Apicoectomy is a surgical procedure requiring precise planning and access to locate apices and avoid vital anatomic structures. Traditional methods limit treatment because they rely on two-dimensional radiography and corrective actions during surgery. Surgical guidance, which uses computed tomography and computer-aided design and computer-aided manufacturing processing, has been utilized in dentistry, but not in endodontics. Therefore, the aim of this study was to introduce periapical surgical guidance using computed tomography and computer-aided design and computer-aided manufacturing surgical guides and to compare apical access accuracy using guidance versus a conventional method. Results showed that distance from the apex was 0.79 mm (+/-0.33 SD) using guidance and 2.27 mm (+/-1.46 SD) using freehand drilling. An error greater than 3 mm occurred over 22% of the time freehand, yet never occurred with guidance. This in vitro study suggests that greater accuracy and consistency can be achieved during endodontic surgery with surgical guidance. Advantages also include presurgical visualization in three dimensions.
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