Ostectomy versus
osteotomy with
repositioning of the
vestibular cortical in
periapical surgery of
mandibular molars: A
Berta Garca-Mira , Barbara Ortega-Snchez ,
preliminary
study
Maria Penarrocha-Diago , Miguel Penarrocha Diago
Med Oral Patol Oral Cir Bucal. 2010 Jul 1;15 (4):e628-32
Introduction
In periapical surgery (PS), in order to eliminate the
inflammatory apical tissue, form the root-end cavity
and achieve proper sealing of the apical foramen with
rootend filling , it is necessary to eliminate the
periapical bone via ostectomy ).
This removal should be the minimum necessary to
allow access to the entire lesion and enable visual
control of the apices to the affected roots .
Due to the greater thickness of the vestibular cortical in
this region, access to the mandibular molar root apices
requires a large ostectomy, occasionally leaving
extensive bone defects
Aim and objective
The aim was to make a preliminary study
of the morbidity and prognosis following
PS using ostectomy or by osteo-tomy
with repositioning of the vestibular
cortical bone.
Material and Methods
Retrospective clinical study
89 patients underwent PS on mandibular molars
between May 1999 and June 2004.
6 patients excluded for non-completion of the
pain and swelling scales,
6 for not following the postoperative indications
2 for having an incomplete follow up (less than
12 months).
75 patients(18 male 57 female), with 87
mandibular molars, 107 lesions and 200 canals
were included in the study.
Two groups
Group1 (G1) treated with ostectomy
Group 2(G2) treated by osteotomy
mandibular molars apicoectomized using
ultrasound,
minimum follow up of 12 months
Group 2 comprised patients treated by
osteotomy with repositioning of the cortical bone
when the vestibular cortical was intact and the
teeth apices were more than 8 mm from the
mandibular canal.
Surgical procedure
All operations were carried out by the same
surgeon
local anesthesia articaine at 4% and
1:100,000 adrenaline
The ostectomy was made using a 0.27 mm
round tungsten carbide drill
The osteotomy window was formed using
trephine burrs
The cortical bone was raised with the aid of a surgical
hammer and chisel.
The bony lid was replaced following apicoectomy and
root-end filling.
Ultrasound tips for periapical surgery were used to form
the root-end cavity, root-end filling was made with zincfree silver amalgam
All patients were prescribed the same postoperative
medication:
Amoxicillin 500 mg/8 hours for 7 days;
Ibuprofen 600 mg/8 hours for 3 days,
Mouthwash with chlorhexidine at 0.12% 3 times a day for 7
days.
Pre op
Follow up
Osteoctomy
Intra op
Post op after 12 months
Pre op
Osteoto
my
Intra op
Intra op root end filling Radiograph following surgery Post-op after 12 month
Data collection
The number of operated teeth and lesions was recorded.
size of the ostectomy and osteotomy measured by digital
caliper the sizes were classified
Postoperative pain was recorded on a 4-point descriptive scale ,
less than 1 cm2, between 1 and 2 cm2, and greater than 2 cm2.
1 absence of pain; 2 slight; 3 moderate; 4 intense pain).
Swelling recorded as
1 absent (no swelling); 2 slight (intraoral swelling at the operated
area); 3 moderate (moderate) intraoral swelling at the operated
area); 4 intense (intensive extraoral swelling extending beyond the
operatedarea)
pain and swelling were recorded by each
patient 2, 4, 6 and 12 hours after surgery,
and on each of the 7 postoperative days.
Suture removal after 7 days
Check for postoperative complications
such as hematoma, wound opening,
infection or postoperative neuropathy
Success was determined by panoramic radiographic
study using a digital orthopantomograph OP100.
The resulting image was calibrated using the
CliniView program Version and introduced into an
image analyzer,
Evolution evaluated at 6 and 12 months of surgery
according to the criteria of von Arx and Kurt
classified as:
1 failure; 2 improvement; 3 success.
It was also noted if the tooth remained in the mouth,
being classified as either a functional or nonfunctional
tooth (if the tooth had been extracted)
Results
Table of patients, lesions, teeth and size by
ostectomy and osteotomy.
No of
patient
No of
lesions
No of
teeth
Size
<1c
m
Ostectomy
66
Osteotomy
1-2cm >2cm
98
78
49
44
5
-
Overall evolution at 6 and 12 months following the criteria
of von Arx and Kurt (9) in %.
6 months
Succes Improve
s
ment
Ostecto
my
12 months
Failure
No of
functio
nal
tooth
succes Improve
s
ment
Failur
e
27.9
( n = 22)
13.1
73
(n=10
)
34.6
(n =
27)
46.1
19.3
(n = 36) (n =
15)
59.0
Osteoto
my
33.3
(n=
3)
55.6
(n = 5)
55.6
(n =
5)
33.3
(n = 3)
11.1
( n=1
)
Over all
34.5
(n
=30)
46.0
19.5
(n = 40) (n=17)
58.4
(n
=51)
29.0
(n = 25)
12.6
(n
=11)
82
11.1
(n =1)
(n=46
)
Postoperative complications
5 patient with hematoma (all in G1),
3 patients with suture dehiscence (2 in G1 and 1
inG2).
1 patient had a postoperative infection(in G1)
1 patient had a transitory mental neuropathy (In
G1).
There was no relationship between postoperative
complications and prognosis in PS (p>0.05).
Patient undergoing osteotomy had a more
distinct peak of pain and swelling. Patients in
G1 perceived maximum pain during the first 48
hours, while in G2 pain increased to a
maximum on day 2
Swelling evolved similarly in G1 and G2;
increasing progressively until reaching a
maximum on the second day.
There was no statistically significant
relationship between the size of the ostectomy
and osteotomy with either pain or swelling
patients subjected to ostectomy (G1)
presented greater postoperative swelling
than patients with osteotomy (G2) (p=0.02).
Regarding prognosis, at 6 months follow-up
the success rate was higher in patients
undergoing osteotomy with repositioning of
the vestibular cortical (G2) against
ostectomy (G1)
Discussion
In the osteotomy group, pain peaked at a maximum
on the second day, while in the ostectomy group
pain remained level during the first 48 hours.
Regarding perceived swelling, a maximum peak
was found on the 2nd postoperative day;
Patients undergoing ostectomy presented greater
swelling during the postoperative period than the
patients with osteotomy and repositioning of the
vestibular cortical.
Although the success rate of PS on mandibular
molars was 58.4% after 12 months follow-up, a high
Ostectomy was used to access the tooth
roots in the majority of the lesions
(91.6%).
Osteotomy allows the repositioning of
the vestibular cortical after surgery, but
brought no benefits in the few cases of
this preliminary study.
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Thank
you
