Restor Dent Endod.  2016 Nov;41(4):310-315. 10.5395/rde.2016.41.4.310.

Apicoectomy of maxillary anterior teeth through a piezoelectric bony-window osteotomy: two case reports introducing a new technique to preserve cortical bone

• Hirsch V
• Kohli MR
• Kim S

• KMID: 2356008
• DOI: http://doi.org/10.5395/rde.2016.41.4.310

Abstract

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.

Keyword

Apicoectomy; Autologous graft; Bony window; Piezoelectric

MeSH Terms

Apicoectomy*
Cerebral Cortex
Follow-Up Studies
Humans
Incisor
Microsurgery
Osteotomy*
Tooth*
Transplants

Figure

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  Figure 1 Treatment radiographs and clinical pictures of Case 1. (a) Pre-operative radiograph with measurement tool; (b) Post-operative radiographs; (c) 9 month follow-up radiograph; (d) 18 month follow-up radiograph; (e) Piezoelectrically created bony window (magnification, ×8); (f) Bony window osteotomy exposing the lesion site; (g) Root-end filling with white MTA and a clean osteotomy site; (h) Bony window repositioned.

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  Figure 2 Treatment radiographs of Case 2. (a) Pre-operative radiograph; (b) Post-operative radiographs; (c) 12 month follow-up radiograph.

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  Figure 3 Intra-operative clinical pictures of Case 2. (a) Piezoelectrically created bony window (magnification, ×8); (b) Bony window osteotomy exposing the lesion site after curettage and root resection; (c) Root-end filling with white MTA; (d) Bone flap repositioned along with some CollaCote collagen material.

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