A novel three-dimensional printed guide for handling three strategic steps of surgical endodontics

Management of large periapical lesions often requires surgical intervention when the nonsurgical approaches are deemed insufficient. Nevertheless, surgical endodontics entails procedural complexities such as soft-tissue laceration during retraction, risk of damaging the adjacent anatomical structures, and postoperative scarring of the tissues. The role of cone-beam computed tomography (CBCT) and three-dimensional (3-D) printing has been monumental in countering these potential complications. This case highlights the use of a single 3-D-printed model for multiple applications. A 20-year-old male healthy patient reported with pus discharge in the maxillary right central and lateral incisor with no complaint of pain. The teeth were associated with large periapical lesion. A diagnosis of chronic periapical abscess was formulated. Surgical treatment was planned for the patient when a dry canal could not be obtained during orthograde root canal treatment. CBCT scan revealed a large periapical lesion (6.3 mm × 9 mm) and an intact buccal cortical plate. A surgical guide was designed to manage soft tissues and hard tissues during the surgical procedure. A single 3-D-printed model was used prudently for precise incision and flap retraction along with preservation of the buccal cortical plate. The surgical guide not only improved the predictability of the procedure but also made it significantly easy to handle the soft tissues. 10-month follow-up revealed complete healing and the patient remained asymptomatic.