Guiding Groove: A New Hypothetical Strategy for Ostectomy and Fenestration in Endodontic Microsurgery

Abstract

Introduction: How to save more bone for the teeth of patients with chronic periapical periodontitis with intact or small defects of the labiobuccal cortical plate in the periapical surgeries is a problem that many dentists are concerned about. The Hypothesis: We came up with a new strategy for periapical surgery by designing a modified osteotomy and fenestration method, which we named the “guiding groove” method. There are two ways to achieve this, one is to perform guided groove positioning under CBCT dynamic navigation, and the other is to design a guide plate that marks the position and direction of the guided groove based on CBCT data before surgery. Evaluation of the Hypothesis: The existence of the “guiding groove” locks in the angle and direction of the ultrasonic root end preparation and retrofilling apparatus, which not only minimizes the deviation of the root canal but also preserves more cortical plate on the labial and buccal sides of the teeth and thus improves the efficiency of treatment. This hypothesis has certain limitations. Firstly, the technical sensitivity of the operation is high, and proficiency in CBCT dynamic navigation technology is required. The accuracy requirements for navigation equipment are also relatively high. It will also increase the patient’s exposure to X-rays. For the guide plate designed before surgery that has already marked the position of the guide groove, it can only accurately avoid the deviation of the operating instrument in the proximal and distal directions, and it is difficult to avoid the deviation of the instrument in the buccal and lingual directions.