Nagy Eszter, Fráter Márk, Antal Márk
Fogorvostudományi Kar, Konzerváló és Esztétikai Fogászati Tanszék,Szegedi Tudományegyetem, Szeged, Tisza Lajos krt. 60-64., 6720.
Orv Hetil. 2020 Jul;161(30):1260-1265. doi: 10.1556/650.2020.31778.
Surgical guides and three-dimensional (3D) planning softwares used in everyday dental implantology open new possibilities in other fields of dentistry. While using the operation microscope in endodontic microsurgery provides more precise apicectomy, there is still no consent on the exact localisation and size of the bony window to be prepared for this surgery. Our aim is to describe a new, guided endodontic microsurgery method when osteotomy and apicectomy are planned in a 3D software and performed with a trephine bur. Based on data from Cone Beam Computed Tomography, planning of the surgical guide was performed with a 3D planning software (Smart Guide, dicomLAB, Hungary) in order to define the size of the bony window, the angulation and the depth of the trephine bur during the apicectomy. After preparing a mucoperiosteal flap, with the help of the dentally supported surgical guide, the trephine bur removes the cortical bone and the apex of the root simultaniously. Following the modern microsurgical protocol, after performing the ultrasonic retrograde preparation, mineral trioxide aggregate (ProRoot MTA; Dentsply Maillefer, Ballaigues, Switzerland) is placed as a retrograde filling to close the resected area. After the uneventful healing period, a complete bony regeneration can be seen on the 1-year follow up X-ray. The patient is symptom-free. This technique is considered to be faster and more precise than the non-guided endodontic microsurgery carried out without the utilization of a trephine bur. Orv Hetil. 2020; 161(30): 1260-1265.
日常牙种植学中使用的手术导板和三维(3D)规划软件为牙科的其他领域开辟了新的可能性。虽然在牙髓显微手术中使用手术显微镜可实现更精确的根尖切除术,但对于该手术所需准备的骨窗的确切定位和大小仍未达成共识。我们的目的是描述一种新的引导式牙髓显微手术方法,即在3D软件中规划截骨术和根尖切除术,并使用环钻进行操作。基于锥形束计算机断层扫描数据,使用3D规划软件(Smart Guide,dicomLAB,匈牙利)进行手术导板的规划,以确定骨窗的大小、环钻在根尖切除术中的角度和深度。制备粘骨膜瓣后,在牙支持的手术导板的帮助下,环钻同时去除皮质骨和根尖。按照现代显微手术方案,在进行超声倒预备后,放置矿物三氧化物凝聚体(ProRoot MTA;登士柏迈弗,瑞士巴拉格)作为倒充填材料封闭切除区域。在顺利的愈合期后,在1年的随访X光片上可见完全的骨再生。患者无症状。该技术被认为比不使用环钻进行的非引导式牙髓显微手术更快、更精确。《匈牙利医学周报》。2020年;161(30): 1260 - 1265。