Palatal root endodontic microsurgery in maxillary molars using the palatal approach: a case study.
Endodontic microsurgery.
Maxillary molar
Palatal approach
Journal
BMC oral health
ISSN: 1472-6831
Titre abrégé: BMC Oral Health
Pays: England
ID NLM: 101088684
Informations de publication
Date de publication:
07 Oct 2024
07 Oct 2024
Historique:
received:
12
05
2024
accepted:
24
09
2024
medline:
8
10
2024
pubmed:
8
10
2024
entrez:
7
10
2024
Statut:
epublish
Résumé
In clinical practice, the buccal approach is typically the primary choice for endodontic microsurgery. Owing to the thickness of the buccal bone plate, the distance between the buccal bone plate and palatal lesion location, and soft tissue traction, the palatal approach may be more suitable for microsurgery for apical periodontitis of the palatal roots of the maxillary molars. However, the length of the palatal root, location of the greater palatine artery (GPA) and foramen (GPF), and surgical field of observation make palatal surgery challenging. With the aid of Cone-beam computed tomography imaging, the palatal approach was successfully applied in nine cases of endodontic microsurgery of the palatal root of a maxillary molar with a periapical lesion in Hangzhou Stomatology Hospital from January to December 2022. Complete healing was assessed based on clinical symptoms and radiographic images at the 3- and 24-month follow-up visits in all nine cases. Several tips have been proposed including surgical positioning, incision design, palate flap modification, bone removal, and root-end resection.
Sections du résumé
BACKGROUND
BACKGROUND
In clinical practice, the buccal approach is typically the primary choice for endodontic microsurgery. Owing to the thickness of the buccal bone plate, the distance between the buccal bone plate and palatal lesion location, and soft tissue traction, the palatal approach may be more suitable for microsurgery for apical periodontitis of the palatal roots of the maxillary molars. However, the length of the palatal root, location of the greater palatine artery (GPA) and foramen (GPF), and surgical field of observation make palatal surgery challenging.
CASE PRESENTATION
METHODS
With the aid of Cone-beam computed tomography imaging, the palatal approach was successfully applied in nine cases of endodontic microsurgery of the palatal root of a maxillary molar with a periapical lesion in Hangzhou Stomatology Hospital from January to December 2022.
CONCLUSIONS
CONCLUSIONS
Complete healing was assessed based on clinical symptoms and radiographic images at the 3- and 24-month follow-up visits in all nine cases. Several tips have been proposed including surgical positioning, incision design, palate flap modification, bone removal, and root-end resection.
Identifiants
pubmed: 39375638
doi: 10.1186/s12903-024-04956-6
pii: 10.1186/s12903-024-04956-6
doi:
Types de publication
Journal Article
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
1192Informations de copyright
© 2024. The Author(s).
Références
Khayat BG. The use of magnification in endodontic therapy: the operating microscope. Pract Periodontics Aesthet Dent. 1998;10(1):137–44.
Pecora G, Andreana S. Use of dental operating microscope in endodontic surgery. Oral Surg Oral Med Oral Pathol. 1993;75(6):751–8.
doi: 10.1016/0030-4220(93)90435-7
Michaelides PL. Use of the operating microscope in dentistry [published correction appears in J Calif Dent Assoc 1996;24(10):9]. J Calif Dent Assoc. 1996;24(6):45–50.
Carr GB. Microscopes in endodontics. J Calif Dent Assoc. 1992;20(11):55–61.
Kim S, Kratchman S. Modern endodontic surgery concepts and practice: a review. J Endod. 2006;32(7):601–23.
doi: 10.1016/j.joen.2005.12.010
Kim S. Principles of endodontic microsurgery.Dental. Clin North Am. 1997;41(3):481–97.
Floratos S, Kim S. Modern endodontic microsurgery concepts: a clinical update. Dent Clin North Am. 2017;61(1):81–91.
doi: 10.1016/j.cden.2016.08.007
Kratchman SI. Endodontic microsurgery. Compend Contin Educ Dent. 2007;28(7):399–407.
Feldman M. Microscopic surgical endodontics. N Y State Dent J. 1994;60(8):43–5.
Forbes G. Apical microsurgery for failed endodontics. Atlas Oral Maxillofac Surg Clin North Am. 2000;8(1):1–25.
doi: 10.1016/S1061-3315(18)30039-8
Kahler B. Microsurgical endodontic retreatment of post restored posterior teeth: a case series. Aust Endod J. 2010;36(3):114–21.
doi: 10.1111/j.1747-4477.2010.00277.x
Bi C, Zhou M, Han X, et al. Endodontic microsurgery with Orthodontic Treatment in a Mandibular Left Molar with symptomatic apical periodontitis. J Endod. 2020;46(11):1799–805.
doi: 10.1016/j.joen.2020.07.033
Bi C, Zhou M, Zhang Y, et al. Endodontic microsurgery of Mandibular Second molars using the Bony Lid Approach: a Case Series. J Endod. 2022;48(12):1533–8.
doi: 10.1016/j.joen.2022.10.001
Bernardi S, Bianchi S, Lupi E, Gerardi D, Macchiarelli G, Varvara G. Plasmacytoma in the Maxillary Jaw: a diagnostic and therapeutic challenge. Hematol Rep. 2024;16(1):22–31.
doi: 10.3390/hematolrep16010003
Bernardi S, Bianchi S, Gerardi D, et al. Anatomy of Maxillary Sinus: Focus on Vascularization and Underwood Septa via 3D imaging. Tomography. 2024;10(4):444–58.
doi: 10.3390/tomography10040034
Patel S, Brown J, Pimentel T, Kelly RD, Abella F, Durack C. Cone beam computed tomography in Endodontics - a review of the literature. Int Endod J. 2019;52(8):1138–52.
doi: 10.1111/iej.13115
Chan F, Brown LF, Parashos P. CBCT in contemporary endodontics. Aust Dent J. 2023;68(Suppl 1):S39–55.
Angiolani F, Piattelli M, Rinaldi F, Trubiani O, Varvara G. Prevalence and localization of Canalis Sinuosus: a Mini Review. Italian J Anat Embryol. 2023;127(2):41–5.
doi: 10.36253/ijae-14680
Rinaldi F, Piattelli M, Angiolani F, Bernardi S, Rastelli E, Varvara G. Volumetric evaluation of maxillary sinuses using CBCTS: radiographic study. Italian J Anat Embryol. 2023;127(2):47–50.
doi: 10.36253/ijae-14681
Kopacz M, Neal JJ, Suffridge C, et al. A clinical evaluation of cone-beam computed tomography: implications for endodontic microsurgery. J Endod. 2021;47(6):895–901.
doi: 10.1016/j.joen.2021.03.014
Lee SH, Cho SY, Kim DH, et al. Clinical outcomes after apical surgery on the Palatal Root of the Maxillary First Molar using a Palatal Approach. J Endod. 2020;46:464–70.
doi: 10.1016/j.joen.2020.01.005
Molven O, Halse A, Grung B. Observer strategy and the radiographic classification of healing after endodontic surgery. Int J Oral Maxillofac Surg. 1987;16:432–9.
doi: 10.1016/S0901-5027(87)80080-2
Tavelli L, Barootchi S, Ravidà A et al. What is the Safety Zone for Palatal Soft tissue graft harvesting based on the locations of the Greater Palatine Artery and Foramen? A systematic review. J Oral Maxillofac Surg. 2019;77(2).
Chrcanovic BR, Custódio AL. Anatomical variation in the position of the greater palatine foramen. J Oral Sci. 2010;52:109–13.
doi: 10.2334/josnusd.52.109
Wang TM, Kuo KJ, Shih C, et al. Assessment of the relative locations of the greater palatine foramen in adult Chinese skulls. Acta Anat (Basel). 1988;132:182–6.
doi: 10.1159/000146572
Choi J, Park HS. The clinical anatomy of the maxillary artery in the pterygopalatine fossa. J Oral Maxillofac Surg. 2003;61(1):72–8.
doi: 10.1053/joms.2003.50012
Fu JH, Hasso DG, Yeh CY, et al. The accuracy of identifying the greater palatine neurovascular bundle: a cadaver study. J Periodontol. 2011;82(7):1000–6.
doi: 10.1902/jop.2011.100619
Tashi S, Purohit BS, Becker M, et al. The pterygopalatine fossa: imaging anatomy, communications, and pathology revisited. Insights Imaging. 2016;7(4):589–99.
doi: 10.1007/s13244-016-0498-1
Smith BG, Pratt AM, Anderson JA, et al. Targeted endodontic microsurgery: implications of the Greater Palatine Artery. J Endod. 2021;47(1):19–27.
doi: 10.1016/j.joen.2020.10.005
Saxena DGT, Gupta P. Static vs. dynamic navigation for endodontic microsurgery - A comparative review. J Oral Biol Craniofac Res. 2022;12:410–12.
doi: 10.1016/j.jobcr.2022.04.010
Jamali JA. Palatal flap. Oral Maxillofac Surg Clin North Am. 2014;26(3):305–11.
doi: 10.1016/j.coms.2014.05.012
Moore BA, Magdy E, Netterville JL, et al. Palatal reconstruction with the palatal island flap. Laryngoscope. 2003;113(6):946–51.
doi: 10.1097/00005537-200306000-00007