The aim of this investigation was to review the surgical factors related to ostectomy in periapical surgery and their relationship to prognosis. An update was made of different techniques to achieve adequate access to the periapical lesion. Visual control of the affected roots is important for a successful result in periapical surgery; for this reason, the bone tissue from the vestibular cortical bone must be removed through an ostectomy or osteotomy. The technique used and the amount of bone removed must be analyzed preoperatively, since it will have a direct relationship to the surrounding anatomical structures, the healing time and the need to perform bone regeneration techniques. With the use of microsurgical techniques, the size of the ostectomy should not exceed 5 mm in order to reduce the healing time and thus improve the prognosis of periapical surgery. Osteotomy is an alternative technique that allows preservation of the external cortical bone, but has been little studied.
KeywordsOstectomy; osteotomy; periapical surgery; endodontic surgery; prognosis.
The following article describes 2 original techniques that use CAD/CAM technology to generate a pre-surgical healing abutment or provisional restoration. Two clinical cases are described using different techniques to create a guided soft-tissue emergence profile using a pre-surgical custom healing abutment or provisional restoration and their benefits. The first case describes the use of digital libraries with pontic emergence profiles. The 3-D object (tooth) is manipulated to replicate or to establish a natural contour that will determine the shape of the soft tissue during the healing process. The second technique describes the use of segmentation and mirroring of a natural tooth to generate an exact replica and emergence profile of the patient’s dentition. These techniques constitute a very simple and efficient way of generating a pre-surgical customized healing abutment or provisional restoration that allows the clinician to guide the soft-tissue healing process and emergence profile immediately after the surgery. The techniques are developed not to be software-specific, but rather to be used with any free or paid open architecture software.
KeywordsCAD/CAM; guided surgery; 3-D printing; segmentation; digital wax-up.