Three-dimensional Assessment of Healing Variability after Endodontic Microsurgery Using the Bone Lid Technique: A Case Series.

Cortical bone healing after endodontic microsurgery on molars with apical lesions can be delayed or unpredictable. The bone lid technique offers enhanced surgical access while minimizing bone loss. This case series reports on patients with intact buccal cortical bone thicker than 1 mm, treated surgically using the bone lid technique. Bone lids were created with a piezotome, preserved in Hank's Balanced Salt Solution, and repositioned after root-end surgery using a collagen matrix for stabilization. Healing was assessed using three-dimensional cone beam computed tomography criteria and evaluation of the bone lid integration perimeter. Out of 6 cases, 2 showed complete healing without complications. One case demonstrated limited cortical plate healing, and in two cases, the bone lids became dislodged, necessitating further intervention. These findings indicate that the bone lid technique in endodontic microsurgery may support favorable cortical healing when postoperative stability is maintained. Bone lid integrity appears to be a critical factor in successful outcomes.