Abstract
BackgroundRoot-end resection is an endodontic surgical intervention that requires high precision so that all ramifications and lateral canals so as infected tissues are eliminated. An exploratory study was conducted to justify the clinical safety and accuracy of guided root-end resection with a trephine.MethodsFourteen root-end resections were performed in 11 patients. With the aid of computer tomography and rapid prototyping a stereolithographically fabricated, tooth-supported surgical template was used to guide trephinations. Surgery was performed using the printed surgical stent and a trephine was used not only for the osteotomy but for the root end resection as well.ResultsThe root end was successfully and completely resected by the trephine in all cases. No intraoperative complications were observed in any of the cases, and the patients were free of symptoms indicating recurrence or complications at the 6-month follow-up. The median angular deviation of the trephination was 3.95° (95% CI: 2.1–5.9), comparable to the angular deviation of guided implant surgery. The mean apex removal error (ARE) was 0.19 mm (95% CI: 0.03–0.07). The mean osteotomy depth error (ODE) was 0.37 mm (95% CI: 0.15–1.35). Overpenetration was a characteristic finding, which indicates the necessity of a stop-trephine.ConclusionsWithin the limitations of this study, we conclude that our results support the use of guided trephination for root-end resection.
Highlights
Root-end resection is an endodontic surgical intervention that requires high precision so that all ramifications and lateral canals so as infected tissues are eliminated
The results of a meta-analysis suggested that the use of highpower magnification alone can elevate the success rate of endodontic microsurgical interventions to as high as 94% [1]
Relative and absolute contraindications of endodontic surgery counted as exclusion criteria, as well as any other condition that would have put the patient at unacceptable risk during or after surgery
Summary
Root-end resection is an endodontic surgical intervention that requires high precision so that all ramifications and lateral canals so as infected tissues are eliminated. Ultrasonic retrograde preparation with modern root-end filling materials, such as MTA (mineral trioxide aggregate) and bioceramics is superior to shallow cavity preparation with adhesive materials in terms of healing [4] All these innovations have been introduced to endodontic surgery in the last few decades, allowing more predictable outcomes. The challenge here is to direct the osteotomy in a way that allows the removal of the desired section as accurately as possible [5] - a goal that is extremely difficult to achieve solely via mental navigation For this reason, cone-beam computed tomography (CBCT) is considered to be essential before periapical surgical procedures [6]. This leaves plenty of room for error, and the profession has been on the search for further and better navigation aids for some time
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