Targeted Endodontic Microsurgery: A Retrospective Outcomes Assessment of 24 Cases

Targeted endodontic microsurgery (TEMS) replaces freehand carbide or diamond bur osteotomy and root-end resection with a guided approach using an end-cutting trephine bur rotated within a guide tube. TEMS departs from traditional endodontic microsurgery in osteotomy size, control of resection level and bevel, surgical time, and resection method; yet, the impact of these departures on clinical outcomes has yet to be assessed. The aim of this study was to assess clinical outcomes of TEMS surgeries at least 1 year after treatment.

Potential cases were retrospectively identified from a secure database of all patients who received TEMS in the Air Force Postgraduate Dental School from June 2017-May 2019 with a postsurgical follow-up examination at 1 year or beyond (23 patients with 24 teeth). Two board-certified endodontists completed a calibration exercise before assessing radiographs. A retrospective outcomes assessment was conducted considering follow-up clinical and radiographic findings to assign 1 of 3 healing designations: complete healing, reductive healing, or failure.

Combined clinical and radiographic data led to 20 designations of complete healing, 2 designations of reductive healing, and 2 failures (91.7% success rate). Considered alone, radiographic criteria for complete healing were met for 20 cases, reductive healing for 3 cases, and radiographic failure for 1 case.

This limited retrospective outcomes assessment is an early indication that TEMS-guided trephine bur root-end resection leads to similar success as is established for freehand carbide and diamond bur resection. Controlled clinical trials with long-term follow-up are warranted.