Basic Research|Articles in Press

The Influence of Cone Beam Computed Tomography-Derived 3D-Printed Models on Endodontic Microsurgical Treatment Planning and Confidence of the Operator

Published:February 15, 2023DOI:



      Currently, there are no studies evaluating the impact of 3-dimensional (3D) printed models on endodontic surgical treatment planning. The aims of this study were: 1) to determine if 3D models could influence treatment planning; and 2) to assess the effect of 3D supported planning on operator confidence.


      Endodontic practitioners (n = 25) were asked to analyze a preselected cone beam computed tomography (CBCT) scan of an endodontic surgical case and answer a questionnaire that elucidated their surgical approach. After 30 days, the same participants were asked to analyze the same CBCT scan. Additionally, participants were asked to study and to perform a mock osteotomy on a 3D printed model. The participants responded to the same questionnaire along with a new set of questions. Responses were statistically analyzed using chi square test followed by either logistic or ordered regression analysis. Adjustment for multiple comparison analysis was done using a Bonferroni correction. Statistical significance was set at ≤0.005.


      The availability of both the 3D printed model and the CBCT scan resulted in statistically significant differences in the participants' responses to their ability to detect bone landmarks, predict the location of osteotomy, and to determine the following: size of osteotomy, angle of instrumentation, involvement of critical structures in flap reflection and involvement of vital structures during curettage. In addition, the participants’ confidence in performing surgery was found to be significantly higher.


      The availability of 3D printed models did not alter the participants’ surgical approach but it significantly improved their confidence for endodontic microsurgery.

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        • Cohn D.
        Evolution of computer-aided design [Internet]. Digital Engineering. 2010.
        (Available at:) (Accessed XXX)
        • McMenamin P.G.
        • Quayle M.R.
        • McHenry C.R.
        • Adams J.W.
        The production of anatomical teaching resources using three-dimensional (3D) printing technology.
        Anat Sci Educ. 2014; 7: 479-486
        • Oberoi G.
        • Nitsch S.
        • Edelmayer M.
        • et al.
        3D printing—encompassing the facets of dentistry.
        Front Bioeng Biotech. 2018; 6: 172
        • Anderson J.
        • Wealleans J.
        • Ray J.
        Endodontic applications of 3D printing.
        Int Endod J. 2018; 51: 1005-1018
        • Shah P.
        • Chong B.S.
        3D imaging, 3D printing and 3D virtual planning in endodontics.
        Clin Oral Investig. 2018; 22: 641-654
        • Friedman T.
        • Michalski M.
        • Goodman T.R.
        • Brown J.E.
        3D printing from diagnostic images: a radiologist’s primer with an emphasis on musculoskeletal imaging—putting the 3D printing of pathology into the hands of every physician.
        Skelet Radiol. 2015; 45: 307-321
        • 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.
        • Ray J.J.
        Targeted endodontic microsurgery and endodontic microsurgery: a surgical simulation comparison.
        Int Endod J. 2020; 53: 715-722
        • Ray J.J.
        • Giacomino C.M.
        • Wealleans J.A.
        • Sheridan R.R.
        Targeted endodontic microsurgery: digital workflow options.
        J Endod. 2020; 46: 863-871
        • Tchorz J.P.
        • Brandl M.
        • Ganter P.A.
        • et al.
        Pre-clinical endodontic training with artificial instead of extracted human teeth: does the type of exercise have an influence on clinical endodontic outcomes?.
        Int Endod J. 2014; 48: 888-893
        • Reymus M.
        • Fotiadou C.
        • Hickel R.
        • Diegritz C.
        3D-printed model for hands-on training in dental traumatology.
        Int Endod J. 2018; 51: 1313-1319
        • Reymus M.
        • Fotiadou C.
        • Kessler A.
        • et al.
        3D printed replicas for endodontic education.
        Int Endod J. 2018; 52: 123-130
        • Patel S.
        New dimensions in endodontic imaging: part 2. Cone beam computed tomography.
        Int Endod J. 2009; 42: 463-475
        • Fedorov A.
        • Beichel R.
        • Kalpathy-Cramer J.
        • et al.
        3D slicer as an image computing platform for the quantitative imaging network.
        Magn Reson Imaging. 2012; 30: 1323-1341
        • Chae Y.
        • Lee H.
        • Jih M.
        • et al.
        Validation of a three-dimensional printed model for training of surgical extraction of supernumerary teeth.
        Eur J Dent Educ. 2020; 24: 637-643
        • Feng J.
        • Qi W.
        • Duan S.
        • et al.
        Three-dimensional printed model of impacted third molar for surgical extraction training.
        J Dent Educ. 2021;
        • Kim S.
        • Kratchman S.
        • Karabucak B.
        • et al.
        Microsurgery in Endodontics.
        Wiley Blackwell, Hoboken, NJ2018
        • Cotton T.
        • Geisler T.
        • Holden D.
        • et al.
        Endodontic applications of cone-beam volumetric tomography.
        J Endod. 2007; 33: 1121-1132
        • Estrela C.
        • Bueno M.
        • Leles C.
        • et al.
        Accuracy of cone beam computed tomography and panoramic and periapical radiography for detection of apical periodontitis.
        J Endod. 2008; 34: 273-279
        • Low K.
        • Dula K.
        • Burgin W.
        • von Arx T.
        Comparison of periapical radiography and limited cone-beam tomography in posterior maxillary teeth referred for apical surgery.
        J Endod. 2008; 34: 557
        • Estrela C.
        • Bueno M.R.
        • Azevedo B.C.
        • et al.
        A new periapical index based on cone beam computed tomography.
        J Endod. 2008; 34: 1325-1331
        • D'Urso P.
        • Barker T.
        • Earwaker W.
        • et al.
        Stereolithographic biomodelling in craniomaxillofacial surgery: a prospective trial.
        J Craniomaxillofac Surg. 1999; 27: 30-37
        • Nizam A.
        • Gopal R.
        • Naing L.
        • Samsudin A.
        Dimensional accuracy of the skull models produced by rapid orototyping technology using stereolithography apparatus.
        Arch Orofac Sci. 2006; 1: 60-66
        • Salmi M.
        • Paloheimo K.S.
        • Tuomi J.
        Accuracy of medical models made by additive manufacturing (rapid manufacturing).
        J Craniomaxillofac Surg. 2013; 41: 603-609
        • Taft R.
        • Kondor S.
        • Grant G.
        Accuracy of rapid prototype models for head and neck reconstruction.
        J Prosthet Dent. 2011; 106: 399-408
        • Cekic A.
        • Begic-Hajdarevic D.
        • Cohodar M.
        • et al.
        Optimization of stereolithography and fused deposition modeling process parameters.
        DAAAM Proc. 2019; : 681-687
        • Velvart P.
        • Peters C.
        • Peters O.
        Soft tissue Management: flap design, incision, tissue elevation, and tissue retraction.
        Endod Top. 2005; 11: 78-97