Targeted Endodontic Microsurgery: Digital Workflow Options

Targeted endodontic microsurgery (TEMS) combines a precisely designed 3-dimensional (3D)-printed surgical guide with a trephine bur for safe and efficient osteotomy and root-end resection. The TEMS digital workflow converts the patient's anatomy into digital data in 4 steps. First, bone, teeth, and neurovascular spaces are rendered with cone-beam computed tomographic imaging. Next, crowns and soft tissues are rendered with an intraoral optical scan, a benchtop optical scan of an impression or cast, or a cone-beam computed tomographic scan of an impression or cast. Third, these renderings are merged within design software to create a 3D construction containing a virtual model. Finally, guide design is performed on the virtual model for 3D printing. A significant gap in knowledge exists in that digital workflow principles and considerations are not documented in the endodontic literature. The aim of this article is to describe TEMS digital workflow guiding principles.