Endodontic Microsurgery Using Dynamic Navigation and Trephine Burs
Trenton Smith, DDS1, Sameer Jain, DDS, MS, MSD5, Jeffrey Nick Sanders, DDS1*, Michael Block, DDS2, Mark A. Odom DDS3 and Albert F. McMullen III DDS4
1 Post-graduate Endodontic Resident, Louisiana State University Health Science Center School of Dentistry, 1100 Florida Ave, New Orleans, LA, USA.
2 Department of Oral Maxillofacial surgery, Louisiana State University Health Science Center School of Dentistry, 1100 Florida Ave, New Orleans, LA, USA.
3 Department Head- Endodontics, Louisiana State University Health Science Center School of Dentistry, 1100 Florida Ave, New Orleans, LA, USA.
4 Director of Post-graduate Endodontics Louisiana State University Health Science Center School of Dentistry, 1100 Florida Ave, New Orleans, LA, USA.
5 Private practice of Endodontics, Woodland Hills, CA, USA.
*Corresponding Author: Jeffrey Nick Sanders, DDS, Post-graduate Endodontic Resident, Louisiana State University Health Science Center School of Dentistry, 1100 Florida Ave, New Orleans, LA, USA.
DOI: https://doi.org/10.58624/SVOADE.2024.05.0184
Received: July 24, 2024 Published: August 13, 2024
Abstract
Objectives: The use of the surgical operating microscope, CBCT imagining, biocompatible filling materials and ultrasonic instruments have improved the success and predictability of apical surgery. Despite these advances, more accurate and precise techniques for creating osteotomies and root-resections (apicoectomies) have not been widely adopted. This study highlights how dynamic navigation systems (DNS) can help avoid unnecessary dentin removal and “mitigate iatrogenic errors” such as root perforation.
Methods: A total of 56 root-end resections were planned and completed on two sets of identical TrueJaw Endosurg models (DE Labs, Santa Barbra, CA, USA). One set of maxillary and mandibular jaws were used for 28 preparations, performed with a DNS (X-Guide, X-Nav Technologies, Lansdale, PA, USA). A second set of maxillary and mandibular jaws were used for 28 preparations executed freehand (FH), with pre-op measurements taken from a CBCT scan (CS 9600; Carestream, Atlanta, GA, USA). A Mann-Whitney test was used to compare the accuracy of the two groups
Results: The average preparation depth was 10.77 mm. For the DNS group the average angular deviation was 2.35 degrees. The average deviation at the terminal end of the preparations was 0.96 mm (global apical deviation). For the freehand group average angular deviation was 13.55 degrees and the average global apical deviation was 2.62 mm. Significant differences were identified between the DNS and FH groups for angular deviation (p<0.05), apical non-depth deviation (p<0.05) and between the Global apical deviation(p<0.05).
Conclusion: Dynamic navigation demonstrated superior accuracy and precision over freehand in the context of apical microsurgery preparations. This study provides further proof of concept for the application of DNS in Endodontics.
Clinical significance: Apical surgery can be a daunting task for an endodontist. Surgical guides can make the procedure easier, but they take time and money to make. DNS virtual planning can be completed rapidly and may be altered mid-procedure. This inherent flexibility makes same-day guided apical surgeries practical and predictable.
Keywords: Endodontic Microsurgery; Apical Surgery; Trephine Burs; Dynamic Navigation
Citation: Smith T, Jain S, Sanders JN, Block M, Odom MA, McMullen III AF. Endodontic Microsurgery Using Dynamic Navigation and Trephine Burs. SVOA Dentistry 2024, 5:4, 147-153. doi:10.58624/SVOADE.2024.05.0184
