Open Access Open Access  Restricted Access Subscription or Fee Access

Application of Guided Surgery Concepts in the Programming and Intraoperative Management of Apicoectomies using a Surgical Template: A Case Report

Fabrizio Carini, Ziad Omara, Fabio Carini, Ayt Alla Bader, Gianluca Porcaro


Apicoectomies are Endodontic Microsurgical procedures that require high precision. However, the state-of-the-art method currently used provides for a certain degree of imprecision as it heavily relies on the clinician’s judgment and experience with the sole aid of preliminary radiographic investigations. This clinical study aims to apply the Surgical Guided Approach, frequently used in Implantology, to Apicoectomies, thereby ensuring higher precision and, therefore, a lower amount of bone tissue loss as a by-product of the procedure. The proposed method uses surgical templates with 4 mm in diameter drilling pilot holes in correspondence to the root apices to be treated. This allows to introduce 4 mm trephine surgical burs. This allows the complete removal and retention of the root apices. The method was tested on polyurethane models first and then applied on a patient for clinical trials. The surgical templates allowed for significant gains in precision and accuracy compared to the currently used method for apicoectomies: reaching and removing the apical roots was possible by performing osteotomies with only 4 mm in diameter through which retrograde root-end preparations and fillings were carried out successfully. The proposed method provides a valid alternative for apicoectomies and allows greater precision and healthy tissue preservation.



Apicoectomy, guided surgery, surgical template, endodontic microsurgery, oral surgery

Full Text:



Chiapasco M. (2013), Manuale illustrato di Chirurgia Orale (Third Edition), Edra S.p.A., Milan, Italy, pp. 237–258.

Società italiana di endodonzia, Berutti E., et al. (2013), Manuale di endodonzia (First Edition), Edra S.p.A., Milan, Italy, pp. 744–769.

Gilheany P.A., Figdor D., Tyas M.J., Apical dentin permeability and microleakage associated with root end resection and retrograde filling, J Endod, 1994; 20:22–6.

Kobayashi K., Shimoda S., Nakagawa Y., Yamamoto A., Accuracy in measurement of distance using limited cone-beam computerized tomography, Int J Oral Maxillofac Implants 2004;19:228e31.

Lund H., Grondahl K., Grondahl H.G., Accuracy and precision of linear measurements in cone beam computed tomography Accuitomo tomograms obtained with different reconstruction techniques, Dentomaxillofac Radiol 2009;38:379e86.

Buser D., Bornstein M.M., Weber H.P., Grutter L., Schmid B., Belser U.C., Early implant placement with simultaneous guided bone regeneration following single-tooth extraction in the esthetic zone: a cross-sectional, retrospective study in 45 subjects with a 2-to 4-year follow-up, J Periodontol, 2008: 79: 1773–1781.

Arisha, Zarabuda, Mumcu, Ozdemir, Implant positioning errors in freehand and computer-aided placement methods: a single-blind clinical comparative study, Int J Oral Maxillofac Implants 2013; 28; 28: 190–2014.

Mehlhaff D.S., Marshall J.G., Baumgartner J.C., Comparison of ultrasonic and high-speed bur root-end preparations using bilaterally matched teeth, J Endod, 1997; 23:448–52.

Int Endod J, 2008, Jan; 41(1):6–31. Application of Guided Surgery Concepts in the Programming Carini et al.

Tsesis I., Faivishevsky V., Kfir A., Rosen E., Outcome of surgical endodontic treatment performed by a modern technique: a meta-analysis of the literature, J Endod, 2009; 35:1505–11.

Von Arx T., Walker W.A. III, Microsurgical instruments for root-end cavity preparation following apicoectomy: a literature review, Endod Dent Traumatol, 2000; 16:47–62.

Torabinejad M., Rastegar A.F., Kettering J.D., Pitt Ford T.R., Bacterial leakage of mineral trioxide aggregrate as a rootend filling material, J Endod, 1995; 21:109–12.

Ackerman S, Aguilera FC, Buie JM, Glickman GN, Umorin M, Wang Q, Jalali P. Accuracy of 3-dimensional-printed Endodontic Surgical Guide: A Human Cadaver Study. J Endod. 2019 ;45(5):615–618.

Kim JE, Shim JS, Shin Y. A new minimally invasive guided endodontic microsurgery by cone beam computed tomography and 3-dimensional printing technology. Restor Dent Endod. 2019 25;44(3):e29.

Sutter E, Lotz M, Rechenberg DK, Stadlinger B, Rücker M, Valdec S. Guided apicoectomy using a CAD/CAM drilling template. Int J Comput Dent. 2019;22(4):363–369



  • There are currently no refbacks.

Copyright (c) 2022 Research & Reviews: A Journal of Dentistry