Apicoectomy of maxillary anterior teeth through a piezoelectric bony-window osteotomy: two case reports introducing a new technique to preserve cortical bone

Abstract

Two case reports describing a new technique of creating a repositionable piezoelectric bony window osteotomy during apicoectomy in order to preserve bone and act as an autologous graft for the surgical site are described. Endodontic microsurgery of anterior teeth with an intact cortical plate and large periapical lesion generally involves removal of a significant amount of healthy bone in order to enucleate the diseased tissue and manage root ends. In the reported cases, apicoectomy was performed on the lateral incisors of two patients. A piezoelectric device was used to create and elevate a bony window at the surgical site, instead of drilling and destroying bone while making an osteotomy with conventional burs. Routine microsurgical procedures - lesion enucleation, root-end resection, and filling - were carried out through this window preparation. The bony window was repositioned to the original site and the soft tissue sutured. The cases were re-evaluated clinically and radiographically after a period of 12 - 24 months. At follow-up, radiographic healing was observed. No additional grafting material was needed despite the extent of the lesions. The indication for this procedure is when teeth present with an intact or near-intact buccal cortical plate and a large apical lesion to preserve the bone and use it as an autologous graft.

Surgical Management of Periapical Lesion: A Case Report

“…Bonson et al found that clinically derived human gingival and periodontal ligament fibroblasts survived and proliferated in direct contact with MTA particles. The above studies are also supported by Balto, [2] who found that human periodontal ligament fibroblasts attached to MTA within4 h and then spread out over the surface during the subsequent 20 hours. [9] Careful use of bone trimmer allows soft tissue juxtaposition and healing.…”

“…[1] It is the recommended therapy for endodontically treated teeth with unresolved periapical lesions when the prognosis of non-surgical root canal treatment is questionable. [2] The traditional surgical endodontics involves root resection (45˚ bevel), retrograde preparation of canal using burs. According to literature, this technique has a success rate of approx 60%.…”

The bone lid technique in lateral sinus lift: a systematic review and meta-analysis

“…The reposition of the bone window has been described for several indications in oral surgery with favorable outcomes [14,[21][22][23][24][25][26][27][28], including its application for sinus floor elevation [29][30][31][32][33][34][35].…”

Targeted Endodontic Microsurgery

“…Guided endodontic microsurgery enables an accurate visualization; identification; and a more accessible, precise, and minimally invasive treatment permitting faster postoperative healing. [ 8 ] Osteotomy diameters <5 mm resulted in improved osseous healing compared with those in excess of 5 mm, which resulted in fibrous tissue formation and delayed healing. [ 9 ] During an apicoectomy procedure, freehand drilling deviation 70% of the time is 2 mm and 22% of the time is 3 mm; however, with guided approach, a deviation of 0.79 mm (0.33 mm standard deviation) has been noted,[ 10 ] enabling dentists without extensive surgical skills to achieve predictable results.…”