Title: The use and evolution of 3D printed surgical decompression devices in the management of large apical lesions : A case series
Abstract:
Aim: To describe the use of a digital workflow in the management of large periapical lesions with the use of 3D printed decompression devices using a case series.
Summary: The development of periapical pathology is influenced by a variety of factors such as local microbiology and pathophysiology. In large lesions, orthograde endodontic treatment is often insufficient in promoting healing of the periapical tissues alone and therefore is followed by apical surgery to reduce inflammation. While traditional treatments often involve surgical enucleation, decompression techniques have been shown to provide a less invasive alternative when combined with non-surgical and surgical endodontic treatment. This case series describes the management of five cases which have utilised a digital workflow to fabricate novel customised decompression devices in the management of large lesions. The reduction of intra-cystic pressure alongside active irrigation reduces inflammatory compounds, contributing to a reduction in the lesion size and promotion of osseus healing. The cases encompass large apical lesions affecting maxillary anterior teeth, which are important for both function and aesthetics. They portray the use of decompression in its own right as a treatment option, whilst also discussing it’s use as a key adjunct to orthograde and retrograde endodontic treatments. This improves treatment outcomes whilst minimising the need for more invasive approaches and their associated risks without increasing the rate of recurrence. Key learning points:
• Treatment options for large periapical lesions including enucleation and decompression.
• The advantages of surgical decompression and indication for its use.
• Report on a case series which showed positive clinical and radiographic outcomes following surgical decompression across five cases.
• The use of a digital workflow in combining CBCT information with digital planning software to fabricate custom 3D printed decompression devices.
• The use of intra-lesional irrigation protocol in reducing inflammatory markers and improving healing.
• The use of decompression preceding retrograde endodontic treatment in the improvement of treatment outcomes.
