“Bone Window - 3D-Printed Guide” Technique Aided Endodontic Microsurgery

In the case with substantial periapical lesion and intact buccal cortical bone, when conducting a “Bone Window” technique aided Endodontic Microsurgery (EMS), the 3D-printed surgical guide can facilitate bone window precisely locating and improve operative efficiency. A 48-year-old female complained of occlusal pain in the left mandibular posterior region for 2 months; and had undergone a root canal treatment six months prior for chronic periapical periodontitis as well. The clinical examination revealed a percussion sensitivity on tooth #36; radiographic examination suggested an extensive low-density radiopaque area compared to the previous imaging, where measuring up to approx.7.6mm × 8.5mm × 11.8 mm; but the buccal cortical remained intact. An EMS treatment plan to the mandibular first molar was concluded following the patient’s consent granted. Preoperatively, a tooth-supported surgical guide was designed and 3D-printed with an external edge access pathway, subsequently the bone window aided EMS was completed. In the substantial periapical lesion case with intact cortical bone, the bone window technique is able to minimizes iatrogenic bone loss while enhancing regenerative outcome. The preoperative design must deliberate the individual patient conditions A well-designed static guide enables the operators to perform a cortical incision safely and efficiently, whose philosophy benefiting both the static and dynamic navigation technology.