Targeted endodontic microsurgery and endodontic microsurgery: a surgical simulation comparison

To compare surgical time, bevel angle and site volumetric profiles of osteotomy and resection accomplished by targeted endodontic microsurgery (TEMS) and traditional endodontic microsurgery (EMS) in a surgical simulation model.

An 80x80-mm cone beam computed tomography (CBCT) file was imported into Mimics software where artificial periapical lesions were created encompassing twelve root apices. Maxillary and mandibular models were 3D-printed. TEMS surgical guides were designed and 3D-printed for each surgical site. Three board-certified endodontists used the original CBCT to plan and perform EMS on models of six maxillary and six mandibular teeth. Next, the same endodontists performed TEMS on duplicate 3D-printed models for the same teeth. All surgeries were timed. Postoperative CBCT images of experimental models were made and imported into Amira software for measurement of bevel angle and site volumetric profiles. Paired t-tests compared the mean differences between EMS and TEMS groups. A Bonferroni correction determined data to be significant at P < 0.004.

TEMS significantly reduced surgical time (P < 0.00001), had bevel angles more closely approaching zero degrees (P < 0.01) and had significantly less volume of over-resection (P < 0.001) and length of root resection (P < 0.01).

In this surgical simulation scenario, TEMS provided more efficient completion of osteotomy and resection, with a more appropriate root-end resection volume and bevel angle.