Targeted Endodontic Microsurgery: A Novel Approach to Anatomically Challenging Scenarios Using 3-dimensional–printed Guides and Trephine Burs—A Report of 3 Cases

Endodontic microsurgery (EMS) techniques have increased success rates over traditional approaches. Despite surgical advances, anatomically challenging scenarios can preclude EMS in certain cases. The aim of this article was to introduce targeted EMS, which uses 3-dimensional–printed surgical guides (3DSGs) and trephine burs to achieve single-step osteotomy, root-end resection, and biopsy in complex cases. In each of 3 cases, a 3DSG with a trephine port was printed using computer-aided design/computer-aided manufacturing implant planning software. The osteotomy site, angulation, and depth of preparation were defined preoperatively to avoid sensitive anatomic structures. The 3DSG was inserted at the target site to achieve precise osteotomy and root-end resection during surgery. A hollow trephine rotated within the 3DSG port produced single-step osteotomy, root-end resection, and biopsy. Root-end preparation and fill were accomplished, and tissues were sutured in place. Targeted EMS potentiated successful surgical treatment in 3 anatomically challenging scenarios: (1) a palatal approach to the palatal root of a maxillary second molar, (2) a facial approach to a fused distofacial-palatal root of a maxillary first molar, and (3) a mandibular second premolar in close proximity to the mental foramen. Trephine burs guided by 3DSGs produce efficient targeted osteotomies with a predictable site, angulation, and depth of preparation. Apical surgery in challenging anatomic cases such as the palatal root of the maxillary second molar, fused molar roots, and root ends in approximation to the mental nerve are possible with targeted EMS.     

A comparative Study of the Masticatory Efficiency in Complete Dentures Using Acrylic and Metal Occlusal Posterior Teeth—Photocolorimetric Analysis

Masticatory efficiency is always compromised in complete denture patients. The denture teeth with compromised occlusal anatomy and material further compound the inherent limitations of complete dentures. To compare the masticatory efficiency of patients with complete denture using acrylic and metal occlusal posterior teeth. Ten edentulous patients with well-formed ridges were selected. Complete dentures using acrylic and metal occlusal posterior teeth were fabricated. The masticatory efficiency was calculated using photo colorimeter. Complete dentures with 20° acrylic resin posterior teeth were fabricated for ten edentulous patients and masticatory efficiency was measured using raw beetroot as test food on a photocolorimeter after 10, 15, 20 strokes. The acrylic resin posterior teeth were replaced with metal occlusal posterior teeth on the same denture base. The masticatory efficiency was measured by the same method. The mean average percentage of masticatory efficiency with acrylic resin teeth and metal occlusal teeth were first calculated and statistical analysis was done using students unpaired t test. The average masticatory efficiency with acrylic teeth was 46.46% and metal occlusal teeth was 65.62, ‘t’ = 5.38. The difference between the mean average masticatory performance percentage with acrylic teeth and metal occlusal teeth was significant at 1% i.e. P < 0.01. Within the limitation of this study the average percentage value of masticatory efficiency improves considerably when metal occlusal teeth replace normal acrylic teeth without any alteration in position or relation.