A Novel Robot-Assisted Access in Endodontic Microsurgery Combined with Sinus Floor Elevation for Maxillary First Molar

Abstract

Endodontic microsurgery (EMS) is an important treatment option for endodontic disease when the nonsurgical endodontic treatment fails. However, EMS for maxillary molars often presents a clinical challenge due to the root apex close to the maxillary sinus floor, which may increase the risk of sinus membrane perforation. Furthermore, the depth between the apex of the palatal root and the buccal cortical plate significantly impacts EMS precision for restricting visualization and instrument access. This case report is the first to use an autonomous robotic system for minimally invasive EMS on a maxillary first molar, combined with precise lateral wall sinus fenestration. A 55-year-old male patient presented with symptomatic apical periodontitis associated with previously treated left maxillary first molar. Cone-beam computed tomography revealed low-density areas surrounding the mesiobuccal and palatal (P) roots, and maxillary sinus floor descended between the palatal and buccal roots. Integrating cone-beam computed tomography and intraoral scan data, the autonomous robotic system performed guided sinus fenestration localization, autonomous osteotomy, and a 15-mm root-end resection from buccal to palatal root, with real-time monitoring of depth, angulation, and force. The clinician employed endoscopic assistance to verify the integrity of the sinus membrane and ensure the removal of debris from the surgical site. Root-end preparation and filling were carried out under a microscope. Follow-ups at 1 week, 1 month, 3 months, and 6 months indicated an absence of clinical symptoms. This approach offers a precise and minimally invasive treatment option for molars with a descended maxillary sinus floor located between the buccal and palatal root.