Digital Guide Plate Combined With Autogenous Bone Reposition In Tems

Targeted endodontic microsurgery (TEMS) is an advanced apical surgery supported by CBCT and CAD/CAM, which uses 3D printed guide plates to accurately locate the apical lesion. The corresponding autogenous bones removed during surgery were repositioned, which protected the apical region and accelerated the formation of new bone. In this case, 4 upper anterior teeth (11,12,21,22) progressed apical cysts (diameter 4-5mm) after RCT and PFM. 2 digital guide plates were produced according to preoperative CBCT. The corresponding labial bones (diameter 5mm), apical lesions (root tip 3mm) and periapical cysts were removed during surgery. Apical inverted preparations and fillings were completed through oral microscope and biomaterials (iRoot BP Plus). The autogenous bones were repositioned after placing absorbable collagen sponges (φ7-12x15, BONANGA).The immediate postoperative apical X-ray showed that apices were well inverted filling. Follow-up CBCT at 3 months after surgery showed the disappearance of apical shadows. TEMS precisely removed the labial bones and periapical lesions, reduced the operative and healing time. The autogenous bones were repositioned to promote bone healing and stabilize the reduction. This approach preserved more of the bone structure and eliminated the need for additional bone grafting. But, due to the limited surgical approach, treatment must be facilitated by oral microscope and specially ultrasound probes. TEMS can accurately locate the apical lesion, avoid damaging adjacent teeth or teeth surrounding organizations, and promote the healing of both soft and hard tissues in the surgical area.