The Osteotomy Window

Enough bone has to be removed to be able to identify and expose the apex or the radicular surface of the defect, and create an adequate access for all microinstruments to the lesion. Osteotomy is an extremely important issue because, if it is done incorrectly, it can dramatically extend the time of treatment and complicate any single step of the procedure. A 5 mm diameter osteotomy window is small, but at the same time it is big enough to allow easy traffic of all instruments: burs, curettes, micromirrors, ultrasonic tips, micro-pluggers, etc. The microscope is used at lowest magnification (4x).

Armamentarium

• Round tungsten
• Lindemann H161 bone bur
• Trephine
• Impact Air handpiece

TIP Just because some lesions do not appear on the radiograph does not mean they do not have granulation tissue - especially in mandible lesions when only trabecular bone is affected.

Preliminaries

Before starting the osteotomy it is important to check the diagnostic radiograph, in order to calculate the length and number of the roots, the curvature of the roots, and the position of the apices, in relation to the cusp tips and to important anatomical landmarks like the mental foramen, mandibular nerve or maxillary sinus.

There are three different clinical situations the surgeon can encounter, and these are described below.