Introduction
Endodontic treatment aims to eliminate bacterial biofilms that
colonize complex root canal anatomy. Achievement of this goal is
performed by mechanically shaping, cleaning and obturation of the root
canals to create an adequate environment for periradicular healing (1)
.
Even with the advancement in endodontic tools such as magnification,
Cone beam computed tomography (CBCT), Ni-Ti rotary files and
ultrasonics, some cases cannot be successfully managed through nonsurgical treatment or retreatment which necessitate surgical intervention
(2,3)
.
The outcome of endodontic surgery was reported an estimated
overall success rate ranged from 82 % to 94 % (4,5,6)
. The outcome of
endodontic surgery depends on several factors such as gender, site, size
and extent of the bony cavities in addition to the techniques used for the
osteotomy and root end resection (7)
. The osteotomy and root end
resection are mostly accomplished by conventional tools, Piezosurgery
and/or Trephine bur. The technique used for the osteotomy and root end
resection influences the degree of postoperative complications such as
pain and swelling (8,9,10)
.
Conventional tools such as surgical burs are characterized by
availability, ease and speed. Nevertheless, there are several
complications associated with conventional tools, such as excessive
cutting force, high cutting temperature and surrounding tissue damage
(11)
. Research revealed that increasing the cutting temperatures above 47
°C during surgical procedures, even for intermittent periods, leads to
irreversible osteonecrosis that has a negative impact on the postoperative recovery time and complications(9,10)
.
Piezosurgery is a typical ultrasonic vibration cutting device that
has been gradually applied to bone surgery, such as osteotomy, implant
2
surgery, maxillofacial surgery, spinal surgery and neurosurgery (12)
. The
bone grafts harvested with a piezosurgery exhibited greater short-term
cell viability than chips harvested with a bur and showed greater
osteocyte viability and reduced cell death. (13)
. It was found that
Piezosurgery had less postoperative inflammation, trismus, and pain in
comparison with traditional rotary instruments in lower third molar
extraction (14)
. Piezosurgery is usually considered to be more expensive
and slower than conventional tools. Besides, Piezosurgery is associated
with an initial learning curve that takes time to learn how to use
effectively during the osteotomy (15)
.
Trephine burs are traditionally used for the removal of failed
implants and bone graft harvesting. Recently, trephine burs were used
for bone osteotomy and root ends resection. Only a few studies
investigated piezosurgery and trephine bur osteotomy and the
underlying outcomes. The aim of the study was directed to evaluate the
effect of piezosurgical technique in compared to trephine bur technique
after guided endodontic periapical microsurgery on the post-surgical
clinical and radiographic outcomes.