Restorative Dentistry & Endodontics

Endodontic micro-resurgery and guided tissue regeneration of a periapical cyst associated to recurrent root perforation: a case report: Fernando Córdova-Malca, Hernán Coaguila-Llerena, Lucía Garré-Arnillas, Jorge Rayo-Iparraguirre, Gisele Faria; Restor Dent Endod 2022;47(4):e35. Published online September 3, 2022; DOI: https://doi.org/10.5395/rde.2022.47.e35

Abstract PDF PubReader ePub: Although the success rates of microsurgery and micro-resurgery are very high, the influence of a recurrent perforation combined with radicular cyst remains unclear. A 21-year-old white female patient had a history of root perforation in a previously treated right maxillary lateral incisor. Analysis using cone-beam computed tomography (CBCT) revealed an extensive and well-defined periapical radiolucency, involving the buccal and palatal bone plate. The perforation was sealed with bioceramic material (Biodentine) in the pre-surgical phase. In the surgical phase, guided tissue regeneration (GTR) was performed by combining xenograft (lyophilized bovine bone) and autologous platelet-rich fibrin applied to the bone defect. The root-end preparation was done using an ultrasonic tip. The retrograde filling was performed using a bioceramic material (Biodentine). Histopathological analysis confirmed a radicular cyst. The patient returned to her referring practitioner to continue the restorative procedures. CBCT analysis after 1-year recall revealed another perforation in the same place as the first intervention, ultimately treated by micro-resurgery using the same protocol with GTR, and a bioceramic material (MTA Angelus). The 2-year recall showed healing and bone neoformation. In conclusion, endodontic micro-resurgery with GTR showed long-term favorable results when a radicular cyst and a recurrent perforation compromised the success.

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A new minimally invasive guided endodontic microsurgery by cone beam computed tomography and 3-dimensional printing technology: Jong-Eun Kim, June-Sung Shim, Yooseok Shin; Restor Dent Endod 2019;44(3):e29. Published online July 25, 2019; DOI: https://doi.org/10.5395/rde.2019.44.e29

Abstract PDF Supplementary Material PubReader ePub: Endodontic microsurgery is defined as the treatment performed on the root apices of an infected tooth, which was unresolved with conventional root canal therapy. Recently, the advanced technology in 3-dimensional model reconstruction based on computed tomography such as cone beam computed tomography has opened a new avenue in application of personalized, accurate diagnosis and has been increasingly used in the field of dentistry. Nevertheless, direct intra-oral localization of root apex based on the 3-dimensional information is extremely difficult and significant amount of bone removal is inevitable when freehand surgical procedure was employed. Moreover, gingival flap and alveolar bone fenestration are usually required, which leads to prolonged time of surgery, thereby increasing the chance of trauma as well as the risk of infection. The purpose of this case report is to present endodontic microsurgery using the guide template that can accurately target the position of apex for the treatment of an anterior tooth with calcified canal which was untreatable with conventional root canal therapy and unable to track the position of the apex due to the absence of fistula.

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Effects of four novel root-end filling materials on the viability of periodontal ligament fibroblasts: Makbule Bilge Akbulut, Pembegul Uyar Arpaci, Ayce Unverdi Eldeniz; Restor Dent Endod 2018;43(3):e24. Published online May 25, 2018; DOI: https://doi.org/10.5395/rde.2018.43.e24

Abstract PDF PubReader ePub: Objectives
The aim of this in vitro study was to evaluate the biocompatibility of newly proposed root-end filling materials, Biodentine, Micro-Mega mineral trioxide aggregate (MM-MTA), polymethylmethacrylate (PMMA) bone cement, and Smart Dentin Replacement (SDR), in comparison with contemporary root-end filling materials, intermediate restorative material (IRM), Dyract compomer, ProRoot MTA (PMTA), and Vitrebond, using human periodontal ligament (hPDL) fibroblasts.
Materials and Methods
Ten discs from each material were fabricated in sterile Teflon molds and 24-hour eluates were obtained from each root-end filling material in cell culture media after 1- or 3-day setting. hPDL fibroblasts were plated at a density of 5 × 10³/well, and were incubated for 24 hours with 1:1, 1:2, 1:4, and 1:8 dilutions of eluates. Cell viability was evaluated by XTT assay. Data was statistically analysed. Apoptotic/necrotic activity of PDL cells exposed to material eluates was established by flow cytometry.
Results
The Vitrebond and IRM were significantly more cytotoxic than the other root-end filling materials (p < 0.05). Those cells exposed to the Biodentine and Dyract compomer eluates showed the highest survival rates (p < 0.05), while the PMTA, MM-MTA, SDR, and PMMA groups exhibited similar cell viabilities. Three-day samples were more cytotoxic than 1-day samples (p < 0.05). Eluates from the cements at 1:1 dilution were significantly more cytotoxic (p < 0.05). Vitrebond induced cell necrosis as indicated by flow cytometry.
Conclusions
This in vitro study demonstrated that Biodentine and Compomer were more biocompatible than the other root-end filling materials. Vitrebond eluate caused necrotic cell death.

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Proximity of the mandibular molar root apex from the buccal bone surface: a cone-beam computed tomographic study: Dokyung Kim, Jung-Hong Ha, Myoung-Uk Jin, Young-Kyung Kim, Sung Kyo Kim; Restor Dent Endod 2016;41(3):182-188. Published online July 14, 2016; DOI: https://doi.org/10.5395/rde.2016.41.3.182

Abstract PDF PubReader ePub: Objectives
The purpose of this study was to evaluate the proximity of the mandibular molar apex to the buccal bone surface in order to provide anatomic information for apical surgery.
Materials and Methods
Cone-beam computed tomography (CBCT) images of 127 mandibular first molars and 153 mandibular second molars were analyzed from 160 patients' records. The distance was measured from the buccal bone surface to the root apex and the apical 3.0 mm on the cross-sectional view of CBCT.
Results
The second molar apex and apical 3 mm were located significantly deeper relative to the buccal bone surface compared with the first molar (p < 0.01). For the mandibular second molars, the distance from the buccal bone surface to the root apex was significantly shorter in patients over 70 years of age (p < 0.05). Furthermore, this distance was significantly shorter when the first molar was missing compared to nonmissing cases (p < 0.05). For the mandibular first molars, the distance to the distal root apex of one distal-rooted tooth was significantly greater than the distance to the disto-buccal root apex (p < 0.01). In mandibular second molar, the distance to the apex of C-shaped roots was significantly greater than the distance to the mesial root apex of non-C-shaped roots (p < 0.01).
Conclusions
For apical surgery in mandibular molars, the distance from the buccal bone surface to the apex and apical 3 mm is significantly affected by the location, patient age, an adjacent missing anterior tooth, and root configuration.

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Apicoectomy of maxillary anterior teeth through a piezoelectric bony-window osteotomy: two case reports introducing a new technique to preserve cortical bone: Viola Hirsch, Meetu R. Kohli, Syngcuk Kim; Restor Dent Endod 2016;41(4):310-315. Published online July 5, 2016; DOI: https://doi.org/10.5395/rde.2016.41.4.310

Abstract PDF PubReader ePub: Two case reports describing a new technique of creating a repositionable piezoelectric bony window osteotomy during apicoectomy in order to preserve bone and act as an autologous graft for the surgical site are described. Endodontic microsurgery of anterior teeth with an intact cortical plate and large periapical lesion generally involves removal of a significant amount of healthy bone in order to enucleate the diseased tissue and manage root ends. In the reported cases, apicoectomy was performed on the lateral incisors of two patients. A piezoelectric device was used to create and elevate a bony window at the surgical site, instead of drilling and destroying bone while making an osteotomy with conventional burs. Routine microsurgical procedures - lesion enucleation, root-end resection, and filling - were carried out through this window preparation. The bony window was repositioned to the original site and the soft tissue sutured. The cases were re-evaluated clinically and radiographically after a period of 12 - 24 months. At follow-up, radiographic healing was observed. No additional grafting material was needed despite the extent of the lesions. The indication for this procedure is when teeth present with an intact or near-intact buccal cortical plate and a large apical lesion to preserve the bone and use it as an autologous graft.

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Patients' perception and satisfaction with apicoectomy: Euiseong Kim, Seung-Jong Lee, Jeong-Won Park, Su-Jung Shin; J Korean Acad Conserv Dent 2011;36(2):114-118. Published online March 31, 2011; DOI: https://doi.org/10.5395/JKACD.2011.36.2.114

Abstract PDF PubReader ePub: Objectives
This study was aimed to examine the patients' perception and satisfaction with the results of endodontic microsurgery which was apicoectomy with retrofilling.
Materials and Methods
A questionnaire was given to 109 patients, who were recalled after a minimum of 3 months upon endodontic microsurgery in the Department of Conservative Dentistry, Yonsei University. A contingency table and correlation analysis were used to determine if there were any correlations between age/gender and the patients' responses (p = 0.05).
Results
Approximately 60% of respondents answered they had never heard of surgical endodontic procedures. 63.3% of respondents chose the surgical option because they wanted to keep their natural teeth. If the patient required the same procedure on another tooth later, 100 out of 109 respondents answered they would choose microsurgery instead of extraction. Most patients (82.57%) appeared to be satisfied with the surgical procedure.
Conclusions
Endodontic microsurgery consisting of apicoectomy and retrofilling seems to appeal to majority of patients as a satisfactory and valuable treatment choice.

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