Author: Dr. Libertucci Mauro


When there are indications, endodontic surgery can lead to the resolution of periapical infections, but in particular cases it may require advanced surgical skills. When the lesion to be treated is particularly close to noble anatomical structures such as the alveolar nerve or is located behind particularly thick vestibular cortices, having a system to guide our surgery simplifies the procedure. The technique devised by the colleges Giuseppe Carrieri, Paula Villa and Mauro Rigolone provides that radiological data are collected through a CBCT and a 3D optical scan of the arch in question to obtain a DICOM file and an STL file. Using a special software made available to the clinician by 3DIEMME it is possible to “match” these files and design a surgical guide. This can be used both for guiding a dedicated cutter for a circular hatch, and for guiding the tip of the Piezo or Erbium Laser for a rectangular hatch.

In this case, the template for a circular hatch was used to treat the mesial root of a 36. The cortical cut was performed with a dedicated bur which allows reaching the apex area with a cutting diameter of only 4 mm which reduces postoperative morbidity. The cut of the apex, which in this case was not performed at 0 degrees as required by the technique, can be performed without distinction both with the same drill used for the osteotomy and with the Piezo tips, as well as with traditional rotary instruments. The preparation of the retrograde cavity was performed with dedicated tips mounted on a sub sonic or ultrasonic hand piece. For the control of the various working phases, it is very useful to use micro-mirrors with black and flexible stems to avoid annoying reflections and to orient them according to need. The retrograde filling was performed with fast-hardening putty bioceramic cement. The bone hatch is repositioned upside down according to the dictates of the SOOR (Single Overturning of Ridge) technique currently being published in an important scientific journal.

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