A Novel Method for Periapical Microsurgery With the Aid of 3D Technology

A Case Report

Shangzhu Ye; Shiyong Zhao; Weidong Wang; Qianzhou Jiang; Xuechao Yang


BMC Oral Health. 2018;18(85) 

In This Article


When a radiotransparent periapical lesion measures over 8 to 10 mm in diameter[1] and it is a suspected periapical cyst, endodontic surgery is required to remove the cyst and a biopsy is needed to confirm histologic diagnosis of the lesion.[2]

A most commonly performed endodontic surgery usually involves exposure of the periapical lesion through an osteotomy, surgical removal of the lesion, removal of part of the root-end tip.[3] However, the root-end surface sometimes can be difficult to distinguish from the surrounding osseous tissues.[4]

In such cases, conventionally, the approximate location of the root-end may be estimated using preoperative radiographs.[3] The method of locating the root apex is to first locate the body of the root substantially coronal to the apex, where the bone covering the root is thinner. Once the root has been located and identified, the bone covering the root is slowly and carefully removed, working in an apical direction until the root apex is identified.[5]

The limitations and disadvantages of the classical surgical method have become apparent due to the rapid advance of technology. Firstly, searching for root apex from the coronal direction of root end inevitably increases damage and risk to non-pathological osseous tissues.[4] Secondly, conventional radiography shows only two-dimensional images, which does not represent the lesion area accurately and distinctly. Thirdly, it is not easy for inexperienced endodontic surgeons to balance between limiting damage to osseous tissues and gaining enough visual and operative access for root-end resection and root-end filling.[4] Based on CBCT, CAD and 3D printing technology, however, these problems can be solved.

Rapid prototyping technology, better known as 3D printing, has provided new possibilities for diagnosis, surgical planning, prosthesis design, and student education in medicine. In dentistry, 3D printing technology has been used for treatment planning, surgical guidance, and the fabrication of dental models for appliances in orthognathic surgery, implant surgery, oral and maxillofacial surgery, orthodontics, and prosthodontics.[6–10] The high accuracy of 3D printing and extended flexibility render this technology very promising.[11–15] In endodontics, 3D printing has also gained wide application. Kim et al.[16] fabricated a 3D printed physical tooth model to aid the endodontic treatment of an anomalous anterior tooth; a 3D printed template was used in root canal treatment for teeth with pulp canal calcification,[17] and its accuracy was proven;[11] Shi X et al.[18] described the application of a 3D printed template for the predictable navigation of obliterated canal systems during root canal treatment to avoid iatrogenic damage of the root;[18] In endodontic surgery, a 3D printed retractor was invented and fabricated for soft tissue retraction.[8]

This case report describes a novel method for guided periapical surgery, which removed overlying cortical bone and root-end precisely with the aid of a 3D-printed surgical template.