Sunteți pe pagina 1din 9

Invited Review

A new dimension in endo surgery: Micro endo surgery


Gabriele Edoardo Pecora, Camilla Nicole Pecora1
Private Practice Limited to Micro Endo Surgery, 1Private Practice limited to Oral Surgery, Rome, Italy

Abstract
There is an immense difference between tradizional Endodontic Surgery and Micro-Endo Surgery.
Microsurgical techniques made possible and accessible results,that were unimaginable before.Under microscopic control,the
operative techniques reached continous changes,allowing a better precision and quality standards.
The dramatic evolution from Endo Surgery to Micro-Endo Surgery has enlarged the horizon of therapeutic options.
Illumination and magnification through the Microscope has fundamentally and radically changed the way endo surgery can
be performed.
Keywords: Operatory Microscope, Light and illumination, GTR, Fresh socket implants, maxillary sinus

INTRODUCTION
Operatory Microscope has generally brought a new
dimension in Dentistry and particularly in Endodontic
Surgery [Figure 1a].
Light and magnification have determined a new higher
standard of quality in the profession.[1]
Microscopy is a young specialty in a great and continuous
evolution, not only in the field of application, but also in
the development of new instruments and techniques.
Dentistry rests its quality standard on the realization of the
higher possible precision.
Concepts based on evolution, advanced technology
applications, characteristics of perfectioned materials have
brought major improvment on long-term results and an
excellent predictability in the surgical techniques.
In particular, the extensive use of the Microscope in
conventional endo has enlarged the indications for the
positive treatment of failures and restricted the indications
for surgical treatment.
The concept of apical surgery has been expanded to
periradicular surgery and today we speak in terms of
Micro-Endo Surgery.[2]
Address for correspondence:

Dr. Camilla Nicole Pecora,


Private Practice Limited to Oral Surgery,
Via B. Gozzoli 62-00142, Rome, Italy.
E-mail: camilla_nicole@yahoo.com
Date of submission : 28.05.2014
Review completed : 11.08.2014
Date of acceptance : 17.09.2014

Throughout the history of endodontics, never before


there have been as many changes as in the last 25
years.
They have been dramatic, especially in Endodontic
Surgery.
There is an immense difference between traditional
Endodontic Surgery and Micro-Endo Surgery. A New
Dimension has been created working in different
directions, which we can summarize in:
1. New operative protocol
2. Guided regeneration principles
3. Maxillary sinus management in Endo Surgery
4. Limits of conservative therapy
5. Implants as an alternative.
One of the most important advantages in using the
Microscope is the evaluation of our surgical technique.
More light can be shed on the rationality of the treatment
to perform procedures in certain ways.
Microsurgery is defined as a surgical procedure on
exceptionally small and complex structures with an
operating microscope. This instrument enables the
surgeon to assess pathological changes more precisely
and to treat pathological lesions with the greatest
precision, thus minimizing tissue damage during
surgery.
Access this article online
Quick Response Code:
Website:
www.jcd.org.in

DOI:
10.4103/0972-0707.148864

Journal of Conservative Dentistry | Jan-Feb 2015 | Vol 18 | Issue 1

Pecora and Pecora: A new dimension in endo surgery: Micro endo surgery

Endodontic Microsurgery combines magnification and


illumination, provided by the microscope, with the proper
use of new microinstruments [Figure 1b].
It does not improve the access to the surgical field.
If the access is limited for traditional surgery, it will also be
limited when the microscope is placed between the surgeon
and the surgical field. However, the microscope creates
a much better view of the surgical field by appropriate
magnification and highly focused illumination.
Since vision is greatly enhanced, cases can be better
treated with higher precision and accuracy. Microscopists
often wonder how they managed to work without it in the
past. There is a maxim: to see better is to do better. We
might add: to do it more easily.[3]
The Microscope allows an exceptional evidentiation of
the anatomy with the consequent possibility of a more
accurate diagnosis and a more incisive operative capacity.
Furthermore, the better vision leads to a less invasive
approach respecting the tissues and, therefore, a lesser
post-operative discomfort and faster healing.
The advanced technologies, applied to medical surgical
specialties, have brought to exceptional progresses,
achievement of unthinkable results and have also
contributed to simplify technical steps, making them
accessible to a larger number of specialists and more
predictable in the results.
Dentistry has gone through many historical moments.
Just think to the use of air drills and ultrasounds to the
application of Magnetic Resonance and Laser.
Microsurgical techniques made possible and accessible
results that were unimaginable before. Think to limbs

reattachment, to otosclerosis surgery, to eye surgery,


and you will understand that advanced technology and
technical operative improvements today allow the opening
of new frontiers.
In the 80s we had a raising interest for Microscope in
Dentistry.
Sometimes, Endodontics has a limited visual field, with
little and very little anatomic structures, and has particularly
difficult vision of the inside of the tooth and the canals.
Therefore, it has got major benefits from the possibility to
see better through light and magnification.
Under microscopic control, the operative techniques
reached continuous changes. The evolution towards
suitable and practical modification, allows a better
precision and quality standards.
We can treat only what we can see.
The introduction of the Microscope in Endodontic Surgery
will give clinicians the necessary means to treat difficult cases
with a higher degree of confidence and clinical success.[4]
Once we reached the goal of an hermetic sealing of the Root
Canal System (RCS) exits and, in particular, the sealing of the
new apex, we expanded our horizon to Endo Perio Surgery.
We begun our treatments applying guided tissue
regeneration (GTR) and guided Bone regeneration (GBR)
principles to the borderline cases obtaining encouraging
results. The use of the microscope allowed us to gain
access to the maxillary sinus in a very conservative way. The
diagnostic potential has grown as well as the therapeutic
options and this allowed us to successfully intervene on
the oro-antral pathologies.
On one hand, the microscope enhanced the orthograde
treatment as well as the retreatment, reducing the
indications for surgery; on the other hand, we started
to deal with impossible cases, moving the borderline
towards conservative surgical treatment. In those cases in
which the extraction of the tooth was the only alternative,
we claimed for the endodontist the right to insert implants
simoultaneously to the extraction with immediate loading.
The challenge for the future will be predictable for
thesuccessfull management of the endo perio lesions.

New operative protocol


c

Figure 1: (a) Pecora, Rubinstein, Kimthe new dimension of


teaching (b) Mirror and micromirrors (c and d) We can treat
only what we can see

The step from apical surgery to periradicular micro surgery


has involved new concepts, new techniques, new materials,
new instruments but, particularly, the use of LIGHT
and MAGNIFICATION through the surgical Microscope
[Figures 1c and d].

Journal of Conservative Dentistry | Jan-Feb 2015 | Vol 18 | Issue 1

Pecora and Pecora: A new dimension in endo surgery: Micro endo surgery

All these phases of the surgical protocol have taken


advantage from the use of this instrument and there
have been tremendous changes in the approach and the
execution of surgery.[5]

Many comparative clinical studies have been carried out to


evidentiate the differences between traditional and micro
surgery and the advantages in the use of the Microscope[6]
[Figures 2a-f].

Rubinstein and Kim[7,8] have given scientific evidence that


the increase of long-term success with Micro-Endo Surgery
on molars premolars and single-rooted teeth has to be
attributed to the utilization of the Microscope.

From the common experience of different operators and


from literature investigation, we have stated technical
determinant factors in the following steps:
1. Diagnosis
2. Flap design and elevation
3. Osteotomy[10]
4. Apicoectomy: Courettage
biopsy
emostasis
cut surface
5. Retrofilling[11]
6. GTR evaluation
7. Suture.

With its use, we can consider the following as the main


advantages in our practice:
Easy identification of the apical third
Smaller osteotomies
Efficient evaluation of cut surface with minimal
resection angle
Increased diagnostic power
Easier and safer management of anatomic structures
Mininvasive approach to pathological tissues
Potential of creating an hermetic seal in the neo-apex.[9]
The combination of microscope, ultrasonic tips and
microintruments allows conservative, coaxial, deep
root-end preparation and retrofilling. This satisfies the
requirements for RCS sealing and the realization of the
triad: cleaning, shaping, filling of the RCS itself.
When we begin a surgical treatment. the primary concern
is to create conditions that favor healing of periradicular
tissues either for regeneration or for repair.
These conditions include:
Removal of necrotic tissues

Removal of disintegration tissues


Decontamination of root surface
Entomb bacteria present in RCS
Removal of the apical part with the most accessory
canals
Creation of the best neo-apical seal.

In the last decade, the operative protocol has undergone


major evolution, achieving better results.

Hermetic seal of the neo-apex and exits of RCS is the target


of surgical treatment [Figures 3a and b].
To perform the operative phases at best, we need:
A correct diagnosis and adequate treatment
planning
The possibility to evaluate and choose the most
favorable solution in case of controversial situations
A complete identification and visualization of the
anatomy of the surgical area
The best quality level of each technical moment in the
surgery
Correct evaluation of operatory risks
Minimal dissection and damage of healthy tissues.

Figure 2: (a) Failure of endo-treatment (b) Apicoectomy without retrofilling (c) Recurrency at 3 years
(d) Retrofilling 22X (e) Rx post-op control (f) Healing at 6 months

Journal of Conservative Dentistry | Jan-Feb 2015 | Vol 18 | Issue 1

Pecora and Pecora: A new dimension in endo surgery: Micro endo surgery

Figure 3: (a) Cutting surface evaluation, methylene blue 2% staining (b) Retro-filling control 22X

Guided regeneration principles


The regeneration finds a limit in the dimension of the
lesion. The concept of critical size defect has its total
application in Endodontic Micro-Surgery.
In some clinical situations, the total regeneration of
the lost tissues is not possible due to pathological
aggression.
There are many misunderstandings not only for the
indication to guide the healing toward regeneration, but
also among researchers on the techniques and the grafting
materials.
A small defect undergoes spontaneous healing while a
large defect has a different and non difficult healing. The
ultimate goal of Micro-Endo Surgery is the predictability of
the regeneration of the peri-apical tissues.[12]
It is important to define the difference between
Regeneration and Repair.
Regeneration is a biological process to replace the
destroyed tissues with new tissue that has same cells,
same architecture, same function and capability of reaction
against the pathologic stimulations.
Repair is a biologic process where the lost tissue is
substituted by a new tissue with different cells, different
architecture, different capability of reaction against the
pathologic stimulations. This is an acceptable type of
healing depending on which part of the root it occurs.
According to Pecoras anatomo-pathologic classification,
we have: TYPE 1 (above the apex); TYPE 2 (middle root
area); TYPE 3 (endo-perio communications) [Figures 4a-c].
When a defect can spontaneously heal, bone fillers are
ineffective or inappropriate.

10

However, there are many clinical situations requiring the


use of regenerative materials and techniques:
Large lesions (more than 5 mm)[13]
T & T lesions[14,15]
Endo-perio lesions[16]
Sinus membrane perforation[17]
Root perforations with large lesions.[18]
The prognostic limit of the regenerative techniques and
therapeutic possibilities can be evaluated with Pecoras
classification[19], where CLASS E lesions represent the
borderline and the evaluation criteria are based on the
distance of bony walls and their thickness.
Large defects, endo-perio communications and
through-and-through defects need a guide for healing.
Osteoconductive principle is based on this point.[20]
Osteoconduction occurs when a non-vital biomaterial
works as a scaffold in order to guide osteoblasts precursor
cells into the defect.
The healing of the bone defect depends on the presence of
these cells in the surrounding bone and tissue as well as on
their capability to colonize the area and differentiate into
osteoblasts.[21]
In borderline cases, a lesion of endodontic origin is
complicated by the loss of the marginal attachment. The
effectiveness of Endo-Surgery may be diminuished, if
epithelial cells are allowed to populate the root surface.
Membrane barriers inhibit this epithelial proliferation
and, thereby, promote regeneration of funcional
attachment.[22]
GTR techniques should be incorporated into the endodontic
surgery protocols and used when indicated.
Today, the controversial use of regenerative therapies,
even if limited in the indications and cases,- allows the

Journal of Conservative Dentistry | Jan-Feb 2015 | Vol 18 | Issue 1

Pecora and Pecora: A new dimension in endo surgery: Micro endo surgery

Figure 4: (a) Lesion above the apex TYPE I (b) Middle root lesion TYPE II (c) Endo-marginal lesion

clinicians to treat extreme cases and to have an optimal


and predictable treatment of those lesions considered as
untreatable cases in the past [Figures 5a-d].

Maxillary sinus management


Anatomical relations between apices of postero-superior teeth
and maxillary sinus, imply the risk of endo-perio pathologies
transmission, bacteria, debris, instruments penetration and
resected apices violation during Endo-Micro Surgery.

Particular attention has to be given to the type of healing


and how the event may influence the healing process.
A study from Matisko et al., evidentiated that the use of
GTR (collagene membranes) in MS perforation brings to
bone formation when compared to spontaneous healing
with fibrous tissue in the CONTROL sites, in rabbits.[17]

Limits of conservative therapy

All these potential clinical situations determine therapeutic


needs, diagnostic and prognostic problems.

Microsurgical procedures have implemented our skills


to treat successfully most of the failures in the endo
treatments. The application of GTR principles has moved
many heroic cases towards the conservative approach.[23]

In the last years, the utilization of the Microscope has


determined new horizons in the prevention and therapeutic
options in Maxillary Sinus (MS) involvement during EndoSurgery or consequent to endo-perio lesions.

Which is the limit between conservative treatment and


overtreatment?

The Endodontist has to be very careful when dealing with


the following MS involvements:
Endo-perio
Cyst
EAS (endo antral syndrome)
OAC (oro antral communication)
OAF (oro antral fistula).

The feeble point is the success and failure evaluation


criteria.
It is too simple to consider the lack of symptoms or
clinical signs or a decreasing of the radiolucency a
success. Many teeth, also if they cannot be included
into the success criteria, remain asymptomatic and infunction for years.

The Schneiders membrane of the sinus may present:


Thickening
Perforation.

The critical point is when the progression of infection is


out of control and the situation may lead to massive bone
loss, jeopardizing the future correct implant insertion.

With or without symptoms.

Necessarily we have to respect a logic protocol, which


foresees:
Endo-treatment
Eventual retreatment
Indication for surgery
Diagnostic flap
Possibility of infection control
Evaluation of healing and regenerative potential.

The MUST is to prevent foreign bodies, bacteria, debris


penetration into the sinus, and if a perforationexists, the
correct choice is its immediate closure.
If we have to perform an endo-surgery and if a thin
layer of bone separates the apex from the sinus or if a
communication pre or intra op occurs, the correct therapy
is to close the perforation and increase the amount of bone
above the neo-apex to prevent future recurrencies.
In case of perforation, a clean and precise operative
technique is important to avoid the MS contamination.

In the final decision, we have to consider, beyond


periodontal and restorative considerations, factors as:
esthetic, proprioceptive sensibility, postural balance,
prosthetic relevance of the tooth, anatomic limitations,
economical aspects and patients will.

Journal of Conservative Dentistry | Jan-Feb 2015 | Vol 18 | Issue 1

11

Pecora and Pecora: A new dimension in endo surgery: Micro endo surgery

Figure 5: (a) Large lesion with endo-perio communication (b) Apicoectomy with calcium sulfate graft (c) Rx at 2
months (d) Rx at 6 months

To the traditional goals of therapy:


Decreasing or disappearing of radiolucency
Control of symptoms
Restoring of function.

We have to add:
control of infections progression and bone destruction.

In a clinical study, Novaes and Novaes[24] concluded


that the chronically infected sites do not constitute a
contraindication for immediate implant placement if some
pre-and post-operative clinical cares are followed:
Antimicrobical therapy pre- and post-op;
Meticolous cleansing and debridement of the alveoli
before implant placement.

Therapeutic option, correct diagnosis, predictability of


the results have to be validated with a diagnostic flap. The
microscope and the methylene blue as biological indicators,
make it easier to chose between the different options.

Implants as alternative
Once the decision to extract the tooth is made, clinicians
have to face two therapeutic options:
Immediate post-extraction regeneration
Fresh socket implant with immediate loading.
There are no objective criteria of evaluation, but only
clinical experience and studies focusing single aspects of
the problem exists.
The decision can be the most favorable compromise when
we combine experience of the operator, logical approach
and a few fundamental points [Figures 6a and b].
Quality of bone and primary stability are the main factors.
Primary stability depends on bone density and implants
design. Bone density depends on bone trabeculae and their
structure.
It is essential for the surgeon to decide how and where
to place the implant and whether an implant can be
immediately loaded.
The leading concept is the evaluation of the post-extractive
defect:

12

Presence of bony wall and thickness;


Endo-perio condition of the closer teeth;
Esthetic aspect (anterior or posterior teeth);
Acute infection or suppuration.

In presence of bone dehischence or missing bone wall, the


choice is first to regenerate the bone and then place the
implant, because the predictability of GTR techniques is
questionable.
Immediate loading can be applied in some clinical situations
where the control of micromotion is possible and if there
are some important advantages:
Decreased healing time
Reduced resorption of alveolar bone
Achievement of optimal esthetic results.
In case of extraction sites in esthetic areas, there is a
restorative challange and particular steps have to be
followed in order to preserve site morphology and to
support the existing hard and soft tissues:
1. Atraumatic tooth extraction with mininvasive operative
techniques that minimize the treatment of the tissues;
2. Appropriate placement, orientation and stabilization
of the implant.
Flapless surgery has been suggested as a favorable option
to enhance implant esthetic, with several advantages:
Reduction of pain and swelling
Minimal intra operative bleeding

Journal of Conservative Dentistry | Jan-Feb 2015 | Vol 18 | Issue 1

Pecora and Pecora: A new dimension in endo surgery: Micro endo surgery

Realistically, we cannot say that implants have a higher


percentage of survival if compared with real teeth treated
and reconstructed in a proper way.[27]
The availability of osteointegrated implants does not
justify the extraction of natural teeth that can still offer a
stable function.
A compromised tooth should be managed with a
multidisciplinary approach and dental implants should be
reserved for patients with truly end-stage tooth failure.
a

Figure 6: (a) Untreatable horizontal fracture (tooth 2.1)


(b) Fresh socket implant with immediate loading

Reduction of surgical time


No need of suture
Maintenance of blood spply
Preservation of hard and soft tissues.

CONCLUSIONS
The dramatic evolution from Endo-Surgery to Micro-Endo
Surgery has enlarged the horizon of therapeutic options.
Illumination and magnification through the Microscope
have fundamentally and radically changed the way
endodontic surgery can be performed.

The only limitation is that this process requires more


operative experience and pre surgical plannig for the
inhability to visualize anatomic landmarks and vital
structures.
A clinical study of Pecora et al. in 1996 [25], pointed
out that the endodontist now has an additional
choice of treatment in cases where tooth extraction
is inevitable.
In conclusion, the placement of implants immediately after
extraction, seems to be a successful procedure.
Even if we have plenty of papers in literature that
evidentiate the good results of the immediate implants,
why they speak in terms of implant survival, remains an
interrogative.
Survival is characterized by the maintainance of a certain
function for a certain period of time without the respect of
fixed parameters and without a long-term control.
Success is qualified and codificated in compliance with
fixed parameters declared in the protocol and respected in
the worlds documented long-term results.
The optimal treatment plan incorporates the best available
evidence together with specific case factors and the
patients desires and needs.[26] Dental implants provide a
useful alternative to replace teeth that cannot otherwise be
treated with a good prognosis.
It is impossible to give a proper evaluation to the success
rate of the various treatments since the same criteria of
evaluation of the results are inconsistent themselves.

The clinical experience has evidentiated the following


benefits:
Optimal hermetic seal of the neo-apex
GTR application increases the long-term results in the
treatment of borderline cases
Correct and favorable management of endo-sinus
pathologies
Expanded diagnostic power in difficult clinical
situations
Excellent evaluation of clinical data to accelerate the
correct choice in the determination between TOOTH
or IMPLANT.
SEE BETTERDO BETTER.
Finally, we would like to stress the concept that fresh socket
implants with endodontic indications have to be considered
an important part of the Endodontists daily practice.
The diagnostic flap helped us to clarify that the postextractive therapeutic options have to follow the decision
to extract the tooth since the immediate loading has
become a trustable and predictable solution.

REFERENCES
1.
2.
3.
4.
5.

Pecora G, Andreana S. Use of dental operative microscope in endodontic


surgery. Oral Surg Oral Med Oral Pathol 1993;75:751.9.
Izawa T, Kim S, Pecora G, Rubinstein R. Microscopic endodontic surgery.
Quintessence 1994;13:54-65.
Kim S, Kratchman S. Modern endodontic surgery concepts and practice
review a review. J Endod 2006;32:601-24.
Rubinstein R. Endodontic microsurgery and the surgical operating
microscope. Compend 1997;8:659-74.
Kim S, Pecora G, Rubinstein R. Comparison of traditional and
microsurgery in endodontics. In: Kim S, Pecora G, Rubinstein R,
editors. Color Atlas of Microsurgery in Endodontics. Philadelphia: W.B.
Saunders; 2001;1:5-11.

Journal of Conservative Dentistry | Jan-Feb 2015 | Vol 18 | Issue 1

13

Pecora and Pecora: A new dimension in endo surgery: Micro endo surgery
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.

Pecora G, Covani U, Giardino L, Rubinstein R. Valutazioni clinicostatistiche sulluso dello stereomicroscopio in odontoiatria. RIS
1993;8:425-31.
Rubinstein R, Kim S. Short-term observation of the results of endodontic
surgery, with the use of surgical operating microscope and Super-Eba
as a root-end filling material. J Endod 1999;25:43-8.
Rubinstein R, Kim S. Long-term follow-up of cases considered healed 1
year after apical microsurgery. J Endod 2002;28:378-83.
Pecora G, De Leonardis D, Rubinstein R, Giardino L, Dal Pont F.
Endodonzia chirurgica: Il microscopio operativo. Dent Cadmos
1998;14:31-40.
Pecora G, Bonelli M, Bonetti I. Surgical endo: Osteotomy under
microscope. Il Dent Modern 2002;9:93-9.
Pecora G, De Leonardis D, Rubinstein R, Meledandri R, Lattanzi U.
Apical preparation with ultrasonics. Dent Cadmos 1998;16:49-56.
De Leonardis D, Pecora G, Martuscelli G, Cornelini R, An Gdreana S.
Impiego della GTR in chirurgia endodontica: Studio clinico controllato.
Dent Cadmos 1999;1:31-8.
Bonelli M, Bonetti I, De Leonardis D, Ricci J, Pecora G. The use of
Calcium Sulphate in surgical endo. Large lesions treatment. Dent
Cadmos 2001;3:29-34.
Murashima Y, Yoshigawa G, Wadachi R, Suda H. Calcium Sulphate a
bone substitute for various osseous defects in R, conjunction with
apicoectomy. Int Endod J 1995;35:768-74.
Pecora G, Kim S, Celletti R, Davarpanah M. The GTR principles in endo
surgery: One year post-op results of large periapical lesions. Int Endod
J 1995;28:41-6.
Kellert M, Chalfin H, Solomon C. GTR: An adjunct to endo surgery. JADA
1994;125:1229-34.
Matisko L, Wallace J, Mundell R, Zullo T. Healing of maxillary sinus
defects using GTR: An experimental study in rabbits. J Endod
1999;25:49-53.
Duggins L, Clay J, Himel V, Dean J. A combined endodontic retrofill and
periodontal GTR technique for the repair of molar endodontic forcation
perforation: A case report. Quintessence Int 1994;25:109-14.

19.

20.
21.
22.
23.
24.
25.
26.

27.

Pecora G. De Leonardis D, Piattelli A. The use of endo-microsurgery


alone or associated to calcium Sulphate graft in the endo-perio lesions
treatment. Controlled clinical study. Giornale Italiano di Endodonzia
2005;1:42-9.
Piattelli A, Orsini G, De Leonardis D, Scarano A, Iezzi G, Spoto G,
et al. Il solfato di calcio nella rigenerazione ossea. Dent Cadmos
2002;10:1-5.
Pecora G, Andreana S, Covani U, Margarone JE, Sottosanti J. Bone
regeneration with a calcium sulfate barrier. Oral Surg Oral Med Oral
Pathol 1997;84:227-34.
Pecora G, Baek SH, Retman S, Kim S. Barrier membrane technique in
endo microsurgery. Dent Clin North Am 1997;41:585-602.
Pecora G, Bonelli M, Pecora CN, Grassi R. The choice between endo
treatment and implant as alternative. Giornale Italiani di Endodonzia
2006;20:47-53.
Novaes AB Jr, Novaes. AB. Immediate implants placed into infected
sites: A clinical report. Int J Oral Maxillofac Implant 1995;10:609-13.
Pecora G, Andreana S, Covani U, De Leonardis D, Schifferle R. New
directions in surgical endodontics: Immediate implantation into an
extraction socket. J Endod 1996;22:135-9.
Pecora GE, Perrotti V, Iezzi G, Pontes QE, Piattelli A. Dental implants
or traditional treatment: A contemporary dilemma. In: Schwartz-Arad D,
editor. Ridge Preservation and Immediate Implantation. Quintessence
Publishing; 2012. p. 1-8.
Salinas TJ, Eckert SE. In patients requiring single-tooth replacement,
what are the outcomes of implant, as compared to tooth-supported
restorations? Int J Oral Maxillofac Implants 2007;22 Suppl:71-95.

How to cite this article: Pecora GE, Pecora CN. A new dimension
in endo surgery: Micro endo surgery. J Conserv Dent 2015;18:7-14.
Source of Support: Nil, Conflict of Interest: None declared.

Announcement

QUICK RESPONSE CODE LINK FOR FULL TEXT ARTICLES


The journal issue has a unique new feature for reaching to the journals website without typing a single leer. Each arcle
on its first page has a Quick Response Code. Using any mobile or other hand-held device with camera and GPRS/other
internet source, one can reach to the full text of that parcular arcle on the journals website. Start a QR-code reading
soware (see list of free applicaons from hp://nyurl.com/yzlh2tc) and point the camera to the QR-code printed in the
journal. It will automacally take you to the HTML full text of that arcle. One can also use a desktop or laptop with web
camera for similar funconality. See hp://nyurl.com/2bw7fn3 or hp://nyurl.com/3ysr3me for the free applicaons.

14

Journal of Conservative Dentistry | Jan-Feb 2015 | Vol 18 | Issue 1

Copyright of Journal of Conservative Dentistry is the property of Medknow Publications &


Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a
listserv without the copyright holder's express written permission. However, users may print,
download, or email articles for individual use.

S-ar putea să vă placă și