Preserving Natural Bone With Bone Window Guided Endodontic Surgery Utilizing a Piezoelectric Device: Case Reports of Two Molars

Aim: This study demonstrated the clinical application of static guided surgery (SGS) combined with piezoelectric technology for endodontic microsurgery. The research objective was to evaluate the benefits of integrating advanced technologies to achieve atraumatic, accurate osteotomy while preserving natural bone for grafting. Summary: Two female patients (ages 38 and 27) with symptomatic apical periodontitis of previously treated mandibular first molars were treated using this innovative approach. The methodology involved comprehensive clinical and radiographic examinations, including CBCT scans and digital oral scans. Virtual surgical planning was performed to design 3D-printed surgical templates that predetermine osteotomy size and apical resection levels. The surgical procedure utilized (Altaqi kit) piezoelectric instruments specially designed for endodontic microsurgery for precise bone and root-tip cutting and root-end preparation under microscopic guidance. The key work in these cases was the ability to precisely and conservatively cut and reposition the bone window as an autogenous bone graft, secured with platelet-rich fibrin plugs. This approach minimized surgical trauma by selectively cutting hard tissues while preserving soft tissues and reducing thermal damage. Both cases demonstrated successful clinical outcomes at 12-18-month follow-up, with patients remaining asymptomatic and showing routine healing without complications. The integration of piezoelectric technology with static surgical guides promoted early healing through bone-preserving techniques. The study concludes that this combined approach offers significant advantages for endodontic microsurgery, particularly in complex anatomical scenarios near critical structures, despite preparation time and equipment costs.