Endodontic Microsurgery Of The Mandibular Premolar Using Dynamic Navigation System

Introduction: In this case, an endodontic microsurgery of the left mandibular first premolar adjacent to the mental foramen was successfully performed with the assistance of dynamic navigation system, which enhanced apical positioning accuracy, shortened the operation time, and avoided the occurrence of nerve injury. Case description: The patient presented with chronic apical periodontitis of the left mandibular first premolar. Due to calcified and non-negotiable root canals, conventional endodontic treatment was unfeasible. Radiographic examination revealed the buccal bone plate in the apical lesion area was intact and only 3 mm away from the mental foramen. After flap reflection, we used the dynamic navigation system to precisely locate the apex, perform osteotomy, and resect 3 mm of the root apex. No postoperative neurosensory disturbances were observed. A 34-months follow-up confirmed complete healing of the periapical lesion. Discussion: In this case, the intact buccal bone overlying the periapical lesion posed challenges for root apex localization, while the lesion's close proximity to the mental foramen increased the risk of nerve injury. The application of dynamic navigation technology significantly improved the surgical precision, reduced operative time, and effectively protect the mental nerve, thereby preventing postoperative neurological complications—particularly beneficial for less-experienced clinicians. Conclusion/clinical significance: The application of dynamic navigation system in endodontic microsurgery ensured superior positioning accuracy and shorter operative time, especially for surgeries involving critical anatomical structures. This technology effectively prevented iatrogenic nerve injuries, enhancing surgical safety.