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

Abstract

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.