A novel simplified workflow for guided endodontic surgery in mandibular molars with a thick buccal bone plate: a Case report
Journal of Endodontics
Introduction One of the challenges in apical surgery in mandibular molars is the thick buccal cortical bone plate, which might lead to access errors, damage to neighboring teeth, and injury to healthy tissue. Surgical guide templates with three-dimensional impressions have been suggested for use in such cases, allowing greater precision. Usually, this technique involves a cone-beam computed tomography (CBCT) exam related to a three-dimensional (3D) oral scanning to generate surgical templates printed from 3D imaging data. This study reports a novel workflow possibility in which apical surgery is performed with the aid of a surgical guide planned only with CBCT, excluding the need for 3D oral scanning.
Case Report A 32-year-old female presented with asymptomatic apical periodontitis and external root resorption on the mesial root of tooth #19. A surgical template was planned using only the patient’s CBCT scan to provide precise access to the lesion and remove a mandibular cortical bone block. The procedure was carried out with apicoectomy, root-end preparation, and retrograde filling, and the bone block was repositioned before suture. No postoperative complications were reported. After 1 year, the patient presented asymptomatic and a CBCT scan confirmed bone healing.
Conclusion The current 3D-printed guides may be planned and printed through a novel simplified
workflow with a CBCT scan only, which allows its application in apical surgery for
precise apex and surgical site location.
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