Endodontic Microsurgery Using Dynamic Navigation and Trephine Burs

Abstract

Objectives: The use of the surgical operating microscope, CBCT imagining, biocompatible filling materials and ultrasonic instruments have improved the success and predictability of apical surgery. Despite these advances, more accurate and precise techniques for creating osteotomies and root-resections (apicoectomies) have not been widely adopted. This study highlights how dynamic navigation systems (DNS) can help avoid unnecessary dentin removal and “mitigate iatrogenic errors” such as root perforation. Methods: A total of 56 root-end resections were planned and completed on two sets of identical TrueJaw Endosurg models (DE Labs, Santa Barbra, CA, USA). One set of maxillary and mandibular jaws were used for 28 preparations, performed with a DNS (X-Guide, X-Nav Technologies, Lansdale, PA, USA). A second set of maxillary and mandibular jaws were used for 28 preparations executed freehand (FH), with pre-op measurements taken from a CBCT scan (CS 9600; Carestream, Atlanta, GA, USA). A Mann-Whitney test was used to compare the accuracy of the two groups Results: The average preparation depth was 10.77 mm. For the DNS group the average angular deviation was 2.35 degrees. The average deviation at the terminal end of the preparations was 0.96 mm (global apical deviation). For the freehand group average angular deviation was 13.55 degrees and the average global apical deviation was 2.62 mm. Significant differences were identified between the DNS and FH groups for angular deviation (p<0.05), apical non-depth deviation (p<0.05) and between the Global apical deviation(p<0.05). Conclusion: Dynamic navigation demonstrated superior accuracy and precision over freehand in the context of apical microsurgery preparations. This study provides further proof of concept for the application of DNS in Endodontics. Clinical significance: Apical surgery can be a daunting task for an endodontist. Surgical guides can make the procedure easier, but they take time and money to make. DNS virtual planning can be completed rapidly and may be altered mid-procedure. This inherent flexibility makes same-day guided apical surgeries practical and predictable.