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Izvestia Journal of the Union of Scientists - Varna. Medicine and Ecology Series

Experimental surgical guide for apical osteotomy, produced by additive technology and based on a CBCT imaging study

Viktoria Petkova, Desislava Konstantinova, Anna Nenova-Nogalcheva


Introduction: Periapical, inflammatory processes of the teeth lead to bone changes that require a precise analysis of the clinical and radiographic images of the patient. The bigger the lesion of the apical area is, the more complex and difficult procedure treatment actions need to be taken.

Aim: The aim of this study was to analyse the possibility of better visualisation of bone defects in the oral cavity, based on 3D imaging and its subsequent reproduction by additive technique.

Case Presentation: A 73-year-old patient with swelling in the facial area and feeling generally unwell, contacted us for emergency dental intervention. From the anamnesis, clinical extra- and intraoral examination, a working diagnosis of periapical, granulomatous periodontitis of tooth 22 was made. After 2D and 3D imaging, the diagnosis was confirmed. The treatment plan included presurgical, endodontic, and pre-prosthetic preparation, followed by periapical surgery of the problem area, after accurate localisation.

Results: The actual visualisation of the bone defect, its exact localisation, dimensions, and orientation in space allowed the oral surgeon to do better planning of the surgical board. The result was a precise preoperative analysis and a short and problem-free postoperative period for the patient.

Conclusion: The presented approach of the surgical planning favours the most optimal treatment plan by developing a prototype for a three-dimensional visualisation of anatomical features of the patient, determined by CBCT scan. All this improves the outcome of the surgical procedure planning and shortens the postoperative period of the patient.


periapical lesions, CBCT, additive technique, surgical intervention

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