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

Márk Antal, Eszter Nagy, Gábor Braunitzer, Márk Fráter, József Piffkó, Márk Antal, Eszter Nagy, Gábor Braunitzer, Márk Fráter, József Piffkó

Abstract

Background: Root-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.

Methods: Fourteen 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.

Results: The 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.

Conclusions: Within the limitations of this study, we conclude that our results support the use of guided trephination for root-end resection.

Keywords: Apicectomy; Computer guided minimally invasive endosurgery; Endodontic microsurgery; Surgical template; Trephine.

Conflict of interest statement

Dr. Gábor Braunitzer is chief researcher at dicomLAB, Ltd.

Figures

Fig. 1
Fig. 1
Surgical plan in the planning software (orovestibular view). a guiding sleeve; b virtual model to represent trephine; c the angulation of the planned osteotomy; d the planned depth of the osteotomy; e the planned length of the piece to be resected
Fig. 2
Fig. 2
Left: the surgical setup demonstrated on a gypsum cast. a surgical template b guiding tunnel with metal sleeve; c trephine. Right: intraoperative image
Fig. 3
Fig. 3
Analysis of angular deviation in Amira (blue: planned, red: realized). This figure does not depict the analysis of any of the actual cases, it is for illustration purposes only
Fig. 4
Fig. 4
Explanation of the 2D measurements. Left: preoperative, Right: postoperative; a: coronal reference point; b: apical reference point (end points of the axis); c: axial length before surgery d: axial length after surgery; e: planned length of removal; f: actual resected length; g: planned depth of osteotomy; h: actual depth of osteotomy (for the measurements, the missing cortical was substituted by a straight line connecting the remaining cortical edges). Calculations: ARE = e-f; ODE = g-h
Fig. 5
Fig. 5
Bone cylinders removed with the trephine containing the resected root ends
Fig. 6
Fig. 6
Overpenetration: note the trephine markings in the palatinal cortical (arrows)

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