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Stress Distribution on Trephine-Resected Root-end in Targeted Endodontic Microsurgery: A Finite Element Analysis

Published:October 18, 2022DOI:https://doi.org/10.1016/j.joen.2022.10.005

      Abstract

      Introduction

      This study aimed to determine if stress distribution from occlusal loads after targeted endodontic microsurgery (TEMS) differed for trephine-resected flat and curved root-ends, with and without bone graft.

      Methods

      Finite element analysis models were constructed from cone-beam computed tomography data of a TEMS-treated maxillary central incisor. Models included flat and curved resected root-ends, with and without apical bone graft, and normal or root canal filled controls. In centric occlusion, axial force was directed on mesial and distal lingual marginal ridges at 120° angle. For lateral excursion, additional mesiodistal forces were applied from centric occlusion. For edge biting, axial force was directed on the incisal edge. Under occlusal loads, stress distribution patterns on tooth and root-end circumference were analyzed.

      Results

      In normal and root filled controls, occlusal stress was distributed on labial and palatal root surfaces, concentrated in the labial cervical area, and maximized at the apex. For resected root-ends, occlusal loads concentrated stress on the labial cervical area. With bone graft, maximum stress concentration shifted to the apex, which implied stress relief and dispersion from the cervical root area. Stress patterns on the root-end were more widely spread in models with apical bone graft, whereas curved root-end showed stress concentrating arc especially when without apical bone support. The mean stress values on root-end circumference were significantly higher in curved than flat root-end (P < .05), especially with apical bone support (P < .05).

      Conclusions

      Occlusal stress patterns on a maxillary central incisor were markedly affected by root-end resection configuration and apical bone support. Trephine-resected curved root-end had stress pattern concentrated on its circumference. Curved and flat root-ends had labial cervical stress that was relieved by bone graft. TEMS resected root-ends should be flattened and bone grafted to disperse stress from occlusal loads.

      Key Words

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      References

        • Kruse C.
        • Spin-Neto R.
        • Wenzel A.
        • et al.
        Cone beam computed tomography and periapical lesions: a systematic review analysing studies on diagnostic efficacy by a hierarchical model.
        Int Endod J. 2015; 48: 815-828
        • von Arx T.
        • Janner S.F.M.
        • Hanni S.
        • et al.
        Agreement between 2D and 3D radiographic outcome assessment one year after periapical surgery.
        Int Endod J. 2016; 49: 915-925
        • Schloss T.
        • Sonntag D.
        • Kohli M.R.
        • et al.
        A comparison of 2-and 3-dimensional healing assessment after endodontic surgery using cone-beam computed tomographic volumes or periapical radiographs.
        J Endod. 2017; 43: 1072-1079
        • Curtis D.M.
        • VanderWeele R.A.
        • Ray J.J.
        • et al.
        Clinician-centered outcomes assessment of retreatment and endodontic microsurgery using cone-beam computed tomographic volumetric analysis.
        J Endod. 2018; 44: 1251-1256
        • Safi C.
        • Kohli M.R.
        • Kratchman S.I.
        • et al.
        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; 45: 831-839
        • Fryback D.G.
        • Thornbury J.R.
        The efficacy of diagnostic imaging.
        Med Decis Making. 1991; 11: 88-94
        • Anderson J.
        • Wealleans J.
        • Ray J.
        Endodontic applications of 3D printing.
        Int Endod J. 2018; 51: 1005-1018
        • Giacomino C.M.
        • Ray J.J.
        • Wealleans J.A.
        Targeted endodontic microsurgery: a novel approach to anatomically challenging scenarios using 3-dimensional-printed guides and trephine burs—a report of 3 cases.
        J Endod. 2018; 44: 671-677
        • Hawkins T.K.
        • Wealleans J.A.
        • Pratt A.M.
        • et al.
        Targeted endodontic microsurgery and endodontic microsurgery: a surgical simulation comparison.
        Int Endod J. 2020; 53: 715-722
        • Strbac G.D.
        • Schnappauf A.
        • Giannis K.
        • et al.
        Guided modern endodontic surgery: a novel approach for guided osteotomy and root resection.
        J Endod. 2017; 43: 496-501
        • Ahn S.Y.
        • Kim N.H.
        • Kim S.
        • et al.
        Computer-aided design/computer-aided manufacturing-guided endodontic surgery: guided osteotomy and apex localization in a mandibular molar with a thick buccal bone plate.
        J Endod. 2018; 44: 665-670
        • Antal M.
        • Nagy E.
        • Sanyo L.
        • et al.
        Digitally planned root end surgery with static guide and custom trephine burs: a case report.
        Int J Med Robot. 2020; 16: e2115
        • Ray J.J.
        • Giacomino C.M.
        • Wealleans J.A.
        • et al.
        Targeted endodontic microsurgery: digital workflow options.
        J Endod. 2020; 46: 863-871
        • Fu W.
        • Chen C.
        • Bian Z.
        • et al.
        Endodontic microsurgery of posterior teeth with the assistance of dynamic navigation technology: a report of three cases.
        J Endod. 2022; 48: 943-950
        • Lu Y.J.
        • Chiu L.H.
        • Tsai L.Y.
        • et al.
        Dynamic navigation optimizes endodontic microsurgery in an anatomically challenging area.
        J Dent Sci. 2022; 17: 580-582
        • Jang Y.
        • Hong H.T.
        • Chun H.J.
        • et al.
        Influence of apical root resection on the biomechanical response of a single-rooted tooth-part 2: apical root resection combined with periodontal bone loss.
        J Endod. 2015; 41: 412-416
        • Jang Y.
        • Hong H.T.
        • Roh B.D.
        • et al.
        Influence of apical root resection on the biomechanical response of a single-rooted tooth: a 3-dimensional finite element analysis.
        J Endod. 2014; 40: 1489-1493
        • Gümrükçü Z.
        • Kurt S.
        • Köse S.
        Effect of root resection length and graft type used after apical resection: a finite element study.
        J Oral Maxillofac Surg. 2019; 77: 1770
        • Kim S.
        • Chen D.
        • Park S.Y.
        • et al.
        Stress analyses of retrograde cavity preparation designs for surgical endodontics in the mesial root of the mandibular molar: a finite element analysis-part II.
        J Endod. 2020; 46: 539-544
        • Wan B.
        • Chung B.H.
        • Zhang M.R.
        • et al.
        The effect of varying occlusal loading conditions on stress distribution in roots of sound and instrumented molar teeth: a finite element analysis.
        J Endod. 2022; 48: 893-901
        • Zhang X.B.
        • Tiainen H.
        • Haugen H.J.
        Comparison of titanium dioxide scaffold with commercial bone graft materials through micro-finite element modelling in flow perfusion.
        Med Biol Eng Comput. 2019; 57: 311-324
        • Ackerman S.
        • Aguilera F.C.
        • Buie J.M.
        • et al.
        Accuracy of 3-dimensional-printed endodontic surgical guide: a human cadaver study.
        J Endod. 2019; 45: 615-618
        • Kim J.E.
        • Shim J.S.
        • Shin Y.
        A new minimally invasive guided endodontic microsurgery by cone beam computed tomography and 3-dimensional printing technology.
        Restor Dent Endod. 2019; 44: e29
        • Martinho F.C.
        • Aldahmash S.A.
        • Cahill T.Y.
        • et al.
        Comparison of the accuracy and efficiency of a 3-dimensional dynamic navigation system for osteotomy and root-end resection performed by novice and experienced endodontists.
        J Endod. 2022; 48: 1327-1333
        • Aldahmash S.A.
        • Price J.B.
        • Mostoufi B.
        • et al.
        Real-time 3-dimensional dynamic navigation system in endodontic microsurgery: a cadaver study.
        J Endod. 2022; 48: 922-929
        • Buniag A.G.
        • Pratt A.M.
        • Ray J.J.
        Targeted endodontic microsurgery: a retrospective outcomes assessment of 24 cases.
        J Endod. 2021; 47: 762-769
        • Sauveur G.
        • Boccara E.
        • Colon P.
        • et al.
        A photoelastimetric analysis of stress induced by root-end resection.
        J Endod. 1998; 24: 740-743
        • Morgan L.A.
        • Marshall J.G.
        The topography of root ends resected with fissure burs and refined with two types of finishing burs.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998; 85: 585-591
        • Qari H.
        • Dorn S.O.
        • Blum G.N.
        • et al.
        The pararadicular radiolucency with vital pulp: clinicopathologic features of 21 cemental tears.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2019; 128: 680-689
        • Watanabe C.
        • Watanabe Y.
        • Miyauchi M.
        • et al.
        Multiple cemental tears.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2012; 114: 365-372
        • Lee A.H.C.
        • Neelakantan P.
        • Dummer P.M.H.
        • et al.
        Cemental tear: literature review, proposed classification and recommendations for treatment.
        Int Endod J. 2021; 54: 2044-2073
        • Perlitsh M.J.
        A systematic approach to the interpretation of tooth mobility and its clinical implications.
        Dent Clin North Am. 1980; 24: 177-193
        • Pallares-Serrano A.
        • Glera-Suarez P.
        • Tarazona-Alvarez B.
        • et al.
        Healing of 295 endodontic microsurgery cases after long-term (5-9 years) versus middle-term (1-4 years) follow-up.
        J Endod. 2022; 48: 714-721
        • von Arx T.
        • Jensen S.S.
        • Hanni S.
        • et al.
        Five-year longitudinal assessment of the prognosis of apical microsurgery.
        J Endod. 2012; 38: 570-579
        • Middleton J.
        • Jones M.
        • Wilson A.
        The role of the periodontal ligament in bone modeling: the initial development of a time-dependent finite element model.
        Am J Orthod Dentofac. 1996; 109: 155-162