Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
J Endod. 2020 Jun;46(6):872-880. doi: 10.1016/j.joen.2020.02.009. Epub 2020 Apr 17.
Endodontic microsurgery for a tooth with a large periapical lesion and an intact cortical plate may necessitate the removal of extra bone and cause delayed or unfavorable healing. In such cases, the "bone window" technique offers excellent exposure to the operative field and preserves cortical bone without placing any additional graft material. In the reported cases, root-end surgery was performed on the maxillary and mandibular molars with a large periapical lesion. The bone window was fashioned with the aid of thin osteotomy instruments and repositioned to the original site at the end of the procedure, which resulted in minimizing bone loss and acted as an autologous graft for the surgical site. At 12- and 16-month follow-ups, clinical examinations and cone-beam computed tomographic scans revealed the healing of the lesion without symptoms or complications. Cone-beam computed tomographic imaging was used as a presurgical assessment tool for indication selection and precise design of the bone window. The use of a bone window in endodontic microsurgery, which appears to be a reliable technique, should be the method of preference when the large lesion is deeply positioned between intact buccal and lingual cortices.
对于有较大根尖病变和完整皮质板的牙齿，牙髓显微外科手术可能需要去除额外的骨组织，并导致延迟或不利的愈合。在这种情况下，“骨窗”技术可提供出色的手术视野，并在不放置任何额外移植物材料的情况下保留皮质骨。在报告的病例中，对上颌和下颌磨牙进行了根尖手术，这些磨牙有较大的根尖病变。在薄骨切开器械的帮助下形成骨窗，并在手术结束时重新定位到原始位置，从而最大限度地减少了骨丢失，并作为手术部位的自体移植物。在 12 个月和 16 个月的随访中，临床检查和锥形束 CT 扫描显示病变愈合，无任何症状或并发症。锥形束 CT 成像被用作术前评估工具，用于选择适应证和精确设计骨窗。当较大的病变位于颊侧和舌侧完整皮质之间的深部位置时，在牙髓显微外科手术中使用骨窗似乎是一种可靠的技术，应成为首选方法。
