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Zhang M, Liu H, Shen Y. The bone lid technique in endodontic microsurgery. Asian J Surg 2024; 47:3126-3127. [PMID: 37689516 DOI: 10.1016/j.asjsur.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/01/2023] [Indexed: 09/11/2023] Open
Affiliation(s)
- Min Zhang
- Department of Stomatology, Affiliated Hospital of Jining Medical University, Jining, China
| | - He Liu
- Division of Endodontics, Department of Oral Biological & Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, Canada.
| | - Ya Shen
- Division of Endodontics, Department of Oral Biological & Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, Canada
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Villa-Machado PA, Restrepo-Restrepo FA, Tobón-Arroyave SI. Dynamically guided transantral piezoelectric endodontic microsurgery: A case report with technical considerations. Int Endod J 2024; 57:490-500. [PMID: 38243920 DOI: 10.1111/iej.14026] [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: 01/20/2023] [Revised: 09/01/2023] [Accepted: 01/08/2024] [Indexed: 01/22/2024]
Abstract
AIM Endodontic microsurgery (EMS) of maxillary molars may represent a complex challenge to the clinician due to the location of the roots and the proximity of the maxillary sinus floor. This report aimed to describe the simultaneous use of a computer-assisted dynamic navigation (C-ADN) system and piezoelectric bony-window osteotomy for the transantral microsurgical approach of a maxillary left first molar with adequate root canal filling and symptomatic apical periodontitis. SUMMARY This case report highlights the importance of C-ADN to carry out a minimally invasive buccal surgical access to palatal roots affected by apical periodontitis and provides a practical example to help clinicians make treatment decisions based on the available evidence. Clinical and tomographic evaluations were performed before the surgical procedure and at 24-month follow-up. This case was treated using a C-ADN system fitted to a piezotome for the buccal approach of the buccal roots, maxillary sinus membrane lifting, and for transantral location, root-end resection, cavity preparation, and filling of the palatal root. The navigation system allowed to achieve an accurate apical canal terminus location and root-end filling of the three roots with a minimally invasive piezoelectric crypt approach. At the 24-month follow-up examination, the patient remains asymptomatic, with normal periapical structures, and regeneration of maxillary sinus walls. It was concluded that the combination of dynamic navigation with piezoelectric bony-window osteotomy offers enhanced accuracy, tissue preservation, diminished risk of iatrogenic complications, and could maximize success and survival rates in transantral EMS.
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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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Yan L, Lin J, Yang L, He S, Tan X, Huang D. Clinical Effect Evaluation of Concentrated Growth Factor in Endodontic Microsurgery: A Cross-Sectional Study. J Endod 2023:S0099-2399(23)00246-7. [PMID: 37182792 DOI: 10.1016/j.joen.2023.05.005] [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: 02/03/2023] [Revised: 04/18/2023] [Accepted: 05/01/2023] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Concentrated growth factor (CGF) is the third-generation platelet concentrate product. This study aimed to evaluate whether the use of CGF during endodontic microsurgery had a positive influence on surgical outcomes. METHODS Fifty-four patients who underwent endodontic microsurgery from January 2017 to November 2021 were enrolled. They were assigned to the CGF and the control group according to whether CGF was used during the surgery and followed up at 6, 12, and 18 months post-surgery. Preoperative classification of the cases and follow-up radiographic outcomes were based on Kim's classification and Molven's criteria respectively and evaluated by two calibrated endodontists. Student t-test and Chi-square test were used to assess the baseline of two groups. Rank sum test was used to determine whether CGF had an impact on the surgical outcome. RESULTS Thirty-one patients (41 periapical lesion sites) were included in the CGF group, and twenty-three patients (26 periapical lesion sites) were included in the control group. The overall success rate of endodontic microsurgery was above 90%. The baseline of the two groups had no difference (P<0.05). In the CGF group, the success rate was always 100% in three follow-ups, while the success rate was 84.2%, 92.8%, and 90% respectively in the control group. The success rate between the CGF group and the control group was statistically significant in all three follow-up points (P<0.05). CONCLUSIONS The application of CGF during endodontic microsurgery might have a positive influence on surgical outcomes, thus, its prognosis. However, higher-grade evidence is needed to demonstrate its role.
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Affiliation(s)
- Lixia Yan
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Conservative Dentistry and Endodontics, West China School of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Jie Lin
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Conservative Dentistry and Endodontics, West China School of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Lei Yang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Conservative Dentistry and Endodontics, West China School of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Shuning He
- West China School of Public Health & West China Fourth Hospital, Sichuan University, Chengdu, 610041, China
| | - Xuelian Tan
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Conservative Dentistry and Endodontics, West China School of Stomatology, Sichuan University, Chengdu, 610041, China.
| | - Dingming Huang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Conservative Dentistry and Endodontics, West China School of Stomatology, Sichuan University, Chengdu, 610041, China.
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Bi C, Zhou M, Zhang Y, Zheng P. Endodontic Microsurgery of Mandibular Second Molars Using the Bony Lid Approach: A Case Series. J Endod 2022; 48:1533-1538. [DOI: 10.1016/j.joen.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 11/06/2022]
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Lucia S, Alessandro P, Giulia B, Giada F, Massimo DF, Daniele B, Fouad K, Stefano S. The bone lid technique in lateral sinus lift: a systematic review and meta-analysis. Int J Implant Dent 2022; 8:33. [PMID: 36036281 PMCID: PMC9424465 DOI: 10.1186/s40729-022-00433-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/20/2022] [Indexed: 02/08/2023] Open
Abstract
Objective This systematic review aimed at assessing the effect of the repositioned bone lid on bone augmentation in lateral sinus lift in pre-clinical in vivo and clinical studies. Secondary aims were to report on the healing of the bone window and to assess the implant survival rate. Material and methods Animal and human studies comparing lateral maxillary sinus floor elevation in combination or not with the repositioned bone lid were retrieved from MEDLINE (PubMed), Web of Science and Cochrane online library. Studies published in English up to April 2022 and reporting on histological and/or radiographic outcomes were considered. Case reports, case series and reviews were excluded. A hand search was also conducted. Risk of bias was assessed and meta-analysis performed to investigate the effect of the bone lid on new bone formation. Results After screening, 5 animal studies (4 in rabbits, 1 in sheep) and 2 clinical studies (1 RCT, 1 case–control) were included. Meta-analysis confirmed a higher new bone formation in rabbits at 2 and 8 weeks using the bone lid. The two clinical studies investigated lateral sinus lift with concomitant implant placement and reported similar results and high short-term implant success rate in both test and control groups. Conclusions The meta-analysis provided moderate evidence that the repositioned bone lid favored the formation of new bone to a higher extent as compared to resorbable membranes in animal studies. Implant success seems not to be influenced by the technique in the short term.
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Affiliation(s)
- Schiavon Lucia
- Department of Neurosciences, Dentistry Section, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Perini Alessandro
- Department of Neurosciences, Dentistry Section, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Brunello Giulia
- Department of Neurosciences, Dentistry Section, University of Padova, Via Giustiniani 2, 35128, Padua, Italy. .,Department of Oral Surgery, University Clinic of Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany.
| | - Ferrante Giada
- Department of Neurosciences, Dentistry Section, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Del Fabbro Massimo
- Department of Biomedical, Surgical and Dental Sciences, Università Degli Studi di Milano, Via Commenda 10, 20122, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | | | - Khoury Fouad
- Department of Oral and Maxillofacial Surgery, University of Munster, Waldeyerstr. 30, 48149, Munster, Germany.,International Dental Implant Center, Private Clinic Schloss Schellenstein, Am Schellenstein 1, 59939, Olsberg, Germany
| | - Sivolella Stefano
- Department of Neurosciences, Dentistry Section, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
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The Bone Lid Technique in Oral and Maxillofacial Surgery: A Scoping Review. J Clin Med 2022; 11:jcm11133667. [PMID: 35806950 PMCID: PMC9267370 DOI: 10.3390/jcm11133667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/19/2022] [Accepted: 06/22/2022] [Indexed: 01/12/2023] Open
Abstract
This scoping review aimed at reporting the outcomes of the bone lid technique in oral surgery in terms of bone healing, ridge preservation, and incidence of complications. Bone-cutting instruments and stabilization methods were also considered. PubMed, Scopus, and the Cochrane Register of Controlled Trials were searched using a combination of terms, including bone lid, bony window, piezosurgery, microsaw, cysts, endodontic surgery, impacted teeth, and maxillary sinus. A hand search was also performed. The last search was conducted on 30 November 2021. No date limitation was set. Searches were restricted to human clinical studies published in English. All types of study design were considered except reviews and case reports. After a two-step evaluation, 20 (2 randomized studies, 2 case-control studies, 3 cohort studies, 13 case series) out of 647 screened studies were included, reporting on 752 bone lid procedures. The bone lid technique was associated with favorable bone healing when compared to other methods, and with a very low incidence of major complications. Clinical indications, surgical procedures, study design, follow-up duration, and outcomes varied among the studies. Overall, favorable outcomes were reported using the bone lid approach, though evidence-based studies were scarce.
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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: 29] [Impact Index Per Article: 14.5] [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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Effect of the Piezoelectric Device on Intraoperative Hemorrhage Control and Quality of Life after Endodontic Microsurgery: A Randomized Clinical Study. J Endod 2021; 47:1052-1060. [DOI: 10.1016/j.joen.2021.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 11/17/2022]
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An Update on Endodontic Microsurgery of Mandibular Molars: A Focused Review. ACTA ACUST UNITED AC 2021; 57:medicina57030270. [PMID: 33809673 PMCID: PMC8002302 DOI: 10.3390/medicina57030270] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/03/2021] [Accepted: 03/12/2021] [Indexed: 11/17/2022]
Abstract
Endodontic microsurgery is a highly predictable treatment option in most cases when conventional endodontic treatment is not feasible. Nevertheless, mandibular molars are still considered by clinicians to be the most difficult type of teeth, with the lowest success rate. In recent years, endodontic microsurgery has been attempted more frequently with the emergence of modern cutting-edge technologies such as dental operating microscopes, various microsurgical instruments, and biocompatible materials, and the success rate is increasing. This review describes the current state of the art in endodontic microsurgical techniques and concepts for mandibular molars. Notably, this review highlights contemporary equipment, technology, and materials.
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