® ENDOSCOPIC TECHNIQUES IN MINIMALLY INVASIVE ORAL SURGERY Wilfried ENGELKE Victor BELTRÁN ® ENDOSCOPIC TECHNIQUES IN MINIMALLY INVASIVE ORAL SURGERY Wilfried ENGELKE1 Victor BELTRÁN2 1 Professor, M.D. and D.D.S. Department of Oral and Maxillofacial Surgery Georg August Clinical Center, University of Göttingen, Germany 2 D.D.S., M.Sc., Faculty of Dentistry Universidad de La Frontera, Temuco, Chile 4 Endoscopic Techniques in Minimally Invasive Oral Surgery Endoscopic Techniques in Minimally Invasive Oral Surgery Wilfried Engelke 1 and Victor Beltrán 2 1 Professor, M.D. and D.D.S., Department of Oral and Maxillofacial Surgery, Georg August Clinical Center, University of Göttingen, Germany 2 D.D.S., M.Sc., Faculty of Dentistry Universidad de La Frontera, Temuco, Chile Correspondence address of the author: Prof. Dr. med. Dr. med. dent. 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ISBN 978-3-89756-929-4 Endoscopic Techniques in Minimally Invasive Oral Surgery 5 Table of Contents 1 Preface ................................................ 6 Endoscopic Techniques .................................. 6 1.1 Direct Endoscopy (DE) ............................... 7 1.2 Immersion Endoscopy (IE) ............................ 8 1.3 Support Endoscopy (SE).............................. 8 1.4 Support Immersion Endoscopy (SIE) ................... 10 1.5 Trocar-Guided Endoscopy (TGE)....................... 11 2 Diagnostic Endoscopy ................................... 12 2.1 Diagnostic Endoscopy of the Maxillary Sinus ............ 12 2.1.1 Antroscopy................................... 12 2.2 Diagnostic Endoscopy of the Dentoalveolar Region ...... 13 2.2.1 Alveoloscopy ................................. 13 2.2.2 Cavitary Endoscopy ........................... 14 2.3 Diagnostic Endoscopy of the Periodontium and Teeth .... 15 2.3.1 Perioscopy................................... 15 2.3.2 Pulposcopy .................................. 16 2.3.3 Root Canal Endoscopy ........................ 16 2.3.4 Implantoscopy................................ 17 3 Operative Endoscopy ..................................... 18 3.1 Operative Endoscopy of the Maxillary Sinus ............. 18 3.1.1 Endoscopic Exploration of the Maxillary Sinus .... 18 3.1.2 Laser Cystostomy and Cystectomy of the Maxillary Sinus .......................... 19 3.1.3 Subantroscopic Laterobasal Sinus Floor Augmentation (SALSA)......................... 20 3.1.4 Transalveolar Sinus Floor Augmentation.......... 23 3.2 Operative Endoscopy of the Dentoalveolar Region ....... 24 3.2.1 Endoscopically Controlled/Assisted Root Tip Resection ............................ 24 3.2.2 Endoscopically Assisted/Controlled Cyst Surgery ................................. 26 3.2.3 Inward Fragmentation Technique (IFT) ........... 27 3.2.3.1 Endoscopically Assisted Third Molar Removal by IFT ....................................... 28 3.2.3.2 Endoscopic Enucleation of Ectopic and Impacted Teeth by IFT ......................... 31 3.2.3.3 Endoscopically Assisted Tooth Root Removal (IFT) ........................... 32 3.2.4 Endoscopically Assisted Implantation............ 33 3.2.4.1 Immediate Implantation in Extraction Sockets..... 34 3.2.4.2 Navigated Cavity Preparation ................... 35 3.2.4.3 Navigated Implantation and Augmentation (Flapless, SALSA) ............................. 36 3.3 Operative Endoscopy of Superficial Soft-Tissue Spaces .................................. 38 3.3.1 Perioscopy with a Para- or Epicrestal Tunnel ..... 38 3.3.2 Tunnel Approach for Laser Surgery . 40 Instrumentation for Endoscopic Techniques in Minimally Invasive Oral Surgery Endoscopes, Instruments and Accessories .................. 41 6 Endoscopic Techniques in Minimally Invasive Oral Surgery Introduction The development of minimally invasive procedures in and maxillofacial surgeon with an overview of currently virtually all areas of human medicine, including oral available techniques. We shall describe the basic surgery, has compelled us to rethink the rationale for technical aspects of endoscopic oral surgery and also classic open surgical techniques involving the elevation review the most important specificpr ocedures, which fall of soft-tissue flaps. Relatively severe postoperative under the collective heading of ”flapless oral surgery.” complaints, the need for bone removal in open tooth As the reader delves more deeply into the subject, it extractions, and increased resorption of the alveolar may become increasingly clear that endoscopy actually ridge after periosteal stripping make it imperative to eliminates the need for classic flapelevation in many oral reconsider alternative strategies. surgical procedures. The greatly improved visualization Endoscopy has been used for decades as a supportive of oral surgical fields demonstrates a new and precise technique for directing minimally invasive oral surgical way to operate less traumatically on the dentoalveolar procedures and in recent years has been used region, with much less collateral damage to hard and increasingly in endoscopically assisted operative soft tissues, than was possible with traditional or techniques. Based on rapid advances in this field, it is conventional methods. time to provide the interested dentist, oral surgeon, Endoscopic Techniques The special anatomy of the stomato- this milieu (bone and dental hard tissue) while sparing 1 gnathic system underscores the need critical structures such as the mandibular canal and for special endoscopic techniques that maxillary sinus mucosa. The system used by the surgeon are comparable in many ways to techniques used in must support ablative and drainage procedures