Endodontic surgery using 3D-guides in-house manufacturing and trephine burs for osteotomy and root-end resection: a proof-of-concept clinical study.

OBJECTIVES: The study described a protocol for static-guided endodontic surgery, involving 3D in-house printed guides and trephine burs, to perform osteotomy and root apex resection simultaneously. MATERIALS AND METHODS: Clinical and radiographic data from 6 patients (9 roots) were evaluated. Cone-Beam Computed Tomography and intraoral scans were imported into the guided surgery software to virtually plan the osteotomy and a 3 mm root-end resection. Based on the virtual plan, surgical guides were designed, and Computer-Aided Design files exported in Standard Tessellation Language format were imported into the slicing software of the 3D printer for manufacturing. Surgeries were carried out under local anaesthesia and involved a mucoperiosteal flap incision and elevation, guided osteotomy and root-end resection using trephine burs, removal of the bone trapdoor, root apex, and periapical lesion with curettes, ultrasonic retropreparation and filling with Mineral Trioxide Aggregate, followed by suturing. RESULTS: For osteotomy, the size ranged from 20.00 to 93.00 mm² (59.17 ± 32.28 mm²), and the surgical time from 40 to 102 min (73.67 ± 23.00 min). These parameters were influenced by the size of the periapical lesion and the limited accessibility and visibility of the area. No complications occurred, and postoperative pain intensity was mild to moderate. Four patients achieved complete healing at the 6-month follow-up, and two by 12 months. CONCLUSIONS: The current findings supported the use of 3D in-house printed guides and trephine burs in endodontic surgery. CLINICAL RELEVANCE: 3D in-house printed guides in static-guided endodontic surgery offer a more cost-effective alternative to centralised facilities.