Endodontic Disease, Endodontic Re-treatment Failure
Conditions
Keywords
Apicoectomy, Guided Endodontic Surgery, Micro-Surgery, Surgical Guide, 3-Dimensional Printed, Critical Structures
Brief summary
In recent years, there was a great interest in employing the surgical guide in dentistry due to the development occurred in the 3D printing which became available widely. Cone beam computed tomography (CBCT) is necessary and crucial in planning for endodontic surgery, but the procedure still depends on how the surgeon reflect the 3D images on the anatomical structures accurately, which may leave room for error. This study is to compare the clinical and radiographic outcomes using guided endodontic microsurgery versus conventional endodontic microsurgery in critical anatomical structures.
Detailed description
Endodontic microsurgery in critical anatomical structures is considered as a serious challenge for the endodontist. Major advances have been made to the techniques used in endodontic surgery to make the procedure easier to perform, safer and more predictable. Several case reports that used surgical guide in endodontic microsurgery found that the procedure was more accurate in control of depth, diameter and angle of osteotomy. The aim of this study is to compare the clinical and radiographic outcomes using guided endodontic microsurgery versus conventional endodontic microsurgery in critical anatomical structures. Patients will be selected that they are indicated for endodontic surgery. Upper and lower teeth will be selected close to critical anatomy such as; maxillary sinus, nasal fossa, mental foramen and mandibular canal. medical and dental history will be obtained from all selected patients. Patients will be randomly distributed to either guided micro-surgery group or conventional micro-surgery group. All steps of the surgical procedure will be performed under microscopic magnification. Bioceramic putty will be used as a root-end filling material. Post-surgical instructions will be given to patients. The time of the surgery will be recorded from the first incision to the last suturing. Success and failure will be assessed using radiographic and clinical evaluation at 6 and 12 months.
Interventions
DEVICE3-D printed Guide
Guided Endodontic micro-surgery
OTHERConventional Endodontic Micro-Surgery
Free-hand endodontic micro-surgery
Sponsors
Damascus University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Masking description
Double-Blind
Intervention model description
Parallel Assignment
Eligibility
Sex/Gender
ALL
Age
18 Years to 50 Years
Healthy volunteers
Yes
Inclusion criteria
* Patients in good general health. * Patients with age ranging between 18-50 years. * Posterior/anterior teeth close to critical anatomical structures that indicated for endodontic surgery. * Patients' acceptance to participate in the trail.
Exclusion criteria
* Patients with allergy to materials or medications used in the trial. * Patients with Serious systemic disease incompatible with surgery. * Pregnant female patients. * Teeth with periapical pathosis associated with vertical root fracture. * Non-restorable teeth. * Teeth with periodontal probe more than 5 mm.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Clinical Success at two weeks | Periodontal tissue healing will be evaluated clinically 2 weeks | The position of the oral mucosa at the flap site will be assessed after surgery to evaluate wound healing using the wound healing index (WHI) by Huang et al 2005 as the following criteria: Score 1 = uneventful healing with no gingival edema, erythema, suppuration, patient discomfort, or flap dehiscence. Score 2 = uneventful healing with slight gingival edema, erythema, patient discomfort, or flap dehiscence, but no suppuration. Score 3 = poor wound healing with significant gingival edema, erythema, patient discomfort, flap dehiscence, or any suppuration. |
| Clinical Success at one year | Clinical signs or symptoms will be evaluated 1 year | The patient's symptoms will be evaluated and the examination will be done on percussion, palpation and probing. Clinical Success will be defined as absence of pain, swelling or sensitivity on percussion. Clinical failure is the persistence of any of the above-mentioned symptoms. |
| Radiographic Success at 6 months | Periapical tissues healing will be evaluated radiographically at 6 months after surgery | Early follow-up will be done and the initial radiographic Success or failure will be assessed. The size of periapical lesions/radiographic transparency will be measured in millimeters by periapical radiographs and CBCT images |
| Radiographic Success at 12 months | Periapical tissues healing will be evaluated radiographically at 12 months after surgery | Radiographic Success will be defined as either complete or incomplete healing (formation of scar tissue). Radiographic Failure will involve either uncertain healing (small or constant lesion size) or unsatisfactory healing (increased lesion size). The size of periapical lesions/radiographic transparency will be measured in millimeters by periapical radiographs and CBCT images |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time of surgery | During surgery | The surgical time will be recorded in minutes from the first incision to the last suturing |
| Change in Pain Perception | Pain will be evaluated at 24, 48, and 72 hours after surgery | Pain assessment will be performed using a Visual Analog Scale (VAS) which is a subjective measure instrument for acute and chronic pain. Scores are recorded by making a handwritten mark on a 10-cm line that represents a continuum between 0 (no pain) and 10 (worst pain). |
Countries
Syria
Outcome results
None listed