The aim of this investigation was to review the surgical factors related to ostectomy in periapical surgery and their relationship to prognosis. An update was made of different techniques to achieve adequate access to the periapical lesion. Visual control of the affected roots is important for a successful result in periapical surgery; for this reason, the bone tissue from the vestibular cortical bone must be removed through an ostectomy or osteotomy. The technique used and the amount of bone removed must be analyzed preoperatively, since it will have a direct relationship to the surrounding anatomical structures, the healing time and the need to perform bone regeneration techniques. With the use of microsurgical techniques, the size of the ostectomy should not exceed 5 mm in order to reduce the healing time and thus improve the prognosis of periapical surgery. Osteotomy is an alternative technique that allows preservation of the external cortical bone, but has been little studied.
KeywordsOstectomy; osteotomy; periapical surgery; endodontic surgery; prognosis.
The prognosis of periapical surgery has been improved in recent years with the use of new instruments and materials. Mineral trioxide aggregate (MTA) is considered the cement of choice for periapical surgery; however, a new calcium silicate-based material seems to improve on some of the properties of MTA. Two patients were referred to the oral surgery department of the University of Valencia, Valencia, Spain, for periapical surgery of 2 maxillary teeth. Clinical examination revealed pain in both cases. Periapical radiography and CBCT confirmed the diagnosis. The same surgical protocol was employed using a tricalcium silicate cement as a retrograde filling material. Up to 1-year clinical and radiographic control showed complete healing of soft and hard tissue. The success of periapical surgery achieved in both cases and the adequate management of tricalcium silicate cement as a retrograde filling material are highly promising.
KeywordsEndodontic surgery; periradicular surgery; Biodentine; retrograde filling.