Accuracy and clinical safety of guided root end resection with a trephine: a case series

Abstract

BackgroundRoot-end resection is an endodontic surgical intervention that requires high precision so that all ramifications and lateral canals so as infected tissues are eliminated. An exploratory study was conducted to justify the clinical safety and accuracy of guided root-end resection with a trephine.MethodsFourteen root-end resections were performed in 11 patients. With the aid of computer tomography and rapid prototyping a stereolithographically fabricated, tooth-supported surgical template was used to guide trephinations. Surgery was performed using the printed surgical stent and a trephine was used not only for the osteotomy but for the root end resection as well.ResultsThe root end was successfully and completely resected by the trephine in all cases. No intraoperative complications were observed in any of the cases, and the patients were free of symptoms indicating recurrence or complications at the 6-month follow-up. The median angular deviation of the trephination was 3.95° (95% CI: 2.1–5.9), comparable to the angular deviation of guided implant surgery. The mean apex removal error (ARE) was 0.19 mm (95% CI: 0.03–0.07). The mean osteotomy depth error (ODE) was 0.37 mm (95% CI: 0.15–1.35). Overpenetration was a characteristic finding, which indicates the necessity of a stop-trephine.ConclusionsWithin the limitations of this study, we conclude that our results support the use of guided trephination for root-end resection.

Efficacy of Computer-Aided Static Navigation Technique on the Accuracy of Endodontic Microsurgery. A Systematic Review and Meta-Analysis

“…Of the seven articles included, three were experimental trials [ 14 , 15 , 16 ], three were CS [ 17 , 18 , 19 ] and one was a clinical trial (CT) [ 20 ]. In addition, three studies compared static navigation with regard to conventional endodontic microsurgery [ 14 , 15 , 16 ].…”

“…The Jadad scale obtained tree articles "not applicable", because they were a case series [17][18][19], and the authors of these articles did not blind and did not randomize the studies. In addition, the CT study [20] was also described as "not applicable", because it was not a comparative study and the authors did not randomize the study. Seven studies were selected and combined using a random effects model with an inverse variance method.…”

Accuracy of digitally planned, guided apicoectomy with a conventional trephine and a custom-made endodontic trephine: An in vitro comparative study

“…In one of our previous publications, we showed that the accuracy of guided apicoectomy performed with a commercially available trephine was similar to the accuracy of guided implant surgery. However, we also found overpenetration to be a regularly occurring (and potentially hazardous) issue as commercially available bone trephines have no physical stop on them to prevent this, only depth markings [22]. We concluded that this might be a major limitation of the method and a considerable source of inaccuracy.…”

“…Guided trephine apicoectomy is an emerging endodontic surgical technique to enhance the accuracy of apicoectomy. While there is already some evidence to suggest that guided apicoectomy, in general, is indeed superior to the freehand approach in terms of accuracy, [20,22,31,32] but data are scarcely available on guided interventions performed with a trephine. In this study, we sought to compare the accuracy of digitally planned, guided apicoectomy performed with a commercially available and a custom-made trephine, in vitro.…”

Gyökércsúcs rezekciója navigált endodontiai mikrosebészeti technikával

“…A bemutatott eset egy korábbi rezekció korrekciós beavatkozása, emiatt fontos volt az optimális [17] korona-gyökér arány megtartására való törekvés és a precíz kivitelezés. A 3D tervezőprogram segítéségével pontosan meg lehet határozni a szükséges minimumot, mellyel az apicalis 3 mm-t és ezzel az esetleges bakteriális reinfekció forrásaként jelen lévő gyökércsúcsi deltát vagy ramificatiókat tudjuk eltávolítani [18][19][20]. A lebenyképzés során figyelmet kell fordítani a szükséges minimális hozzáférés és a megfelelő vérellátás biztosítására, valamint a marginális gingiva integritásának megőrzésére, melyek a gyors, per primam gyógyulást facilitálják, míg az intraossealis gyógyulást az osteotomiás ablak kiterjedése befolyásolja.…”