Palatal root surgery of a maxillary molar using a piezosurgery transantral approach with simultaneous sinus lift grafting: a case report

AIM

To report a case involving transantral palatal root piezoelectric surgery followed by a sinus floor augmentation procedure with the purpose of minimizing and managing complications associated with sinus lining perforations and optimizing bone regeneration at the site of the surgical defect.

SUMMARY

An asymptomatic 28-year-old male patient with the diagnosis of chronic apical periodontitis on a previously root filled right maxillary first molar (FDI tooth 16) and second premolar (No. 15) was managed by transantral apical surgery. Cone-beam computerized tomography (CBCT) revealed the position of the palatal root of the first molar within the maxillary sinus. The case highlights the management of the palatal root and the handling of a perforation of the Schneiderian membrane through a combination of piezosurgery and a sinus lift grafting procedure involving a second-generation of platelet concentrates. No postoperative complications were observed. Sinus bone augmentation after a 26-month recall period was confirmed by CBCT in the clinically asymptomatic teeth.

KEY LEARNING POINTS

The selective bone tissue cutting and enhanced visibility obtained by piezoelectric surgery in comparison with current rotary techniques make this technology the preferred tool for apical surgery when the mucosal lining of the maxillary sinus could be compromised. The wound healing and physical properties of the platelet-rich fibrin membranes in combination with an allograft material can be considered as sinus bone graft options when a transantral approach is performed on a palatal root of a maxillary molar. A preoperative tomographic examination is essential for apical surgery using a transantral approach with sinus bone augmentation, because of the information obtained from the axial and coronal views on the CBCT scan.

SEM comparison of acid-etched, CO2 laser-irradiated, and combined treatment on dentin surfaces

Research into polymer systems capable of bonding to dentin and enamel have resulted in improved bond strengths that allow more conservative restoration and strengthening of teeth. However, pretreatment of the dentin and enamel of various sorts, including exposure to laser energy, have been espoused to enhance this bonding. This study investigated the effects of two pretreatments, acid and CO2 laser exposure, both alone and in combination, on the surface topography of prepared dentin specimens as observed by scanning electron microscopy. Eighteen dentin specimens were flat-sanded with 600 grit sandpaper and exposed to 10% maleic acid and CO2 laser both alone and in combination. SEM observation suggested that laser treatment prior to acid etching could increase the resistance of the smear layer to acid removal, that laser exposure after acid treatment could expose a porous topography suggestive of the underlying dentin inorganic structure by way of vaporization of the collagen surface left after acid demineralization, and that these effects varied in degree with the laser exposure energy.