Air Force

Targeted endodontic microsurgery using 3D printed guides

Tools and method for single-step osteotomy, root-end resection, and biopsy in complex cases

Medical & Biotechnology

The U.S. Air Force has invented a novel tool for perfecting the alignment of trephine drills during complex dental surgeries. The patent-pending technology is available to businesses for development into an available product.

Lt Col. (Dr.) Jarom Ray, one of the technology’s inventors, looks into a microscope while performing a root canal. (Lausanne Morgan/Air Force)

Advances in endodontic microsurgery (EMS) have steadily accumulated over the past 20 years resulting in widespread use, greater efficiency, and improved outcomes for patients.

Non-surgical root canal treatment and EMS provide viable options for dealing with irreversible pulpitis, pulp necrosis, and apical periodontitis in a majority of cases. EMS achieves desirable outcomes through enhanced visualization, magnification, and illumination.

EMS is required for 10 percent of all root canal treatments that result in non-healing. In such instances, an incision is made to access the end of the root and 3mm of the root end is resected. The exposed canal space is prepared and filled with a biocompatible material. Success rates for EMS are around 90 percent.

However, anatomic considerations often prohibit carrying out EMS and these include the location of neurovascular structures, the area towards the posterior dental arch, palatal location in the dental arch, proximity to the maxillary sinus and, areas where bone thickness would prohibit adequate orientation and vision of the root end. For this reason, teeth with prohibitive factors are extracted with resultant morbidity.

To avoid these extractions, Air Force scientists and doctors have developed improvements to conventional EMS procedures and have widened the field of use. The new targeted-EMS technique can be used in areas where anatomical complexities render free-hand osteotomy and root end resection prohibitive. This approach uses 3D–printed surgical guides (3DSGs) and trephine burs to achieve single-step osteotomy, root-end resection, and biopsy in these complex cases.

Procedurally, a 3DSG with a trephine port is designed using CAD/CAM implant planning software and then sent to a 3D printer for fabrication. The osteotomy site, angulation, and depth of penetration are defined preoperatively to avoid sensitive anatomic structures. The 3DSG is inserted at the target site to direct a trephine along a precise osteotomy and root-end resection pathway. A hollow trephine rotated within the 3DSG port produces single-step osteotomy, root-end resection, and biopsy. Root-end preparation and fill are accomplished, and tissues sutured in place.

Targeted EMS brings about clinical simplicity to challenging anatomic cases involving the maxillary sinus, greater palatine artery, posterior dental arch location, mental nerve, and fused roots.

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