Multifactorial Analysis of Endodontic Microsurgery Using Finite Element Models

Background: The present study aimed to classify the relative contributions of four biomechanical factors—the root-end filling material, the apical preparation, the root resection length, and the bone height—on the root stresses of the resected premolar. Methods: A design of experiments approach based on a defined subset of factor combinations was conducted to calculate the influence of each factor and their interactions. Sixteen finite element models were created and analyzed using the von Mises stress criterion. The robustness of the design of experiments was evaluated with nine supplementary models. Results: The current study showed that the factors preparation and bone height had a high influence on root stresses. However, it also revealed that nearly half of the biomechanical impact was missed without considering interactions between factors, particularly between resection and preparation. Conclusions: Design of experiments appears to be a valuable strategy to classify the contributions of biomechanical factors related to endodontics. Imagining all possible interactions and their clinical impact is difficult and can require relying on one’s own experience. This study proposed a statistical method to quantify the mechanical risk when planning apicoectomy. A perspective could be to integrate the equation defined herein in future software to support decision-making.

[1]  P. Boisse,et al.  Precision medicine using patient-specific modelling: state of the art and perspectives in dental practice , 2022, Clinical Oral Investigations.

[2]  I. Baptista,et al.  Impact of Periodontal Attachment Loss on the Outcome of Endodontic Microsurgery: A Systematic Review and Meta-Analysis , 2021, Medicina.

[3]  Sébastien Valette,et al.  Decision Support for Removing Fractured Endodontic Instruments: A Patient-Specific Approach , 2021, Applied Sciences.

[4]  M. Bornstein,et al.  Occurrence of vertical root fractures after apical surgery: A retrospective analysis. , 2020, Journal of endodontics.

[5]  L. Piasecki,et al.  The Buffalo study: outcome and associated predictors in endodontic microsurgery: a cohort study. , 2020, International endodontic journal.

[6]  A. Marques,et al.  Long-Term Prognosis of Endodontic Microsurgery—A Systematic Review and Meta-Analysis , 2020, Medicina.

[7]  P. Boisse,et al.  Validated Finite Element Models of Premolars: A Scoping Review , 2020, Materials.

[8]  Euiseong Kim,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. , 2020, Journal of endodontics.

[9]  Euiseong Kim,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 I , 2019, Journal of endodontics.

[10]  J. Chen,et al.  Effect of length of apical root resection on the biomechanical response of a maxillary central incisor in various occlusal relationships. , 2019, International endodontic journal.

[11]  W. McLean,et al.  The use of Bioceramics as root-end filling materials in periradicular surgery: A literature review , 2018, The Saudi dental journal.

[12]  J. Farges,et al.  Multi-Fiber-Reinforced Composites for the Coronoradicular Reconstruction of Premolar Teeth: A Finite Element Analysis , 2018, BioMed research international.

[13]  F. Setzer,et al.  Outcome of Endodontic Surgery: A Meta‐analysis of the Literature—Part 3: Comparison of Endodontic Microsurgical Techniques with 2 Different Root‐end Filling Materials , 2018, Journal of endodontics.

[14]  I. Tsesis,et al.  The preservation of teeth with root-originated fractures , 2018 .

[15]  A. Pérez Del Palomar,et al.  Approach towards the porous fibrous structure of the periodontal ligament using micro-computerized tomography and finite element analysis. , 2018, Journal of the mechanical behavior of biomedical materials.

[16]  Busayarat Santiwong,et al.  Reinforcement of Simulated Immature Permanent Teeth after Mineral Trioxide Aggregate Apexification , 2018, Journal of endodontics.

[17]  R. Chandra,et al.  Effect of obturating materials on fracture resistance of simulated immature teeth , 2017, Journal of conservative dentistry : JCD.

[18]  T. Johnson,et al.  Materials for retrograde filling in root canal therapy. , 2016, The Cochrane database of systematic reviews.

[19]  A. Elnaghy,et al.  Fracture resistance of simulated immature teeth filled with Biodentine and white mineral trioxide aggregate - an in vitro study. , 2016, Dental traumatology : official publication of International Association for Dental Traumatology.

[20]  T. Nicholson,et al.  Methodologies for measuring the setting times of mineral trioxide aggregate and Portland cement products used in dentistry , 2016, Acta biomaterialia odontologica Scandinavica.

[21]  H. Chun,et al.  Influence of apical root resection on the biomechanical response of a single-rooted tooth: a 3-dimensional finite element analysis. , 2014, Journal of endodontics.

[22]  Wen Du,et al.  Review of research on the mechanical properties of the human tooth , 2014, International Journal of Oral Science.

[23]  Euiseong Kim,et al.  Does apical root resection in endodontic microsurgery jeopardize the prosthodontic prognosis? , 2013, Restorative dentistry & endodontics.

[24]  Michel Desvignes,et al.  A web interface for 3D visualization and interactive segmentation of medical images , 2012, Web3D '12.

[25]  S. Friedman,et al.  Five-year longitudinal assessment of the prognosis of apical microsurgery. , 2012, Journal of endodontics.

[26]  F. Setzer,et al.  Outcome of endodontic surgery: a meta-analysis of the literature--Part 2: Comparison of endodontic microsurgical techniques with and without the use of higher magnification. , 2011, Journal of endodontics.

[27]  M. Peñarrocha,et al.  Prognostic factors in apical surgery with root-end filling: a meta-analysis. , 2010, Journal of endodontics.

[28]  Yen-Hsiang Chang,et al.  Evaluation of the relative contributions of multi-factors in an adhesive MOD restoration using FEA and the Taguchi method. , 2009, Dental materials : official publication of the Academy of Dental Materials.

[29]  F. Kroon,et al.  A comparative prospective randomized clinical study of MTA and IRM as root-end filling materials in single-rooted teeth in endodontic surgery. , 2005, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[30]  R. Rubinstein,et al.  Long-term follow-up of cases considered healed one year after apical microsurgery. , 2002, Journal of endodontics.

[31]  S. Hondrum Temporary dental restorative materials for military field use. , 1998, Military medicine.