CC BY-NC-ND 4.0 · Dental Journal of Advance Studies 2022; 10(03): 161-169
DOI: 10.1055/s-0042-1758227
Case Report

Guided Endodontic Micro-Surgery (GEMS): A Novel Approach for a Targeted Apicoectomy—A Report of 3 Cases

Hamid R. Abedi
1   Department of Endodontics, Cornerstone Dental Specialties. Inc, Irvine, United States
2   Department of Endodontics, School of Dentistry, Loma Linda University, Loma Linda, California, United States
Farzad Foroughi
3   Department of Research and Development, Cornerstone Specialty Products LLC., Irvine, United States
4   Department of Endodontics, School of Dentistry, University of California Los Angeles (UCLA), Los Angeles, United States
Muaz Zendaki
5   Department of Restorative Dentistry CERT, University of California Los Angeles (UCLA), Los Angeles, United States
› Author Affiliations
Funding This study was supported by Cornerstone Specialty Products (Grant no. CSP20210115). Two of the authors (Hamid R. Abedi and Farzad Foroughi) have a professional and financial interest in GEMS having filed patents on it (US 2020/0000549Al, US 2020/0306008Al, US 2021/0022831Al) and a trademark under the name of GEMS (Reg. No. 6486821).


Guided endodontic microsurgery, also known as guided endodontic microsurgery, is a surgical procedure used to treat failed endodontically treated teeth with periapical infections. Guided endodontic microsurgery can be problematic in some situations, such as when there are tough anatomical features or limited surgical access. Some of these complex cases can be managed using cone beam computed tomography imaging, CAD software design, and 3D printing technologies. A surgical stent was manufactured using a 3D printer in each of the three cases. Prior to surgery, the infection location, depth, and angulation of preparation were determined to protect sensitive anatomical components. The target location is chosen to ensure precise root excision and avoid infection during surgery. Infected root tip resection and biopsy were accomplished in one step by rotating a trephine bur in the surgical stent hole. Once the root preparation and the retrograde filling were completed, bone graft material can be added to the surgical site and then the tissues were sutured to achieve primary closure. Surgical stents produce effective targeted apicoectomy with a certain angle and depth of preparation. In addition, the soft tissue is reflected or protected with the unique features of the stent.

Publication History

Article published online:
08 November 2022

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