli MR, Karabucak B, Kim S. Outcome of endodontic surgery: a meta-analysis of the literature--part 1: comparison of traditional root-end surgery and endodontic microsurgery. J Endod 2010;36:1757-1765. https://doi.org/10.1016/j.joen.2010.08.007
  4. Kim S, Kratchman S. Modern endodontic surgery concepts and practice: a review. J Endod 2006;32:601-623. https://doi.org/10.1016/j.joen.2005.12.010
  5. Song M, Kim SG, Lee SJ, Kim B, Kim E. Prognostic factors of clinical outcomes in endodontic microsurgery: a prospective study. J Endod 2013;39:1491-1497. https://doi.org/10.1016/j.joen.2013.08.026
  6. Zhou W, Zheng Q, Tan X, Song D, Zhang L, Huang D. Comparison of mineral trioxide aggregate and iRoot BP Plus Root Repair Material as root-end filling materials in endodontic microsurgery: a prospective randomized controlled study. J Endod 2017;43:1-6. https://doi.org/10.1016/j.joen.2016.10.010
  7. Kim S, Jung H, Kim S, Shin SJ, Kim E. The influence of an isthmus on the outcomes of surgically treated molars: a retrospective study. J Endod 2016;42:1029-1034. https://doi.org/10.1016/j.joen.2016.04.013
  8. von Arx T, Hanni S, Jensen SS. Correlation of bone defect dimensions with healing outcome one year after apical surgery. J Endod 2007;33:1044-1048. https://doi.org/10.1016/j.joen.2007.06.010
  9. Sisk AL, Hammer WB, Shelton DW, Joy ED Jr. Complications following removal of impacted third molars: the role of the experience of the surgeon. J Oral Maxillofac Surg 1986;44:855-859. https://doi.org/10.1016/0278-2391(86)90221-1
  10. Pinsky HM, Champleboux G, Sarment DP. Periapical surgery using CAD/CAM guidance: preclinical results. J Endod 2007;33:148-151. https://doi.org/10.1016/j.joen.2006.10.005
  11. Strbac GD, Schnappauf A, Giannis K, Moritz A, Ulm C. Guided modern endodontic surgery: a novel approach for guided osteotomy and root resection. J Endod 2017;43:496-501. https://doi.org/10.1016/j.joen.2016.11.001
  12. Song M, Kim SG, Shin SJ, Kim HC, Kim E. The influence of bone tissue deficiency on the outcome of endodontic microsurgery: a prospective study. J Endod 2013;39:1341-1345. https://doi.org/10.1016/j.joen.2013.06.036
  13. Gutmann JL, Harrison JW. Posterior endodontic surgery: anatomical considerations and clinical techniques. Int Endod J 1985;18:8-34. https://doi.org/10.1111/j.1365-2591.1985.tb00415.x
  14. Capuzzi P, Montebugnoli L, Vaccaro MA. Extraction of impacted third molars. A longitudinal prospective study on factors that affect postoperative recovery. Oral Surg Oral Med Oral Pathol 1994;77:341-343. https://doi.org/10.1016/0030-4220(94)90194-5
  15. Mora MA, Chenin DL, Arce RM. Software tools and surgical guides in dental-implant-guided surgery. Dent Clin North Am 2014;58:597-626. https://doi.org/10.1016/j.cden.2014.04.001
  16. Floratos S, Kim S. Modern endodontic microsurgery concepts: a clinical update. Dent Clin North Am 2017;61:81-91. https://doi.org/10.1016/j.cden.2016.08.007
  17. Blumenthal NM. A clinical comparison of collagen membranes with e-PTFE membranes in the treatment of human mandibular buccal class II furcation defects. J Periodontol 1993;64:925-933. https://doi.org/10.1902/jop.1993.64.10.925
  18. Seibert JS. Reconstruction of deformed, partially edentulous ridges, using full thickness onlay grafts. Part I. Technique and wound healing. Compend Contin Educ Dent 1983;4:437-453.
  19. Rasmusson L, Meredith N, Kahnberg KE, Sennerby L. Effects of barrier membranes on bone resorption and implant stability in onlay bone grafts. An experimental study. Clin Oral Implants Res 1999;10:267-277. https://doi.org/10.1034/j.1600-0501.1999.100403.x