Evolution and the difficulties of static guided periapical surgery

With the help of modern diagnostic methods and advanced treatment options in dentistry, the success rate of endodontic treatments rose steeply in the last decades. If the orthograde approach does not eliminate the occurring symptoms, in the presence of a lege artis root canal obturation, surgical removal of the apex and the inflamed periapical tissues is used as a routine intervention. Innovations of implant dentistry and the presence of CBCT can offer a combined method to reduce the steps and make apicoectomy less invasive. The unique visualization provided by the CBCT and numerous planning software can improve the planning phase and precision of any kind of surgery. These methods are wide spread in implant dentistry nowadays. In the last decade, new publications have raised the option of targeted endodontic surgery. These publications included the option of pilot guides so as the recently introduced targeted surgeries with bone trephines. The digital workflow is similar to static implant guides, however with some differences and unique difficulties. These anatomical deviations can be solved using different approaches for the workflow including intraoral scanners and special impression trays. In this article, we summarize the evolution of static guided periapical surgery with its difficulties and technical solutions.