Healing After Endodontic Microsurgery Using a Rotary Bur Versus Piezoelectric Unit for Osteotomy and Root Resection

NCT ID: NCT07197658

Last Updated: 2025-09-29

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

130 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-04-25

Study Completion Date

2026-12-10

Brief Summary

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The goal of this clinical trial is to compare bone healing after using apical tooth microsurgery to remove root end infection, either by use of rotary burs for cutting bone and root end, or by use of piezoelectric surgery for the same procedures.

The main questions it aims to answer are:

* Is there a difference in bone healing and reformation between the two surgical procedures ?
* Is there a difference in bone healing between cutting the bone with a rotary bur and cutting the bone with the 'bone window' technique that uses piezoelectric unit ?

Detailed Description

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The aim of this study is to prospectively compare postsurgical healing after the use of microsurgical technique to eliminate apical pathology, either by use of rotary burs for osteotomy and root resection, or by use of piezoelectric surgery for the same clinical procedures. Null hypothesis is that there is no difference in healing and buccal bone thickness reformation between the two surgical procedures Another purpose of the study is to prospectively evaluate healing after the application of a novel buccal bone preservation technique, called the 'bone window' technique. The technique will be applied in a subgroup of patients on maxillary and mandibular premolar and molar teeth with an intact buccal cortical bone and healing and buccal bone reformation will be assessed at follow up. Null hypothesis in this part, is that there is no difference in healing and buccal bone preservation between osteotomy with a bur and the 'bone window' technique.

Conditions

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Periapical Periodontitis Endodontic Microsurgery Osteotomy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

For this prospective investigation, patients will be randomly allocated into two groups. In the experimental group, endodontic microsurgery will be performed by use of a rotary bur for osteotomy and apical root resection.

In the control group, piezoelectric surgery will be used for the same clinical procedures. All surgical procedures will be performed by one operator. Postsurgical healing as well as certain preoperative and postoperative parameters will be assessed and compared in the two groups. In a subgroup of patients having at least 2mm of intact buccal cortical bone thickness preoperatively, piezoelectric surgery will be used to prepare a rectangular buccal 'bone window'. The buccal bone thickness will be measured preoperatively on the coronal slices of the Cone Beam Computed Tomography (CBCT). After completing the root end filling, the bone window will be repositioned at the original position
Primary Study Purpose

BASIC_SCIENCE

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Group 1 (Experimental Group) - Rotary bur

Endodontic microsurgery will be performed by use of a rotary bur

Group Type EXPERIMENTAL

endodontic microsurgery / rotary bur osteotomy

Intervention Type PROCEDURE

Endodontic microsurgery will be executed by use of a rotary bur

Group 2 (Control Group) - Piezoelectric unit

Endodontic microsurgery will be performed by use of a piezoelectric unit

Group Type ACTIVE_COMPARATOR

Endodontic microsurgery / piezo osteotomy

Intervention Type PROCEDURE

Endodontic microsurgery will be performed by use of a piezosurgery unit

Bone Window subgroup

'Bone window' technique will be performed

Group Type ACTIVE_COMPARATOR

Endodontic microsurgery / bone window

Intervention Type PROCEDURE

'Bone window' technique will be performed by use of piezoelectric surgery

Interventions

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endodontic microsurgery / rotary bur osteotomy

Endodontic microsurgery will be executed by use of a rotary bur

Intervention Type PROCEDURE

Endodontic microsurgery / piezo osteotomy

Endodontic microsurgery will be performed by use of a piezosurgery unit

Intervention Type PROCEDURE

Endodontic microsurgery / bone window

'Bone window' technique will be performed by use of piezoelectric surgery

Intervention Type PROCEDURE

Other Intervention Names

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bur osteotomy endodontic microsurgery endodontic surgery surgical endodontic retreatment piezosurgery apical surgery bone lid

Eligibility Criteria

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Inclusion Criteria

* Age 18 years and older consenting to the surgical procedure as well as agreeing to preoperative, postoperative and at least one follow-up CBCT evaluation after 12 months
* Noncontributory medical history (American Society of Anesthesiologists class I and II)
* A history of previous endodontic treatment with radiographic presence of apical periodontitis
* A true endodontic lesion: microsurgical classification A, B, or C according to Kim and Kratchman, 2006.
* Lesion size 10 mm or smaller in diameter measured on preoperative CBCT
* Coronal restoration should be present at the time of follow up examination.

Exclusion Criteria

* Nonconsenting patients and patients younger than 18 years of age
* Medical history with American Society of Anesthesiologists class III to V
* Insufficient coronal restoration
* Nonrestorability or traumatized teeth
* Teeth with microsurgical classification D, E, or F according to Kim and Kratchman, 2006.
* Mobility I or higher
* Radiographic presence of nonapical root resorption
* Teeth with a vertical root fracture or coronal/ midroot perforation
* Lesion size larger than 10 mm in diameter measured on preoperative CBCT
* Use of bone graft material for regeneration
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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National and Kapodistrian University of Athens

OTHER

Sponsor Role lead

Responsible Party

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Spyros Floratos

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Apostolos Tsolakis, DMD,MS,PhD

Role: STUDY_DIRECTOR

National Kapodistrian University of Athens

Locations

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Private Dental Office

Athens, Attica, Greece

Site Status RECRUITING

Spyros Floratos Private Dental Office

Athens, Attica, Greece

Site Status RECRUITING

Countries

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Greece

Central Contacts

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Spyros Floratos, DMD, PhDCand

Role: CONTACT

+30 697 745 8959

Facility Contacts

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DMD, PhDCand

Role: primary

+30 697 745 8959

Spyros Floratos, DMD,PhDCand

Role: primary

+30 697 745 8959

References

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von Arx T, Janner SF, Hanni S, Bornstein MM. Agreement between 2D and 3D radiographic outcome assessment one year after periapical surgery. Int Endod J. 2016 Oct;49(10):915-25. doi: 10.1111/iej.12548. Epub 2015 Oct 8.

Reference Type BACKGROUND
PMID: 26356580 (View on PubMed)

Chen I, Karabucak B, Wang C, Wang HG, Koyama E, Kohli MR, Nah HD, Kim S. Healing after root-end microsurgery by using mineral trioxide aggregate and a new calcium silicate-based bioceramic material as root-end filling materials in dogs. J Endod. 2015 Mar;41(3):389-99. doi: 10.1016/j.joen.2014.11.005. Epub 2015 Jan 14.

Reference Type BACKGROUND
PMID: 25596728 (View on PubMed)

Hirsch V, Kohli MR, Kim S. Apicoectomy of maxillary anterior teeth through a piezoelectric bony-window osteotomy: two case reports introducing a new technique to preserve cortical bone. Restor Dent Endod. 2016 Nov;41(4):310-315. doi: 10.5395/rde.2016.41.4.310. Epub 2016 Jul 5.

Reference Type BACKGROUND
PMID: 27847753 (View on PubMed)

Khoury F, Hensher R. The bony lid approach for the apical root resection of lower molars. Int J Oral Maxillofac Surg. 1987 Apr;16(2):166-70. doi: 10.1016/s0901-5027(87)80125-x.

Reference Type BACKGROUND
PMID: 3110314 (View on PubMed)

Vercellotti T, De Paoli S, Nevins M. The piezoelectric bony window osteotomy and sinus membrane elevation: introduction of a new technique for simplification of the sinus augmentation procedure. Int J Periodontics Restorative Dent. 2001 Dec;21(6):561-7.

Reference Type BACKGROUND
PMID: 11794567 (View on PubMed)

Yaman Z, Suer BT. Piezoelectric surgery in oral and maxillofacial surgery. Annals of Oral and Maxillofacial Surgery. 2013; 1:1-9

Reference Type BACKGROUND

Chopra P, Chopra P. Piezosurgery and its applications in Periodontology and Implantology. International Journal of Contemporary Dentistry. 2011;2(4): 16-24

Reference Type BACKGROUND

Rashad A, Kaiser A, Prochnow N, Schmitz I, Hoffmann E, Maurer P. Heat production during different ultrasonic and conventional osteotomy preparations for dental implants. Clin Oral Implants Res. 2011 Dec;22(12):1361-5. doi: 10.1111/j.1600-0501.2010.02126.x. Epub 2011 Mar 21.

Reference Type BACKGROUND
PMID: 21435005 (View on PubMed)

Song M, Kim E. A prospective randomized controlled study of mineral trioxide aggregate and super ethoxy-benzoic acid as root-end filling materials in endodontic microsurgery. J Endod. 2012 Jul;38(7):875-9. doi: 10.1016/j.joen.2012.04.008. Epub 2012 May 16.

Reference Type BACKGROUND
PMID: 22703646 (View on PubMed)

Tsesis I, Rosen E, Schwartz-Arad D, Fuss Z. Retrospective evaluation of surgical endodontic treatment: traditional versus modern technique. J Endod. 2006 May;32(5):412-6. doi: 10.1016/j.joen.2005.10.051.

Reference Type BACKGROUND
PMID: 16631838 (View on PubMed)

Setzer FC, Shah SB, Kohli MR, Karabucak B, Kim S. Outcome of endodontic surgery: a meta-analysis of the literature--part 1: Comparison of traditional root-end surgery and endodontic microsurgery. J Endod. 2010 Nov;36(11):1757-65. doi: 10.1016/j.joen.2010.08.007. Epub 2010 Sep 17.

Reference Type BACKGROUND
PMID: 20951283 (View on PubMed)

Safi C, Kohli MR, Kratchman SI, Setzer FC, Karabucak B. Outcome of Endodontic Microsurgery Using Mineral Trioxide Aggregate or Root Repair Material as Root-end Filling Material: A Randomized Controlled Trial with Cone-beam Computed Tomographic Evaluation. J Endod. 2019 Jul;45(7):831-839. doi: 10.1016/j.joen.2019.03.014. Epub 2019 May 9.

Reference Type BACKGROUND
PMID: 31078325 (View on PubMed)

Floratos S, Kim S. Modern Endodontic Microsurgery Concepts: A Clinical Update. Dent Clin North Am. 2017 Jan;61(1):81-91. doi: 10.1016/j.cden.2016.08.007.

Reference Type BACKGROUND
PMID: 27912820 (View on PubMed)

Kim S, Kratchman S. Modern endodontic surgery concepts and practice: a review. J Endod. 2006 Jul;32(7):601-23. doi: 10.1016/j.joen.2005.12.010. Epub 2006 May 6.

Reference Type BACKGROUND
PMID: 16793466 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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129586

Identifier Type: -

Identifier Source: org_study_id

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