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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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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: 6] [Impact Index Per Article: 3.0] [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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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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Reddy S, Gadhiraju S, Quraishi A, Kamishetty S. Targeted Endodontic Microsurgery: A Guided Approach - A Report of Two Cases. Contemp Clin Dent 2022; 13:280-283. [PMID: 36213851 PMCID: PMC9533388 DOI: 10.4103/ccd.ccd_345_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/16/2021] [Accepted: 10/18/2021] [Indexed: 11/04/2022] Open
Abstract
Targeted endodontic microsurgery combines a precisely designed three-dimensional (3D)-printed surgical guide in which the osteotomy site and angulation is defined preoperatively to avoid damaging anatomically important structures. The current endodontic microsurgical procedures have been progressing in pace with technological advances as a predictable alternative to nonsurgical treatment of persistent and recurrent apical periodontitis. The 3D-printed template has been used earlier in the guided endodontic procedure (access openings). The endodontic microsurgery utilizes the surgical microscope and microsurgical instruments which help in enhanced magnification, illumination, and visualization compared to conventional endodontic surgery. Cone beam computed tomography (CBCT) plays an important role in surgical endodontics as it helps in measuring the distance between the cortical plate and the apex, position of the roots within the bone, and the proximity of vital structures can be assessed. The true size, location, and extent of the periapical lesion can also be appreciated preoperatively. In the present cases, the guide allowed the clinicians to precisely reach the targeted tissues in a faster and more accurate manner with a more conservative and less traumatic treatment procedure. A 1-year CBCT follow-up of both cases showed complete 3D healing of the surgical site.
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Affiliation(s)
- Smitha Reddy
- Department of Conservative Dentistry and Endodontics, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India
| | - Sravya Gadhiraju
- Department of Conservative Dentistry and Endodontics, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India,Address for correspondence:Dr. Sravya Gadhiraju, E 18/1, Research Centre Imarat, Vignyana Kancha, Hyderabad - 500 069, Telangana, India. E-mail:
| | - Akram Quraishi
- Department of Conservative Dentistry and Endodontics, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India
| | - Shekhar Kamishetty
- Department of Conservative Dentistry and Endodontics, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India
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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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Dedania MS, Shah NC, Arora A, Pisal N. Three-dimensional printing: A revealing pathway to an unpredictable maze. J Conserv Dent 2021; 23:533-537. [PMID: 33911366 PMCID: PMC8066681 DOI: 10.4103/jcd.jcd_190_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/19/2020] [Accepted: 06/27/2020] [Indexed: 11/21/2022] Open
Abstract
Three-dimensional (3D) technology has gained wide acceptance in dentistry. It has been used for treatment planning and surgical guidance. This case report presented a novel treatment approach to remove and preserve the cortical bone and root-end resection during periapical surgery with the help of cone-beam computed tomography (CBCT), computer-aided design, and 3D printing technology. A 22-year-old male patient presented with a large periapical lesion in the right maxillary central and lateral incisors was referred for endodontic surgery. The data acquired from a preoperative diagnostic CBCT scan and an intraoral scan were uploaded into surgical planning software and matched. A template that could be used to locate root ends and lesion areas was virtually designed based on the data and was fabricated using a 3D printer. With the guidance of the template, the overlying cortical bone was precisely removed and preserved, and apicectomy was performed. The patient was clinically asymptomatic at a 6-month follow-up review. Six months after the surgery, the lesion was healing well, and no periapical radiolucency was observed on radiographic examination. The digitally designed directional template worked in all aspects to facilitate the periapical surgery as anticipated. The root ends were accurately located and resected. The surgical procedure was simplified, and the treatment efficiency was improved. This technique minimized the damage and reduced iatrogenic injury.
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Affiliation(s)
- Meetkumar S Dedania
- Department of Conservative Dentistry and Endodontics, K. M. Shah Dental College, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Nimisha C Shah
- Department of Conservative Dentistry and Endodontics, K. M. Shah Dental College, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Ankit Arora
- Department of Conservative Dentistry and Endodontics, K. M. Shah Dental College, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Nidhi Pisal
- Department of Conservative Dentistry and Endodontics, K. M. Shah Dental College, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
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The Application of “Bone Window” Technique in Endodontic Microsurgery. J Endod 2020; 46:872-880. [DOI: 10.1016/j.joen.2020.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/30/2020] [Accepted: 02/23/2020] [Indexed: 11/18/2022]
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Hegde MN, Honap MN, Narayanan S. Evaluation of surface integrity of root end cavities prepared using conventional and piezoelectric devices: A scanning electron microscopy study. Indian J Dent Res 2019; 30:772-776. [PMID: 31854372 DOI: 10.4103/ijdr.ijdr_237_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction An array of factors control the success of endodontic surgery. One of them is the technique used to prepare the root end cavities which is conventionally being done with burs. In past decades, ultrasonic instruments have been introduced for the same. Studies comparing these instruments on root surface integrity are scarce. Thus, an in-vitro Scanning Electron Microscopy study was designed to evaluate the surface integrity of root end cavities prepared using conventional and piezoelectric devices. Methodology Twelve single-rooted human intact mandibular premolar teeth were endodontically treated and included in the study. They were divided into two groups. In the first group, 3 mm root-end cavities were prepared using conventional retro preparation burs and in the second group, 3 mm root-end cavities were prepared using piezoelectric retro-tips. The specimens were coded for blind evaluation and analysed under scanning electron microscope at 100x, 500x and 1000x magnification for smear layer and debris. Gutmann's scoring criteria was followed to score the specimens. Statistical analysis was carried out using Shapiro Wilk test and the independent sample t-test was used to check mean differences between variables. Results It was noted that significant statistical differences existed in mean debris and smear layer scores (p< 0.001) between the two groups. In the piezoelectric group, significantly lower debris layer and smear layer was found, compared to the conventional bur group. Conclusion Root-end cavities prepared using piezo retrotips produced cleaner, well-centered and more conservative surface with minimal debris & smear layer, compared to root-end cavities prepared using conventional burs.
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Affiliation(s)
- Mithra N Hegde
- Department of Conservative Dentistry and Endodontics, A B Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Manjiri Nagesh Honap
- Department of Conservative Dentistry and Endodontics, A B Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Sreenath Narayanan
- Department of Conservative Dentistry and Endodontics, A B Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
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Popowicz W, Palatyńska-Ulatowska A, Kohli MR. Targeted Endodontic Microsurgery: Computed Tomography–based Guided Stent Approach with Platelet-rich Fibrin Graft: A Report of 2 Cases. J Endod 2019; 45:1535-1542. [DOI: 10.1016/j.joen.2019.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 08/15/2019] [Accepted: 08/24/2019] [Indexed: 12/29/2022]
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The bone lid technique in oral surgery: a case series study. Int J Oral Maxillofac Surg 2017; 46:1490-1496. [DOI: 10.1016/j.ijom.2017.06.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 05/16/2017] [Accepted: 06/29/2017] [Indexed: 11/20/2022]
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