Comparison of the Three-Dimensional Accuracy of Guided Apicoectomy Performed with a Drill or a Trephine: An In Vitro Study

Guided apicoectomy performed with 3D-printed polymer-based static surgical guides is an emerging trend in endodontic surgery. Static-guided apicoectomy is carried out with either a drill or a trephine. The aim of this in vitro study was to assess the accuracy of osteotomy and apicoectomy performed through a polymer guide, with both drill and trephine, and to compare the accuracy achievable with the two instruments. Six plaster models of a maxilla master model with extracted human maxillary teeth in polymethyl-methacrylate resin were used. The modeled osteotomies were performed in these. The master model was CBCT-scanned, and digital surgical plans were prepared, based on which the surgical guides were printed. The plans contained both drill and trephine apicoectomies. Digital three-dimensional position analysis was performed with dedicated algorithms. A total of 39 drill and 47 trephine osteotomies were analyzed. A statistically significant difference between the two instruments was found only in the global deviation of the distal endpoint, indicating lower deviation for the trephine procedure (1.53 mm vs. 1.31 mm, p = 0.038). Nevertheless, from a clinical perspective, this distinction is inconsequential. The results suggest that, for all practical purposes, the two approaches to apicoectomy allow the same level of accuracy

Assessment of a novel electrochemically deposited smart bioactive trabecular coating (SBTC®): a randomized controlled clinical trial

Abstract Objectives A randomized controlled clinical trial of dental implants was conducted to compare the clinical properties of a novel electrochemically deposited calcium phosphate coating to those of a common marketed surface treatment. Material and methods Forty implants of the same brand and type were placed in 20 fully edentulous participants requiring mandibular implantation. The two study groups were defined by the surface treatment of the implants. 20 implants in the control group were coated via a commercial electrochemical surface treatment that forms a mixture of brushite and hydroxyapatite, while the remaining 20 in the test group were coated with a novel electrochemical Smart Bioactive Trabecular Coating (SBTC®). A split-mouth design was employed, with each participants receiving one control implant in one mandibular side and a test implant in the other. To mitigate potential operator-handedness bias, control and test implants were randomly assigned to mandibular sides. All cases underwent digital planning, implant placement with a static surgical guide, and participants received locator-anchored full-arch dentures. The primary outcome was implant stability (measured using Osstell ISQ) assessed at insertion, loading, and then 3 months, 9 months, and 2 years post-insertion. The secondary outcome was bone level change (in millimeters) over the 2-year observation period. Oral health-related quality of life (OHRQL) was monitored using the OHIP-14 questionnaire. Complications and adverse events were recorded. Results Successful osseointegration and implant stability were achieved in all cases, allowing loading. ISQ values steadily increased throughout the observation period. While no significant differences were observed between the SBTC® and control coatings, the test group exhibited a higher ISQ gain. Bone resorption was somewhat lower in the SBTC® but not significantly so. Patients' OHRQL significantly improved after denture delivery and remained stable throughout the follow-up. No complications or adverse events were observed. Conclusions Based on the study results, we conclude that the new surface treatment is a safe alternative to the widely used control surface, demonstrating similar osseointegrative properties and time-dependent bone level changes. Further research may explore the broader implications of these findings. Trial registration The study is registered on clinicaltrials.gov under the identifier ID: NCT06034171