Personalized 3D-printed osteotomy guide combined with an ultrasonic bone scalpel for precise periapical cystectomy: a case report.

Periapical lesions persisting after root canal treatment, particularly those radiographically suggestive of true cysts, often necessitate surgical management. This report introduces a synergistic technique for precise periapical surgery in anatomically challenging areas, combining a 3D-printed osteotomy guide with an ultrasonic bone scalpel. A personalized, tooth-supported osteotomy guide was designed based on fused cone-beam computed tomography (CBCT) and intraoral scan data to ensure accurate localization of the lesion and minimal buccal bone window dimensions. An ultrasonic bone scalpel was then employed to execute the planned osteotomy, facilitating the reflection of a buccal bone lid that remained attached to the mucoperiosteal flap. Following complete cyst enucleation and apical resection, retrograde root canal filling was performed under microscopic vision. The pedicled bone lid was subsequently repositioned to promote healing and prevent soft tissue ingrowth. This combined protocol effectively addresses the challenges of limited visibility and access in the posterior maxilla, demonstrating a precise and minimally invasive approach for managing complex periapical lesions.