Targeted Endodontic Microsurgery: Computed Tomography-based Guided Stent Approach with Platelet-rich Fibrin Graft: A Report of 2 Cases.

Endodontic microsurgery is a predictable alternative to nonsurgical treatment of persistent and recurrent apical periodontitis. The modern endodontic microsurgical procedure has been evolving in pace with technological advances. The introduction of modern innovations such as cone-beam computed tomographic (CBCT) imaging, 3-dimensional (3D) printing technology, and a 3D surgical guide designed with computer-aided software has allowed for a novel approach to the surgical site. The aim of these case reports was to describe root-end surgery with the use of the implant DDS-Pro planning software (Natrodent Polska, Poland), a 3D-printed surgical guide precisely positioned according to the preoperative CBCT scan measurements (CS 8100; Carestream Dental, Atlanta, GA), and a modified soft tissue access. A hollow trephine bur was used to perform the osteotomy, resection of the root, and enucleation of the lesion. The intact cortical plate was salvaged and used as a graft along with plasma-rich fibrin acquired preoperatively from the patient's blood. The positioning guide allowed the clinicians to precisely achieve targeted tissues and shorten the procedure time. Modified soft tissue management helped achieve a small surgical wound for uneventful healing. A less than 12-month CBCT follow-up of both cases showed complete 3D healing of the surgical site.