School of Dentistry, Federal University of Goiás, Goiânia, Goiás, Brazil; School of Dentistry, Alfredo Nasser University Center, Aparecida de Goiânia, Goiás, Brazil.
School of Dentistry, Federal University of Goiás, Goiânia, Goiás, Brazil.
J Endod. 2022 Jul;48(7):930-935. doi: 10.1016/j.joen.2022.04.001. Epub 2022 Apr 9.
One of the challenges in apical surgery in mandibular molars is the thick buccal cortical bone plate, which might lead to access errors, damage to neighboring teeth, and injury to healthy tissue. Surgical guide templates with 3-dimensional (3D) impressions have been suggested for use in such cases, allowing greater precision. Usually, this technique involves a cone-beam computed tomography (CBCT) examination related to a 3D oral scanning to generate surgical templates printed from 3D imaging data. This study reports a novel workflow possibility in which apical surgery is performed with the aid of a surgical guide planned only with CBCT, excluding the need for 3D oral scanning. A 32-year-old woman presented with asymptomatic apical periodontitis and external root resorption on the mesial root of tooth #19. A surgical template was planned using only the patient's CBCT scan to provide precise access to the lesion and remove a mandibular cortical bone block. The procedure was carried out with apicoectomy, root-end preparation, and retrograde filling, and the bone block was repositioned before suture. No postoperative complications were reported. After 1 year, the patient presented asymptomatic, and a CBCT scan confirmed bone healing. The current 3D-printed guides may be planned and printed through a novel simplified workflow with a CBCT scan only, which allows its application in apical surgery for precise apex and surgical site location.
在下颌磨牙的根尖手术中，一个挑战是颊侧皮质骨板较厚，这可能导致手术入路错误、损伤邻牙和健康组织。对于这种情况，已经提出使用带有三维（3D）印模的手术导板，以提高精确度。通常，这种技术涉及与 3D 口腔扫描相关的锥形束 CT（CBCT）检查，以生成从 3D 成像数据打印的手术模板。本研究报告了一种新的工作流程可能性，即在仅使用 CBCT 规划的手术导板的帮助下进行根尖手术，无需进行 3D 口腔扫描。一名 32 岁女性因牙 19 的近中根出现无症状的根尖周炎和外吸收而就诊。仅使用患者的 CBCT 扫描规划了一个手术模板，以精确进入病变部位并切除下颌皮质骨块。手术包括根尖切除术、根管末端预备和逆行充填，并在缝合前重新定位骨块。术后无并发症报告。1 年后，患者无症状就诊，CBCT 扫描证实骨愈合。目前的 3D 打印导板可以通过仅使用 CBCT 扫描的新简化工作流程进行规划和打印，这允许其在精确的根尖和手术部位定位的根尖手术中应用。
