Autonomous Robot-Assisted Microscopic Apicoectomy With Maxillary Sinusitis

For teeth with severe periapical lesions or lesions involving critical anatomical structures, microscopic apicoectomy is required for treatment. In recent years, oral surgical robots have played an increasingly pivotal role in the management of endodontic diseases. This case report presents a refractory periapical periodontitis complicated by maxillary sinusitis treated with autonomous robot-assisted microscopic apicoectomy. A 21-year-old female patient underwent sequential root canal therapy, apical cyst enucleation, and root canal retreatment for tooth 16. Postoperative review revealed persistent lesions in the distobuccal root with pathological communication to the maxillary sinus and concurrent maxillary sinusitis. A diagnosis of chronic periapical periodontitis of tooth 16 with maxillary sinusitis was confirmed. Utilizing an oral surgical robot, an apicoectomy plan was formulated. A buccal bone window was created, and 3mm of the root apex was precisely resected under robotic guidance. Following microsurgical apicoectomy, concentrated growth factors (CGF) were implanted, and the bone block was repositioned. At the 3-month follow-up, the buccal mucosa exhibited satisfactory healing, the periapical radiolucency was reduced, and maxillary sinus mucosal thickness had decreased. Robot-assisted oral surgery enables enhanced visualization, minimally invasive manipulation, and improved precision in microscopic apicoectomy. This technology allows accurate localization and resection of the root apex in complex anatomical regions, minimizes osteotomy scope, and reduces complication risks. It provides an innovative therapeutic approach for refractory periapical periodontitis complicated by maxillary sinusitis.