Bony Lid Research Articles

Computer-Guided Bony Lid Approach and Micro-endodontic Surgical Approach for the Management of Maxillary Cysts

Computer-Guided Bony Lid Approach and Micro-endodontic Surgical Approach for the Management of Maxillary Cysts

Advances in the application of the bony window technique in endodontic microsurgery

The bony window technique refers to cutting the intact bone plate to form a bone window and a free bone block to get access to lesions under the bone. At the end of the surgery, the dislocated bony lid needs to be repositioned to its original position. In endodontic microsurgery, compared with conventional osteotomy, the bony window technique has the advantages of improving the view of surgery and operability, reducing postoperative bone defects, promoting bone healing, and maintaining the integrity of the jaw outline. Accurate positioning and preparation of the bony window are important prerequisites for subsequent operations during the surgery, but it's difficult in some situations, such as when the operative area is located posteriorly or the bone cortex on the lesion surface is thick and intact. What's more, whether the free bone block can be stabilized in situ after repositioning is closely related to the prognosis of the surgery. The complementary application of digital navigation technology and bone cavity filling materials may help to improve the bony window technique and provide more possibilities for the retention of affected teeth in difficult cases.

Endodontic Microsurgery of Mandibular Second Molars Using the Bony Lid Approach: A Case Series

Endodontic microsurgery is important for preservation of natural teeth with symptomatic apical periodontitis when conventional endodontic treatment is neither feasible nor effective. The thick buccal cortex, poor visibility, and potential neurovascular complications can make microsurgical procedures of mandibular second molars infeasible. With the aid of cone-beam computed tomography, the bony lid approach was applied in 10 cases of endodontic microsurgery of mandibular second molars at the VIP Center, Hangzhou Stomatology Hospital between 2019 and 2020. In all cases, the clinical and radiographic findings at the 24- or 36-month follow-up revealed complete healing of the periapical lesions. The bony lid technique contributed to precise root-end localization and helped avoid excessive postoperative pain or unfavorable healing that occurred in cases of excessive alveolar bone resection. Some clinical tips on preserving the cortical bone, obtaining precise access, and improving surgical efficiency have been proposed in this report.

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

IntroductionTreatment 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. MethodsThe 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. ResultsEach 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. ConclusionsThe 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 2: PRESS-Defined Site Location

IntroductionTreatment 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. MethodsThe 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. ResultsEach 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. ConclusionsThe 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.

Sinus lift, antral pseudocyst removal and horizontal bone augmentation using a bony lid - Case report

Purposes: Complex cases often require various treatment modalities that increase patients morbidity, treatment time and costs. In the present case we combined several techniques in order to perform a sinus lift, remove an antral pseudocyst and augment the site horizontally. Case report : A 69 year old female patient presented herself at our office looking for an oral rehabilitation solution. A need for sinus grafting as well a horizontal augmentation was noticed. An antral pseudocyst occupied a large portion of the right sinus. We removed a bony lid to access the sinus, aspirated the antral pseudocyst´s content and removed it through the Schneiderian membrane. After suturing it, the membrane was elevated, the sinus lift performed and the access window closed with a collagen membrane. The bony lid was used to augment the adjacent area. Implants were placed 4 months later. Conclusions : With the present method of treatment we were able to successfully perform a sinus lift, antral pseudocyst removal and bone augmentation, with a low morbidity, combined approach.

A conservative transnasal endoscopic and intraoral approach in a case of a maxillary dentigerous cyst

AbstractThe transoral approach for enucleation of a voluminous odontogenic lesion involving the maxillary sinus is considerably invasive and can cause irreversible damage to the ciliated mucosa with definitive loss of the normal bone morphology. Functional endoscopic sinus surgery (FESS), which increases the patency of the osteomeatal complex (OMC), involves the use of a direct approach to the lesion, facilitating the drainage of secretions and improving the ventilation. Nevertheless, FESS cannot completely enucleate large odontogenic cystic lesions, particularly dentigerous cysts associated with dislocated teeth. Accordingly, a combined transnasal endoscopic and transoral approach is desirable. Here, we report the successful use of FESS combined with a conservative intraoral approach for the treatment of a voluminous dentigerous cyst that completely occupied the maxillary sinus. In a single surgery, FESS was used to enlarge OMC and open the cystic compartment into the nasal cavity, while an intraoral approach involving the removal of a bony lid from the anterolateral wall of the maxillary sinus facilitated minimal removal of the cystic wall associated with the dislocated tooth. The bony lid was repositioned and fixed with titanium plates. Computed tomography performed at 6 months showed that the original cystic compartment, which maintained communication with the nasal cavity through the enlarged OMC, was absent, and that the sinus had recovered its healthy morphology. Computed tomography at 27 months showed the maintenance of this status with no signs of recurrence. We recommend this approach to eradicate such pathology while preserving the sinus structure and function.

The Buccal Lid Approach for Removal of Impacted Mandibular Molars—When, How and Why?

Background: The surgical removal of impacted mandibular molars represents one of the most prevalent procedures carried out by the oral and maxillofacial surgeon. Despite its prevalence, unusual impaction location of mandibular molars necessitates alternative extraction approaches. One of the methods described for extraction of deeply impacted molars is the bony lid approach which was first presented for surgical endodontic treatment of mandibular molars. The aim of this study was to evaluate the outcome of the bony lid approach in extracting mandibular molars. In addition, critical clinical key points, new aspects while performing this procedure, indications and contraindications are discussed. Materials and Methods: 9 patients were treated with the bony lid technique. A retrospective analysis of medical charts was conducted to evaluate the results of surgery. Results: The operative technique described in the article was successfully carried out in 12 cases of impacted mandibular molars. No incidence of permanent sensory deficit was recorded. In one patient, an infection mandated the removal of the bony lids. In all other cases the healing process was uneventful. Conclusion: The bony lid technique has many advantages over alternative extraction methods and should be considered as a treatment option in cases of critical proximity between an impacted tooth and the inferior alveolar nerve.

Strut grafts in revision hip arthroplasty faced with femoral bone defects: an experimental analysis

In total hip arthroplasty fixation of revision stems can be demanding due to femoral bone loss. Strut grafts are often used for bone augmentation and stabilization of the newly inserted prosthesis. The aim of this study was to assess the effect of strut grafts on primary stability under various stem fixation conditions. Two different revision stems (cylindrical and conical shape) were implanted into synthetic femora. Following a semicircular transfemoral osteotomy, three deficient femoral bearings were simulated (bony lid reattached with cable wires; weakened lid reattached with cable wires; strut grafts placed to the weakened lid with cable wires). Relative micro-movements were measured between prostheses and bones due to an axial moment applied to the stems. Relative movements correlated to the stem shape. The cylindrical stem showed higher movements increasing significantly with a weakened bony lid and portrayed a slight decrease of movements with strut graft application. No unequivocal influence of the weakened lid could be detected for the conical implant. Strut graft application did not show an additional stabilizing effect. The primary stability of the cylindrical fixation concept decreases with impaired fixation conditions of the femur. A clear restabilizing effect with strut grafts could not be proven. A decrease of primary stability due to the impaired bone could not be observed for the conical stem shape. Additionally, strut grafts do not enhance fixation for this stem shape. We conclude that surgeons should not rely on a stabilizing effect of strut grafts in revision hip surgery.

Application of Modified Bony Lid Technique to Remove or Replace Compromised Implants

The original bony lid technique involves removing window of cortical bone using a microsaw, removing a failing implant through the window, and then replacing the bone into its original position. The purpose of this case series was to present modifications to the bony lid technique to improve outcomes. Ten patients (9 men and 1 woman) aged between 47 and 89 years were treated during a 5-year period with modifications to the bony lid technique. Modifications to the bony lid technique included restricting the size of the bony lid, use of a long shank drill, performing guided bone regeneration, immediate implant placement, and providing rigid fixation. No complications occurred in the 10 cases presented in this case series. An immediate implant placement procedure was performed in 3 of the 10 patients treated. Fixation screws and a microplate were used to fix the bony lid in 1 patient. Allogenic bone was used in another case. Additional trephine and thin drills were used in 2 cases in the mandibular molar area. Replacing failing dental implants can be successfully accomplished by removing cortical bone on the buccal aspect of the implant and then replacing this bone after the implant is removed or replaced. Using allogenic bone, fixation screws, microplates, and thin drills can help facilitate the success of this procedure.

P45 A conservative method for removal of osseointegrated dental implants – the bony lid technique

P45 A conservative method for removal of osseointegrated dental implants – the bony lid technique

Buccal Bone Plate Thickness of the Asian People

Distances from the apex to the buccal bone plate were measured on the computed tomography (CT) images of 1806 teeth from 66 patients, using an image analyzer program (Image-Pro Plus, Ver. 4.0, Media Cybernetics). In the mandible, the mean distance from the distal apex of the mandibular second molar to the buccal bone plate was the largest distance measured, at 8.51 mm, followed by distance from the mesial root to the buccal bone (7.34 mm). In the mandibular first molar, the mean distal and mesial bone thicknesses were 5.18 mm and 4.09 mm, respectively. However, when there were two distal roots, the distance of the disto-lingual root to the buccal plate was found to be 9.52 mm, which constitutes the greatest measured thickness. In the maxillary buccal roots, the distances from the mesio-buccal and disto-buccal root of the second molar to the buccal bone plate were the largest, at 4.63 mm and 3.61 mm, respectively. The average distances from the palatal apex of the maxillary first and second molars to the buccal bone plate were 10.69 mm and 10.17 mm, respectively, while, from the palatal bone plate, average distances of 3.15 mm and 3.08 mm were measured. Special considerations, such as bony lid approach, lingual approach, or intentional replantation may be required, especially when a patient has a surgical need in the second molars and the disto-lingual root of the mandibular first molar, or in the palatal root of the maxillary molars.

Fashioning of an Anterolateral Femoral Bony Lid for Revision Hip Arthroplasty

Objective Safe removal of a loosened or broken femoral stem together with cement particles and soft tissues. Preparation of the implant bed under direct vision and exact fitting of the new stem. Restoration of pain-free hip motion.

A modified technique of harvesting tibial cancellous bone and its use for sinus grafting.

Autogenous bone is the gold standard graft for sinus augmentation. The harvest of autogenous bone grafts from intraoral sites does often not provide sufficient bone volume and quality. A modified technique of harvesting a tibial cancellous graft is presented. With a micro-bone saw, a bony lid is prepared at the medial condyle of the tibia. The lid stays attached to the tendinous pes anserinus. Following the harvest, the lid is repositioned accurately. This method offers some distinct advantages. A sufficient amount of biologically highly valuable cancellous bone may be harvested for sinus grafting and possibly other surgeries with bone augmentation. The procedure may be performed under local anaesthesia and does not require hospitalisation. Neither major complications nor serious postoperative morbidity were observed.

An effective extraoral approach to the mandible: A technical note

A bony lid technique is described for enucleation of a large ameloblastic fibro-odontoma, encroaching on the left ramus of the mandible in a 5-year-old boy. There was excellent postoperative remodelling and the patient has been followed up for a period of two years. The advantages of the technique are discussed, with a note on the lesions that may be treated by this method.

Bony lid approach for apicoectomy of mandibular molars

Apicoectomy in the lower molar region is indicated in many instances to avoid the need for prosthetic appliances. Nevertheless it is a method sometimes rejected by oral surgeons because of the thickness of the buccal compact bone in the lower molar area leading to extensive bone loss in addition to a restriction of vision and access during the operation. The present study reports twenty-four cases of apicoectomized mandibular molars treated with the bony lid approach which facilitates considerably the apicoectomy procedure. Once part of the buccal compact bone in the periapical area of the molars is removed, favourable conditions are created for the completion of the operation under direct vision of the operational field. The replacement of the buccal compact bone then minimizes the dimensions of the remaining bone cavity.

The bony lid approach for the apical root resection of lower molars

The apical root resection of mandibular molars is an operation seldom performed and then one limited primarily to the lower first molars. Although the first paper on this topic was published at the beginning of the 20th century, little progress has been observed since then. This is due to the thickness of the buccal bony plate in the lower molar region which makes surgery very difficult and leads to a substantial loss of bone. The resultant limitation of the operating field prevents good vision. The aim of our approach is to minimize or to eliminate these problems by opening a bony lid above the roots which are to be resected. This can be made large enough for the surgeon to have easy access and good vision during apical surgery. At the end of the operation the same lid is replaced in order to avoid a bony defect and to facilitate the healing process. Of the 75 patients treated using this technique during a 3-year period, only one post-operative complication has been observed. A complete healing of the bone was observed in the majority of cases within 6 months.