PMC9407037_01
Buccal image and CBCT (NewTom 5G Version FP) examination. (A) Buccal image of the affected tooth. (B) CBCT image of the lesion area.
fsurg-09-923299-g001.jpg
PMC9407037_01_fsurg-09-923299-g001.jpg
F1
The buccal and lingual cortices were continuous and intact, and the mental foramen was located below the tip of tooth 45, which was close to the periapical lesion (Figures 1A,B).
The 3D model of the patient. (A) Rending the target area (B) Obtaining the mandible and the affected tooth (C) Obtaining the lesion area (D) Defining the surface color of the V3D model.
fsurg-09-923299-g002.jpg
PMC9407037_01_fsurg-09-923299-g002.jpg
F2
Using the software, we changed the gray value to segment the mask of the targeted root region of the right mandibular jaw lesion in the 2D image (Figure 2A). The masks of the teeth and jaws were obtained by the threshold segmentation method, and then the STL model of the bone and teeth was obtained using a Marching Cube algorithm for the mask data (Figures 2B,C). Different anatomical structures were color-coded on the V3D model; the lower alveolar nerve was marked yellow, and the lesion area was marked green (Figure 2D).
Both the surgeon and the patient can see the surgical field. (A) Preoperative communication (B) Preoperative matching.
fsurg-09-923299-g003.jpg
PMC9407037_01_fsurg-09-923299-g003.jpg
F3
Most notably, the surgeon can adjust the angle of surgical region to communicate detailed information to the patient (Figure 3A). The V3D data were customized to the patient's mandible to guarantee accuracy of the surgery (Figure 3B).
The surgical template and the MR holographic image were combined to position the mandibular opening window. (A) Intraoperative surgical template application (B) Retaining surgery template (C) Projecting MR holographic image into patients (D) Precise positioning of the window midpoint (E) Opening the window on the bone surface (F) Cutting off apical lesions (G) Apical lesions were successfully removed (H) Tightly sutured mucoperiosteal flap.
fsurg-09-923299-g004.jpg
PMC9407037_01_fsurg-09-923299-g004.jpg
F4
The surgical template was routinely sterilized for intraoperative use (Figure 4A). In this manner, the surgical template and the MR holographic image were combined to position the mandibular opening window, which ensured the accuracy of the window opening position (Figures 4B-D). Surgical tools were used to open a 4 mm*4 mm window at the location of the bone surface (Figure 4E), the apical lesion area was exposed, and 3 mm of the root tip was cut to form a complete plane. After the root tip was removed, it could be seen that the root canal was over filled, and the inflammatory granulation tissue was large (Figures 4F,G). The mucoperiosteal flap was repositioned and attached using a 6-0 silk thread (Figure 4H).
The CBCT images were reviewed. (A) One week postoperative wound condition (B) Complete resection of apical lesions (C) Distance from the inferior alveolar nerve canal in the lesion area after surgical resection (D) Resection range covers the extent of the lesion.
fsurg-09-923299-g005.jpg
PMC9407037_01_fsurg-09-923299-g005.jpg
F5
The patient had no numbness in the lower lip and oral mucosa (Figure 5A). According to an image of the apical area reconstructed by postoperative CBCT, the lesion area had been entirely resected (Figure 5B), but a gap between the area and the inferior alveolar neural tube was present (Figure 5C), which was why the patient did not have numbness after surgery. In the superimposed image, the preoperative lesion area is displayed in green, and the postoperative are is displayed is red; the green area is completely covered by the red area (Figure 5D), indicating that the inflammatory tissue in the operative area was completely removed.