Approaches in apical microsurgery: conventional vs. guided. A systematic review

Abstract

Introduction: Apicoectomy plays a crucial role in the clinical practice of dental professionals. High success rates in this treatment, along with increased precision, suggest that 3D-printed guided apical microsurgery may provide a significant improvement over conventional apical microsurgery. The objectives of this study were to evaluate healing rates in terms of medium- and long-term success percentages and to assess longitudinal deviation rates, measured in millimetres, for both techniques in the apical resection procedure. Materials and methods: This systematic review followed PRISMA guidelines and searched three scientific databases-PubMed, Web of Science, and Scopus-using specific search algorithms focused on 3D-printed guided apical microsurgery and conventional microsurgery. Articles from 2013 onwards were considered, including randomized clinical trials, case series, observational studies, and cohort studies involving human subjects. Results: The initial search yielded a total of 397 articles: PubMed (119), Scopus (137), and Web of Science (141). Of these, 25 were identified as potentially eligible through title and abstract screening. After detailed evaluation, 9 articles met the inclusion criteria and were included in the systematic review. The review found that the longitudinal deviation and healing rates were consistently higher for the guided microsurgery technique compared to conventional microsurgery. Conclusions: Despite limitations within the studies, the 3D-printed guided microsurgery technique appears to offer greater precision and a reduced overall impact on the patient's soft tissues during root-end resection, making it a promising option for improving clinical outcomes in apicoectomy procedures.