Effectiveness of guided endodontic microsurgery using a trephine bur in critical anatomical regions: a randomized controlled clinical trial

This randomized controlled clinical trial evaluated the effectiveness of guided endodontic microsurgery (GEMS) compared to conventional endodontic microsurgery (EMS) in critical anatomy regions. Twenty-eight patients (ages 19–58 years) requiring endodontic microsurgery in critical anatomical regions were randomly allocated to guided surgery ( n = 14) using 3D-printed surgical guides with trephine burs or conventional microsurgery ( n = 14). Primary outcomes included surgical procedure time. Secondary outcomes were periapical lesion size measured by CBCT at 6, 12 months and success rate at 1-year follow-up and complications. statistical analysis employed independent t-tests and chi-square tests. The guided group demonstrated significantly shorter surgical time (18.21 ± 3.45 min vs 26.07 ± 4.29 min) (independent t-test, p < 0.001). Complete lesion resolution at 1 year was achieved in 92.9% of guided cases, compared with 71.4% in conventional cases (chi-square, p = 0.139). No complications were observed. Guided endodontic microsurgery using a 3D-printed surgical guide with trephine burs significantly reduces surgical time. The technique demonstrates a clinically relevant trend toward improved healing outcomes, supporting its adoption for complex endodontic surgical cases. ClinicalTrials.gov Identifier: NCT05283252