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Martinho FC, Bisi BG, Gavini G, Griffin IL, Tordik PA. Comparison of the Accuracy and Efficiency of Two Dynamic Navigation System Workflow for Fiber-Post Removal: Small versus Large Field-of-View Registration Workflows. J Endod 2024:S0099-2399(24)00363-7. [PMID: 38945199 DOI: 10.1016/j.joen.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/18/2024] [Accepted: 06/21/2024] [Indexed: 07/02/2024]
Abstract
INTRODUCTION This study investigates the feasibility of a dynamic navigation system (DNS) small field of view workflow (DNS-SFOVw) for fiber-post removal and compares its accuracy and efficiency to the conventional large field of view workflow (DNS-LFOVw). METHODS Fifty-six extracted human maxillary molars were divided into DNS-SFOVw (n=28) and DNS-LFOVw (n=28). The palatal canal was restored with an intra-radicular RelyX fiber post and luted with RelyX Unicem; a core buildup was used. Teeth were mounted in a 3D-printed surgical jaw. A preoperative cone-beam-computed tomography (CBCT) scan was taken with a 40 x 40 mm FOV for the DNS-SFOVw and a single arch CBCT scan for the DNS-LFOVw. The drilling entry point, trajectory, angle, and depth were planned in the X-guide software. The DNS registration method for the DNS-SFOVw was virtual-based registration on teeth, and the marker point-based method was used for the DNS-LFOVw. The fiber posts were drilled out under DNS guidance. A postoperative CBCT scan was taken. Three-dimensional (3D) deviations, angular deflection, number of mishaps, registration, and total operation time were calculated. RESULTS The DNS-SFOVw was as accurate as DNS-LFOVw (p>.05). The DNS-LFOVw registration time was less than DNS-SFOVw (p<.05). There was no difference in the number of mishaps (p>.05). Both DNS-SFOVw and DNS-LFOVw were time-efficient, with DNS-LFOVw taking less total operational time (p<.05). CONCLUSION Within the limitations of this in-vitro study, the DNS-SFOVw was as accurate as the DNS-LFOVw for fiber-post removal. Both DNS-LFOVw and DNS-SFOVw were time-efficient in removing fiber-posts.
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Affiliation(s)
- Frederico C Martinho
- Clinical Professor - Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry - Baltimore - Maryland.
| | - Bruno G Bisi
- Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil; and Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry - Baltimore - Maryland
| | - Giulio Gavini
- Clinical Professor - Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Ina L Griffin
- Clinical Assistant Professor - Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry - Baltimore - Maryland
| | - Patricia A Tordik
- Clinical Professor - Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry - Baltimore - Maryland
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La Rosa GRM, Peditto M, Venticinque A, Marcianò A, Bianchi A, Pedullà E. Advancements in guided surgical endodontics: A scoping review of case report and case series and research implications. AUST ENDOD J 2024. [PMID: 38887152 DOI: 10.1111/aej.12865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 05/15/2024] [Accepted: 06/08/2024] [Indexed: 06/20/2024]
Abstract
This scoping review examined current case series and reports on guided surgical endodontic applications in order to provide a critical platform for future research. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews guidelines were followed. A search on PubMed and Scopus yielded 611 articles, with 17 case reports and 1 series meeting inclusion criteria. Overall, guided surgery addressed anatomical complexities, with 15 articles employing static protocols and 3 dynamic. Results showed minimal iatrogenic errors and reduced chair time, with no postoperative issues reported. Within the cases described, guided endodontic surgery exhibited satisfactory results in management of anatomical complex cases. Cost-effectiveness, the need for adequate follow-up, procedure's reproducibility and accuracy, and objective measurement of the reduction in operative times and iatrogenic errors are some of the limitations in the current reports that need to be considered for planning of future experimental and cohort studies.
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Affiliation(s)
- Giusy Rita Maria La Rosa
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Matteo Peditto
- Postgraduate School of Oral Surgery, Department of Biomedical, Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Andrea Venticinque
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Antonia Marcianò
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alberto Bianchi
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Eugenio Pedullà
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
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Isufi A, Hsu TY, Chogle S. Robot-Assisted and Haptic-Guided Endodontic Surgery: A Case Report. J Endod 2024; 50:533-539.e1. [PMID: 38280513 DOI: 10.1016/j.joen.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 12/10/2023] [Accepted: 01/15/2024] [Indexed: 01/29/2024]
Abstract
There has been a significant increase in robot-assisted dental procedures in the past decade, particularly in the area of robot-assisted implant placement. The objective of this case report was to assess the initial use of the Yomi Robot's assistance and haptic guidance during endodontic microsurgery. The robot was used during the osteotomy and root-end resection of the first and second upper left premolars. The report aims to inform clinicians of the initial implementation of this cutting-edge technology in endodontics and its potential to enhance endodontic microsurgery. The Yomi Robot was used in performing osteotomy and root-end resection during apical surgery in a patient presenting with symptomatic upper left first and second premolars. The treatment procedure was decided after clinical examination, chart data, and radiographic examinations, which showed periapical lesions on both premolars, taking into consideration the failed endodontic retreatment on the first premolar, the post and ceramic coronal restorations on both teeth, and the desire of the patient to save them. The Yomi Robot system provides auditory, visual, and physical guidance to clinicians during surgery while using a cone-beam computed tomography scan for precision planning with greater accuracy and minimized potential for human error. Further studies are needed to prepare a protocol for robotic-guided procedures in endodontics.
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Affiliation(s)
- Almira Isufi
- Department of Endodontics, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts.
| | - Tun-Yi Hsu
- Department of Endodontics, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts
| | - Sami Chogle
- Department of Endodontics, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts
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4
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Mon A, Kim ME, Kum KY, Kwon HB. 3D finite element analysis of stress distribution on the shape of resected root-end or with/without bone graft of a maxillary premolar during endodontic microsurgery. J Dent Sci 2024; 19:837-845. [PMID: 38618133 PMCID: PMC11010716 DOI: 10.1016/j.jds.2023.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/29/2023] [Indexed: 04/16/2024] Open
Abstract
Background/purpose Apical root resection pattern affects the stress distribution behavior in the apical region of the resected tooth. The purpose of the study was to compare the biomechanical responses of resected teeth between endodontic microsurgery (horizontal resection) and targeted endodontic microsurgery (round resection). Materials and methods Five different models were developed. The basic model without resection (NR) was regarded as the control model, and the others involved: horizontal resection without bone grafting (HN), horizontal resection with bone grafting (HG), round resection without bone grafting (RN), and round resection with bone grafting (RG) models. A static load of 100 N was applied to the buccal and palatal cusps of all the teeth in a 30° oblique direction. The maximum von-Mises stress and tooth displacement values were analyzed and compared. Results Both the HN and RN models exhibited lower stress distribution values on bone compared with the NR (control) model. Regarding maximum stress distribution at the root apex, the stress value of the RN model was slightly higher compared to the HN model, whereas the RG model displayed a slightly lower stress value in comparison with the HG model. For maximum tooth displacement value, there were no significant differences between the HN and RN models, as well as the HG and RG models. Conclusion The round resection pattern had comparable stress distribution behaviors at the root apex and tooth displacement values with the horizontal resection pattern. Targeted endodontic microsurgery might provide better biomechanical response of the resected tooth after root-end resection.
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Affiliation(s)
- Aein Mon
- Dental Research Institute and Department of Prosthodontics, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Mi-El Kim
- Dental Research Institute and Department of Oral Anatomy, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Kee-Yeon Kum
- Dental Research Institute and Department of Conservative Dentistry, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Ho-Beom Kwon
- Dental Research Institute and Department of Prosthodontics, School of Dentistry, Seoul National University, Seoul, Republic of Korea
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Jeong M, Kwon DH, Lee SJ. Computer guided root tip extraction and implant placement: A clinical report. J Prosthet Dent 2024:S0022-3913(23)00832-6. [PMID: 38185591 DOI: 10.1016/j.prosdent.2023.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 01/09/2024]
Abstract
Extraction of a residual root tip and implant placement can be challenging because of the complexity and invasiveness of the procedure. Improvised application of a guided implant surgery may avoid such challenges. This clinical report presents an innovative technique combining a 3-dimensionally printed surgical guide with conventional instrumentation for a residual root tip extraction in a minimally invasive and predictable way.
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Affiliation(s)
- Min Jeong
- Graduate student, Advanced Graduate Prosthodontics, Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Mass
| | - David H Kwon
- Commander, Department of Periodontics, Fort Meade DENTAC, Fort George G. Meade, Md
| | - Sang J Lee
- Associate Professor, Advanced Graduate Prosthodontics, Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Mass.
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Wei X, Du Y, Zhou X, Yue L, Yu Q, Hou B, Chen Z, Liang J, Chen W, Qiu L, Huang X, Meng L, Huang D, Wang X, Tian Y, Tang Z, Zhang Q, Miao L, Zhao J, Yang D, Yang J, Ling J. Expert consensus on digital guided therapy for endodontic diseases. Int J Oral Sci 2023; 15:54. [PMID: 38052782 DOI: 10.1038/s41368-023-00261-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/12/2023] [Accepted: 11/12/2023] [Indexed: 12/07/2023] Open
Abstract
Digital guided therapy (DGT) has been advocated as a contemporary computer-aided technique for treating endodontic diseases in recent decades. The concept of DGT for endodontic diseases is categorized into static guided endodontics (SGE), necessitating a meticulously designed template, and dynamic guided endodontics (DGE), which utilizes an optical triangulation tracking system. Based on cone-beam computed tomography (CBCT) images superimposed with or without oral scan (OS) data, a virtual template is crafted through software and subsequently translated into a 3-dimensional (3D) printing for SGE, while the system guides the drilling path with a real-time navigation in DGE. DGT was reported to resolve a series of challenging endodontic cases, including teeth with pulp obliteration, teeth with anatomical abnormalities, teeth requiring retreatment, posterior teeth needing endodontic microsurgery, and tooth autotransplantation. Case reports and basic researches all demonstrate that DGT stand as a precise, time-saving, and minimally invasive approach in contrast to conventional freehand method. This expert consensus mainly introduces the case selection, general workflow, evaluation, and impact factor of DGT, which could provide an alternative working strategy in endodontic treatment.
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Affiliation(s)
- Xi Wei
- Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua, School of Stomatology, Sun Yat-Sen University & Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Yu Du
- Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua, School of Stomatology, Sun Yat-Sen University & Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lin Yue
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Qing Yu
- Department of Operative Dentistry & Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Benxiang Hou
- Department of Endodontics, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Zhi Chen
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Jingping Liang
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Clinical Research Center for Oral Diseases; National Center for Stomatology; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Wenxia Chen
- College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, China
| | - Lihong Qiu
- Department of Endodontics, School of Stomatology, China Medical University, Shenyang, China
| | - Xiangya Huang
- Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua, School of Stomatology, Sun Yat-Sen University & Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Liuyan Meng
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Dingming Huang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiaoyan Wang
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Yu Tian
- Department of Operative Dentistry & Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Zisheng Tang
- Department of Stomatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qi Zhang
- Department of Endodontics, Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China
| | - Leiying Miao
- Department of Cariology and Endodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jin Zhao
- Department of Endodontics, First Affiliated Hospital of Xinjiang Medical University, and College of Stomatology of Xinjiang Medical University, Urumqi, China
| | - Deqin Yang
- Department of Endodontics, Stomatological Hospital of Chongqing Medical University, Chongqing, China
| | - Jian Yang
- Department of Endodontics, The Affiliated Stomatological Hospital of Nanchang University, Nanchang, China
| | - Junqi Ling
- Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua, School of Stomatology, Sun Yat-Sen University & Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China.
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Martinho FC, Griffin IL, Tordik PA. Piezoelectric Device and Dynamic Navigation System Integration for Bone Window-Guided Surgery. J Endod 2023; 49:1698-1705. [PMID: 37804944 DOI: 10.1016/j.joen.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/06/2023] [Accepted: 09/26/2023] [Indexed: 10/09/2023]
Abstract
INTRODUCTION This study investigates the feasibility of integrating a piezoelectric device (PIEZO) into a dynamic navigation system (DNS) for bone-window guided surgery. It compares the accuracy and efficiency of PIEZO + DNS to PIEZO + Freehand (FH) procedure for bone-window cutting and root-end resection (RER). METHODS Forty-eight mandibular molars of 3D-printed surgical jaw models were divided into two groups: PIEZO + DNS (n = 24) and PIEZO + FH (n = 24). Cone-beam computed tomography scans were taken before and after the procedure. The procedure was virtually planned on X-guide software. The bone-window cutting and RER were conducted with a PIEZO under dynamic navigation in the PIEZO + DNS group and using the dental operating microscope in the PIEZO + FH group. The 2D- and 3D-accuracy deviations and angular deflection were measured for the bone window cut. The root length resected and resection angle were calculated. The bone window cut, RER, total operating time, and number of mishaps were recorded. RESULTS PIEZO + DNS was more accurate than PIEZO + FH for bone-window cutting, showing fewer 2D and 3D deviations and less angular deflection (P < .05). The resection angle was lower in the PIEZO + DNS (P < .05). The bone-window cut and total operating time were significantly reduced using a DNS (P < .05). There was no difference in the number of mishaps (P > .05). CONCLUSIONS Within the limitations of this in vitro study, the integration of a PIEZO into a DNS is feasible for bone-window guided surgery. The DNS improved the accuracy and efficiency of bone-window cutting.
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Affiliation(s)
- Frederico C Martinho
- Clinical Professor, Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland.
| | - Ina L Griffin
- Clinical Assistant Professor, Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland
| | - Patricia A Tordik
- Clinical Professor, Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland
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Zhao D, Xie W, Li T, Wang A, Wu L, Kang W, Wang L, Guo S, Tang X, Xie S. New-designed 3D printed surgical guide promotes the accuracy of endodontic microsurgery: a study of 14 upper anterior teeth. Sci Rep 2023; 13:15512. [PMID: 37726360 PMCID: PMC10509208 DOI: 10.1038/s41598-023-42767-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 09/14/2023] [Indexed: 09/21/2023] Open
Abstract
We aimed to design a novel three-dimensional (3D) printed surgical guide and evaluate its accuracy in assisting endodontic microsurgeries. A new 3D printed surgical guide was designed by computer-aided design and computer-aided manufacturing (CAD/CAM) technology and applied to 7 patients who underwent endodontic microsurgeries of upper anterior teeth from 2020.01 to 2020.12 as the experimental group. 7 patients who suffered from endodontic microsurgeries operated by the same surgeon without using the surgical guide from 2019.01 to 2019.12 were selected as the control group. Cone beam computed tomography (CBCT) was performed more than 12 months after operation, and the accuracy of apical resection was compared between the two groups. The accuracy of the microsurgery focused on the length and angle of the root apical resection. In the study, CBCT data and oral digital scanning data were used to reconstruct 3D models of periapical lesions with soft and hard tissue information, based on which we designed the new 3D printed surgical guides. The guides were successfully applied to the apectomy in endodontic microsurgeries. The deviation of the apical resection length of the experimental group (0.467 ± 0.146 mm) was better than that of the control group (1.743 ± 0.122 mm) (P < 0.0001), and the deviation of the apical resection angle of the experimental group (9.711 ± 3.593°) was significantly less than that of the control group (22.400 ± 3.362°) (P < 0.0001). The 3D-printed surgical guide could effectively guide endodontic microsurgery and improve its accuracy by fixing both the position and the angle of apectomy. The new type of surgical guide could accurately localize the root apex and guide the apical resection.
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Affiliation(s)
- Dan Zhao
- Department of Endodontics, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Weige Xie
- Department of Endodontics, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Tianguo Li
- Department of Endodontics, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Anqi Wang
- Nanjing Tongren Hospital, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Li Wu
- Department of Endodontics, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Wen Kang
- Department of Endodontics, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Lu Wang
- Nantong Stomatological Hospital, The Affiliated Nantong Stomatological Hospital of Nantong University, Nantong, 226000, Jiangsu, People's Republic of China
| | - Shiliang Guo
- Department of Endodontics, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Xuna Tang
- Department of Endodontics, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Sijing Xie
- Department of Endodontics, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, Jiangsu, People's Republic of China.
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Martinho FC, Rollor C, Westbrook K, Aldahmash SA, Fay GG, Rivera E, Parsa A, Price JB, Tordik PA. A Cadaver-based comparison of Sleeve-Guided Implant-drill and Dynamic Navigation Osteotomy and Root-end Resections. J Endod 2023:S0099-2399(23)00288-1. [PMID: 37263496 DOI: 10.1016/j.joen.2023.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/20/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION This study compared the accuracy and efficiency of fully guided static and dynamic computer-assisted surgical navigation techniques for osteotomy and root-end resection (RER). METHODS Fifty roots from cadaver heads were divided into two groups: fully guided static computer-assisted endodontic microsurgery (FG sCAEMS) and dynamic computer-assisted endodontic microsurgery (dCAEMS) (all, n = 25). CBCT scans were taken pre- and postoperatively. The osteotomy and RER were planned virtually in the preoperative CBCT scan and guided using 3D-printed surgical guides in the FG sCAEMS and 3D-dynamic navigation system in the dCAEMS. The 2D and 3D deviations and angular deflection (AD) were calculated. The osteotomy volume, resected root length, and resection angle were measured. The osteotomy and RER time and the number of procedural mishaps were recorded. RESULTS FG sCAEMS was as accurate as dCAEMS, with no difference in the 2D and 3D deviation values or AD (p >.05). The osteotomy and RER time were shortened using FG sCAEMS (p <.05). The FG sCAEMS showed a greater number of incomplete RERs than dCAEMS. Osteotomy volume, RER angle, and root length resected were similar in both groups (p >.05). FG sCAEMS and dCAEMS were feasible for osteotomy and RER. CONCLUSIONS Within the limitations of this cadaver-based study, FG sCAEMS was as accurate as dCAEMS. Both FG sCAEMS and dCAEMS were time-efficient for osteotomy and RER, but FG sCAEMS required less surgical time.
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Affiliation(s)
- Frederico C Martinho
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry - Baltimore - Maryland.
| | - Corey Rollor
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry - Baltimore - Maryland
| | - Kyle Westbrook
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry - Baltimore - Maryland
| | - Sara A Aldahmash
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry - Baltimore - Maryland
| | - Guadalupe G Fay
- Division of Prosthodontics - Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry - Baltimore - Maryland
| | - Elias Rivera
- Division of Prosthodontics - Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry - Baltimore - Maryland
| | - Azin Parsa
- Division of Oral Radiology, Department of Oncology and Diagnostic Sciences, University of Maryland, School of Dentistry, Baltimore, Maryland
| | - Jeffery B Price
- Division of Oral Radiology, Department of Oncology and Diagnostic Sciences, University of Maryland, School of Dentistry, Baltimore, Maryland
| | - Patricia A Tordik
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry - Baltimore - Maryland
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10
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Westbrook K, Rollor C, Aldahmash SA, Fay GG, Rivera E, Price JB, Griffin I, Tordik PA, Martinho FC. Comparison of a Novel Static Computer-aided Surgical and Freehand Techniques for Osteotomy and Root-end Resection. J Endod 2023; 49:528-535.e1. [PMID: 36828284 DOI: 10.1016/j.joen.2023.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/26/2023] [Accepted: 02/15/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION This study compared the accuracy and efficiency of a novel static computer-aided surgical technique using a 3-dimensional (3D)-printed surgical guide (3D-SG) with a fully guided drill protocol (3D-SG FG) to the freehand (FH) osteotomy and root-end resection (RER). METHODS Forty-six roots from 2 cadaver heads were divided into 2 groups: 3D-SG FG (n = 23) and FH (n = 23). Cone-beam computed tomographic scans were taken preoperatively and postoperatively. The endodontic microsurgery was planned in Blue Sky Bio software, and the 3D-SG was designed and 3D printed. The osteotomy and RER were conducted using a guided twist drill diameter of 2 mm and an ascending tapered drill with diameters of 2.8/3.2, 3.2/3.6, 3.8/4.2, and 4.2 mm with respective guided drill guides. Two-dimensional and three-dimensional virtual deviations and angular deflection were calculated. Linear osteotomy measures and root resection angle were obtained. The osteotomy and RER time and the number of mishaps were recorded. RESULTS Two-dimensional and three-dimensional accuracy deviations and angular deflection were lower in the 3D-SG FG protocol than in the FH technique (P < .05). The height, length, and depth of the osteotomy and root resection angle were less in the 3D-SG FG protocol than in the FH technique (P < .05). The osteotomy and RER time with the 3D-SG FG protocol were less than the FH method (P < .05). CONCLUSIONS Within the limitations of this cadaver-based study using denuded maxillary and mandibular jaws, 3D-SG FG protocol showed higher accuracy than FH osteotomy and RER. Moreover, the 3D-SG FG drill protocol significantly reduced the surgical time.
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Affiliation(s)
- Kyle Westbrook
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland
| | - Corey Rollor
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland
| | - Sara A Aldahmash
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland; King Abdullah Bin Abdulaziz University Hospital, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Guadalupe G Fay
- Division of Prosthodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland
| | - Elias Rivera
- Division of Prosthodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland; Private Practice, Stafford, Virginia
| | - Jeffery B Price
- Division of Oral Radiology, Department of Oncology and Diagnostic Sciences, University of Maryland, School of Dentistry, Baltimore, Maryland
| | - Ina Griffin
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland
| | - Patricia A Tordik
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland
| | - Frederico C Martinho
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland.
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Oza S, Lai G, Peters OA, Chen J, Karabucak B, Scott R, Galicia JC. The Influence of Cone Beam Computed Tomography-Derived 3D-Printed Models on Endodontic Microsurgical Treatment Planning and Confidence of the Operator. J Endod 2023; 49:521-527.e2. [PMID: 36804199 DOI: 10.1016/j.joen.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Currently, there are no studies evaluating the impact of 3-dimensional (3D) printed models on endodontic surgical treatment planning. The aims of this study were: 1) to determine if 3D models could influence treatment planning; and 2) to assess the effect of 3D supported planning on operator confidence. MATERIALS Endodontic practitioners (n = 25) were asked to analyze a preselected cone beam computed tomography (CBCT) scan of an endodontic surgical case and answer a questionnaire that elucidated their surgical approach. After 30 days, the same participants were asked to analyze the same CBCT scan. Additionally, participants were asked to study and to perform a mock osteotomy on a 3D printed model. The participants responded to the same questionnaire along with a new set of questions. Responses were statistically analyzed using chi square test followed by either logistic or ordered regression analysis. Adjustment for multiple comparison analysis was done using a Bonferroni correction. Statistical significance was set at ≤0.005. RESULTS The availability of both the 3D printed model and the CBCT scan resulted in statistically significant differences in the participants' responses to their ability to detect bone landmarks, predict the location of osteotomy, and to determine the following: size of osteotomy, angle of instrumentation, involvement of critical structures in flap reflection and involvement of vital structures during curettage. In addition, the participants' confidence in performing surgery was found to be significantly higher. CONCLUSIONS The availability of 3D printed models did not alter the participants' surgical approach but it significantly improved their confidence for endodontic microsurgery.
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Affiliation(s)
- Shreyas Oza
- Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California; Endodontic Private Practice, Dallas, Texas
| | - Gordon Lai
- Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California
| | - Ove A Peters
- Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California; School of Dentistry, The University of Queensland, Brisbane, QLD, Australia
| | - James Chen
- Department of Endodontics, College of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bekir Karabucak
- Department of Endodontics, College of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Raymond Scott
- Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California
| | - Johnah C Galicia
- Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California; College of Dentistry, Manila Central University, Caloocan City, Philippines.
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Yoo YJ, Perinpanayagam H, Kim M, Zhu Q, Baek SH, Kwon HB, Kum KY. Stress Distribution on Trephine-Resected Root-end in Targeted Endodontic Microsurgery: A Finite Element Analysis. J Endod 2022; 48:1517-1525.e1. [DOI: 10.1016/j.joen.2022.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022]
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Martinho FC, Aldahmash SA, Cahill TY, Gupta S, Dianat O, Mostoufi B, Price JB, Griffin I, Tordik PA. Comparison of the accuracy and efficiency of a 3D dynamic navigation system for osteotomy root-end resection performed by novice and experienced endodontists. J Endod 2022; 48:1327-1333.e1. [PMID: 35839859 DOI: 10.1016/j.joen.2022.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/02/2022] [Accepted: 07/04/2022] [Indexed: 11/19/2022]
Abstract
AIM To investigate whether the 3D-dynamic navigation system (3D-DNS) can improve experienced endodontists' (EEs') and novice endodontists' (NEs') accuracy and efficiency in osteotomy and root-end resection (RER) and to verify that the 3D-DNS enables NEs to perform osteotomy and RER as accurately and efficiently as EEs. METHODS Seventy-six roots in cadaver heads were randomly divided into four groups: 3D-DNS-NE, 3D-DNS-EE, Freehanded (FH)-NE, and FH-EE (all, n=19). CBCT scans were taken pre- and postoperatively. Osteotomy and RER were planned virtually in the X-guided software (X-Nav Technologies, Lansdale). Accuracy was calculated by measuring the 2D and 3D virtual deviations and angular deflection (AD) using superimposing software (X-Nav technologies). Efficiency was determined by time of operation and the number of mishaps. RESULTS Accuracy deviations were significantly less in the 3D-DNS-EE group than in the FH-EE group (p<.05). We found lessened 2D and 3D accuracy deviations comparing the 3D-DNS-NE group to the FH-NE group (p<.05). The time required for osteotomy and RER with the 3D-DNS was ∼ ½ of that required for the FH method for both EEs and NEs (p<.05). We found no difference in the number of mishaps between the 3D-DNS and FH groups for EEs and NEs (p>.05). CONCLUSIONS The 3D-DNS improved EEs' and NEs' accuracy and efficiency in osteotomy and RER. The NEs were as efficient as the EEs using 3D-DNS. Notably, the 3D-DNS improved the NEs' accuracy compared to FH method but the 3D-DNS did not enable the NEs to perform osteotomy and RER as accurately as the EEs.
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Affiliation(s)
- Frederico C Martinho
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland.
| | - Sara A Aldahmash
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland; College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Thomas Y Cahill
- School of Dentistry, University of Maryland, Baltimore, Maryland
| | - Swati Gupta
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland
| | - Omid Dianat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland; Centreville Endodontics, Centreville, Virginia
| | - Behzad Mostoufi
- Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, Maryland
| | - Jeffery B Price
- Clinical Professor & Director of Oral Radiology, Department of Oncology and Diagnostic Sciences, University of Maryland, School of Dentistry, Baltimore, Maryland
| | - Ina Griffin
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland
| | - Patricia A Tordik
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland
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Setzer FC, Kratchman SI. Present Status and Future Directions - Surgical Endodontics. Int Endod J 2022; 55 Suppl 4:1020-1058. [PMID: 35670053 DOI: 10.1111/iej.13783] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Abstract
Endodontic surgery encompasses several procedures for the treatment of teeth with a history of failed root canal treatment, such as root-end surgery, crown- and root resections, surgical perforation repair, and intentional replantation. Endodontic microsurgery is the evolution of the traditional apicoectomy techniques and incorporates high magnification, ultrasonic root-end preparation and root-end filling with biocompatible filling materials. Modern endodontic surgery uses the dental operating microscope, incorporates cone-beam computed tomography (CBCT) for preoperative diagnosis and treatment planning, and has adopted piezoelectric approaches to osteotomy and root manipulation. Crown- and root resection techniques have benefitted from the same technological advances. This review focuses on the current state of root-end surgery by comparing the techniques and materials applied during endodontic microsurgery to the most widely used earlier methods and materials. The most recent additions to the clinical protocol and technical improvements are discussed, and an outlook on future directions is given. While non-surgical retreatment remains the first choice to address most cases with a history of endodontic failure, modern endodontic microsurgery has become a predictable and minimally invasive alternative for the retention of natural teeth.
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Affiliation(s)
- F C Setzer
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - S I Kratchman
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Neelakantan P, Vishwanath V, Taschieri S, Corbella S. Present status and future directions ‐ Minimally invasive root canal preparation and periradicular surgery. Int Endod J 2022; 55 Suppl 4:845-871. [DOI: 10.1111/iej.13750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022]
Affiliation(s)
- P. Neelakantan
- Faculty of Dentistry The University of Hong Kong Hong Kong SAR
| | - V. Vishwanath
- Faculty of Dentistry The University of Hong Kong Hong Kong SAR
| | - S. Taschieri
- Department of Biomedical Surgical and Dental Sciences Università degli Studi di Milano Milan Italy
- IRCCS Istituto Ortopedico Galeazzi Milan Italy
- Department of Oral Surgery Institute of Dentistry I. M. Sechenov First Moscow State Medical University Moscow Russia
| | - S. Corbella
- Department of Biomedical Surgical and Dental Sciences Università degli Studi di Milano Milan Italy
- IRCCS Istituto Ortopedico Galeazzi Milan Italy
- Department of Oral Surgery Institute of Dentistry I. M. Sechenov First Moscow State Medical University Moscow Russia
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Shujaat S, Bornstein MM, Price JB, Jacobs R. Integration of imaging modalities in digital dental workflows - possibilities, limitations, and potential future developments. Dentomaxillofac Radiol 2021; 50:20210268. [PMID: 34520239 PMCID: PMC8474138 DOI: 10.1259/dmfr.20210268] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The digital workflow process follows different steps for all dental specialties. However, the main ingredient for the diagnosis, treatment planning and follow-up workflow recipes is the imaging chain. The steps in the imaging chain usually include all or at least some of the following modalities: cone-beam computed tomographic data acquisition, segmentation of the cone-beam computed tomography image, intraoral scanning, facial three-dimensional soft tissue capture and superimposition of all the images for the creation of a virtual augmented model. As a relevant clinical problem, the accumulation of error at each step of the chain might negatively influence the final outcome. For an efficient digital workflow, it is important to be aware of the existing challenges within the imaging chain. Furthermore, artificial intelligence-based strategies need to be integrated in the future to make the workflow more simplified, accurate and efficient.
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Affiliation(s)
- Sohaib Shujaat
- Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Michael M Bornstein
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
| | - Jeffery B Price
- Department of Oncology and Diagnostic Sciences, University of Maryland, School of Dentistry, Baltimore, Maryland, USA
| | - Reinhilde Jacobs
- Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Targeted Endodontic Microsurgery: A Retrospective Outcomes Assessment of 24 Cases. J Endod 2021; 47:762-769. [PMID: 33548331 DOI: 10.1016/j.joen.2021.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Targeted endodontic microsurgery (TEMS) replaces freehand carbide or diamond bur osteotomy and root-end resection with a guided approach using an end-cutting trephine bur rotated within a guide tube. TEMS departs from traditional endodontic microsurgery in osteotomy size, control of resection level and bevel, surgical time, and resection method; yet, the impact of these departures on clinical outcomes has yet to be assessed. The aim of this study was to assess clinical outcomes of TEMS surgeries at least 1 year after treatment. METHODS Potential cases were retrospectively identified from a secure database of all patients who received TEMS in the Air Force Postgraduate Dental School from June 2017-May 2019 with a postsurgical follow-up examination at 1 year or beyond (23 patients with 24 teeth). Two board-certified endodontists completed a calibration exercise before assessing radiographs. A retrospective outcomes assessment was conducted considering follow-up clinical and radiographic findings to assign 1 of 3 healing designations: complete healing, reductive healing, or failure. RESULTS Combined clinical and radiographic data led to 20 designations of complete healing, 2 designations of reductive healing, and 2 failures (91.7% success rate). Considered alone, radiographic criteria for complete healing were met for 20 cases, reductive healing for 3 cases, and radiographic failure for 1 case. CONCLUSIONS This limited retrospective outcomes assessment is an early indication that TEMS-guided trephine bur root-end resection leads to similar success as is established for freehand carbide and diamond bur resection. Controlled clinical trials with long-term follow-up are warranted.
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Dynamically Navigated versus Freehand Access Cavity Preparation: A Comparative Study on Substance Loss Using Simulated Calcified Canals. J Endod 2020; 46:1745-1751. [DOI: 10.1016/j.joen.2020.07.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/31/2020] [Indexed: 12/14/2022]
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Smith BG, Pratt AM, Anderson JA, Ray JJ. Targeted Endodontic Microsurgery: Implications of the Greater Palatine Artery. J Endod 2020; 47:19-27. [PMID: 33091453 DOI: 10.1016/j.joen.2020.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/16/2020] [Accepted: 10/11/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Targeted Endodontic Microsurgery (TEMS) combines trephine burs and 3D-printed guides to make flapless maxillary palatal root-end surgery possible. This study assessed the location of the greater palatine artery (GPA), the relationship of the GPA to maxillary molar root ends, and the feasibility of flapless palatal-approach TEMS. METHODS Three endodontists analyzed 250 cone-beam computed tomographic images of maxillary molars for (1) transition morphology between the hard palate and the alveolar process adjacent to first and second molars as an indication of the most likely location of the GPA, (2) the superior-inferior relationship between the GPA and root ends, and (3) the feasibility of palatal-approach TEMS. RESULTS Palatal transition morphology included 20% Spine, 72% Bridge, and 8% Smooth. GPA position as related to palatal root ends was classified as 34% superior, 40% adjacent, and 21% inferior. Five percent of classifications were undefined. TEMS was deemed feasible for 47% of maxillary first molars and 52% of second molars, and was significantly more feasible with GPAs superior to palatal root ends. Reasons for infeasibility included GPA proximity and unfavorable resection angle or level. Maxillary first molar palatal roots were 11.13 ± 2.68 mm from the greater palatine foramen (GPF) and 2.37 ± 1.46 mm from the GPA. Second molar palatal roots were 4.94 ± 2.55 mm from the GPF and 2.53 ± 1.77 mm from the GPA. CONCLUSIONS Palatal transition morphology and GPA position adjacent to maxillary molars, as manifested in cone-beam computed tomographic coronal views, suggested maxillary palatal root TEMS could be accomplished with a 2-mm safety margin in 47% of first molars and 52% of second molars. Historical paradigms that do not consider flapless palatal surgical approaches may need to be revised.
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Affiliation(s)
- Bracken G Smith
- Air Force Postgraduate Dental School and Uniformed Services University of the Health Sciences Postgraduate Dental College, Joint Base San Antonio--Lackland, Texas; Air Force Postgraduate Dental School and Hurlburt Field Dental Clinic, Hurlburt, Florida.
| | - Allen M Pratt
- Air Force Postgraduate Dental School and Uniformed Services University of the Health Sciences Postgraduate Dental College, Joint Base San Antonio--Lackland, Texas; Air Force Postgraduate Dental School and Hurlburt Field Dental Clinic, Hurlburt, Florida
| | - Julie A Anderson
- Air Force Postgraduate Dental School and Uniformed Services University of the Health Sciences Postgraduate Dental College, Joint Base San Antonio--Lackland, Texas; Air Force Postgraduate Dental School and Hurlburt Field Dental Clinic, Hurlburt, Florida
| | - Jarom J Ray
- Air Force Postgraduate Dental School and Uniformed Services University of the Health Sciences Postgraduate Dental College, Joint Base San Antonio--Lackland, Texas; Air Force Postgraduate Dental School and Hurlburt Field Dental Clinic, Hurlburt, Florida
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Preserving the Neurovascular Bundle in Targeted Endodontic Microsurgery: A Case Series. J Endod 2020; 47:509-519. [PMID: 33096194 DOI: 10.1016/j.joen.2020.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 12/15/2022]
Abstract
Endodontic microsurgery encompasses the use of microscopy, specialized instruments, and advanced imaging with cone-beam computed tomographic (CBCT) imaging. This treatment modality results in high clinical success rates and facilitates the enucleation of osteolytic lesions, the resection of apical root canal complexities harboring persistent bacterial biofilms, and the evaluation of possible root defects and fractures. However, there is the risk of injury to important anatomic structures, particularly when treating posterior teeth. Neurovascular bundles are among these structures at risk for injury. Fortunately, high-resolution CBCT scans can be used to detect these structures that are known to have a high anatomic variability. In addition, CBCT information can be combined with high-resolution intraoral scans to plan, design, and fabricate surgical guides to be used in a targeted endodontic microsurgery (TEMS) approach. We report 3 cases with previous endodontic treatment having persistent apical periodontitis that were treated with TEMS to avoid damage to the neurovascular bundles at risk of injury. In the first case, the palatal root of tooth #14 was adjacent to the greater palatine artery. In the second case, the mental nerve exited through 2 separate foramina close to the predictive osteotomy site for the mesial root of tooth #19. In the third case, the posterior superior alveolar artery was in close proximity to the mesiobuccal root of tooth #14. Collectively, these cases illustrate the diagnostic value of CBCT imaging for detecting neurovascular bundles and the use of TEMS to mitigate the risk of injury to these important structures. Thus, the combination of CBCT imaging and TEMS can potentially minimize the risk of intraoperative complications and postoperative sequelae while increasing the predictability of endodontic microsurgeries in complex cases.
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