Air Force Postgraduate Dental School, Uniformed Services University of the Health Sciences Postgraduate Dental College, Joint Base San Antonio-Lackland, Texas.
Air Force Postgraduate Dental School, Uniformed Services University of the Health Sciences Postgraduate Dental College, Joint Base San Antonio-Lackland, Texas.
J Endod. 2021 May;47(5):762-769. doi: 10.1016/j.joen.2021.01.007. Epub 2021 Feb 4.
Targeted endodontic microsurgery (TEMS) replaces freehand carbide or diamond bur osteotomy and root-end resection with a guided approach using an end-cutting trephine bur rotated within a guide tube. TEMS departs from traditional endodontic microsurgery in osteotomy size, control of resection level and bevel, surgical time, and resection method; yet, the impact of these departures on clinical outcomes has yet to be assessed. The aim of this study was to assess clinical outcomes of TEMS surgeries at least 1 year after treatment.
Potential cases were retrospectively identified from a secure database of all patients who received TEMS in the Air Force Postgraduate Dental School from June 2017-May 2019 with a postsurgical follow-up examination at 1 year or beyond (23 patients with 24 teeth). Two board-certified endodontists completed a calibration exercise before assessing radiographs. A retrospective outcomes assessment was conducted considering follow-up clinical and radiographic findings to assign 1 of 3 healing designations: complete healing, reductive healing, or failure.
Combined clinical and radiographic data led to 20 designations of complete healing, 2 designations of reductive healing, and 2 failures (91.7% success rate). Considered alone, radiographic criteria for complete healing were met for 20 cases, reductive healing for 3 cases, and radiographic failure for 1 case.
This limited retrospective outcomes assessment is an early indication that TEMS-guided trephine bur root-end resection leads to similar success as is established for freehand carbide and diamond bur resection. Controlled clinical trials with long-term follow-up are warranted.
靶向根管内微创手术（TEMS）用导向方法取代了徒手碳化钨或金刚石车针截骨和根尖切除术，该方法使用在导向管内旋转的端切型环钻。TEMS 在截骨大小、切除平面和斜度控制、手术时间和切除方法上与传统根管内微创手术有所不同；然而，这些差异对临床结果的影响尚未评估。本研究旨在评估 TEMS 手术后至少 1 年的临床结果。
从 2017 年 6 月至 2019 年 5 月在空军研究生院接受 TEMS 治疗的所有患者的安全数据库中回顾性确定潜在病例，并在术后 1 年或以上（23 名患者，24 颗牙）进行术后随访检查。两名经过董事会认证的牙髓病医生在评估 X 光片之前完成了校准练习。通过回顾性的结果评估，结合随访的临床和影像学发现，对 3 种愈合情况之一进行指定：完全愈合、缩小愈合或失败。
综合临床和影像学数据，有 20 颗牙齿被指定为完全愈合，2 颗牙齿为缩小愈合，2 颗牙齿为失败（成功率为 91.7%）。仅考虑影像学标准，20 例符合完全愈合，3 例符合缩小愈合，1 例符合影像学失败。
这项有限的回顾性结果评估表明，TEMS 引导的环钻根尖切除术与徒手碳化钨和金刚石车针切除的成功率相当。需要进行长期随访的对照临床试验。
