Francesca Abella Sans, Jaime Barragán Montes, Tomasz Zbozen, Nandini Suresh, Lalli Dharmarajan, Paul M. H. Dummer, Venkateshbabu Nagendrababu
https://doi.org/10.1111/iej.70014
The Art of Gingival Gymnastics
This article presents a clever surgical trick in the form of the MIVIST (see the title) technique, but one is left with the impression that the authors have gone hunting for a problem that barely exists. Soft tissue healing after apicectomy is rarely a limiting factor in success; most cases heal beautifully without such elaborate pre-planning. By framing soft tissue closure as a major barrier to success, the authors have arguably overcomplicated a fairly straightforward aspect of endodontic surgery. It risks giving the impression that the average endodontist should be agonising over flap design for hours, when in practice, routine submarginal incisions suffice in the vast majority of cases.
That said, the case itself was nicely executed, and the surgical stent is an elegant touch. The precision of planning, use of CBCT overlays, and customised guide demonstrate technical artistry and the sort of digital sophistication that would delight a conference audience. But the question must be asked: was it worth it? The amount of digital planning, scanning, and printing described is akin to using a laser-guided missile to swat a fly. The same apicectomy could have been achieved cheaper, quicker, and with equal predictability using conventional methods—and the patient would almost certainly never have noticed the difference in their gingival margin.
Don’t get me wrong. Surgical stents are gaining in popularity and particularly in cases where root apices are deeply positioned or close to adjacent teeth, they are a godsend and highly recommended. But the vertical incision just complicates it all rather than simplifying.
So while the novelty of the approach is interesting, and it might have value in a very select subset of cases—say, a highly visible anterior tooth in a patient with demanding cosmetic expectations—it is difficult to see broad clinical relevance. If a case was to be reported on, the authors might have chosen one with a high bar of justification. The result could have been achieved easily through standard protocols. They were just being flash.
For the everyday general practitioner or endodontist, the technique is less a game-changer and more a curiosity: a showcase of digital dentistry’s capabilities rather than a necessary advance. It’s enjoyable to read for its ingenuity, but its importance to daily practice is limited to the category of “nice, but a little over the top.”
N.B. Seven authors for a single surgical case report? Anyone cynical would think that maybe one or two are jumping in to stack their CV’s.
