Efficacy of Computer-Aided Static Navigation Technique on the Accuracy of Endodontic Microsurgery. A Systematic Review and Meta-Analysis.

Álvaro Zubizarreta-Macho,Jesús Mena-Álvarez,José María Montiel-Company,César Castillo-Amature

doi:10.3390/jcm10020313

Álvaro Zubizarreta-Macho, Jesús Mena-Álvarez + Show 2 more

Open Access

https://doi.org/10.3390/jcm10020313

Copy DOI

Abstract

The aim of this systematic review and meta-analysis was to analyze the efficacy of the computer-aided static navigation technique on the accuracy of root apex location in endodontic microsurgery. Material and Methods: A systematic literature review and meta-analysis, based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, of clinical studies that evaluated the apex location rate of the computer-aided static navigation techniques applied to endodontic microsurgery. A total of four databases were consulted in the literature search: Pubmed-Medline, Scopus, Cochrane, and Web of Science. After eliminating duplicated articles and applying the inclusion criteria, seven articles were selected for the qualitative and the quantitative analysis. Results: The root apex location success rate stated at 96.8% (confidence interval (CI): 93.0–100%) of the cases performed through a computer-aided static navigation technique. The prediction interval ranges from 91.4% to 100%. The meta-analysis did not detect heterogeneity between the combined studies (Q-test = 6.15; p-value = 0.407; I2 = 2.4%). The computer-aided static navigation techniques showed a root apex location success rate 27 times higher than conventional endodontic microsurgery procedures (Q test = 0.80; p = 0.671; I2 = 0%). Three studies of computer-aided static navigation techniques and control group were compared using a random effects model with the Mantel-Haenszel method with a statistically significant odds success ratio of 27.7, with a 95% confidence interval between 11.3 and 68.1 (z test = 7.23; p < 0.0001). Conclusions: According to in vitro studies analyzed, endodontic microsurgeries performed through computer-aided static navigation techniques show a high precision.

Highlights

Bacterial infection is considered the main factor in establishing the effects of pulp tissues, which may lead to subsequent irreversible pulp damage, necrosis, and the formation of periapical lesions [1]
Non-surgical endodontic retreatment is recommended in root canal treatment failure; the non-surgical endodontic retreatment presents a success rate of 80% [4]
The PICO question was, ‘Which is efficacy of computer-aided static navigation techniques on the accuracy of endodontic microsurgery?’ with the following components: population: teeth submitted to endodontic microsurgery performed through computer-aided static navigation techniques; intervention: endodontic microsurgery procedures performed through computer-aided static navigation techniques; comparison: endodontic microsurgery procedures performed through static navigation systems; and outcome: accuracy and apex location by endodontic microsurgery

Summary

Introduction

Bacterial infection is considered the main factor in establishing the effects of pulp tissues, which may lead to subsequent irreversible pulp damage, necrosis, and the formation of periapical lesions [1]. Non-surgical endodontic retreatment is recommended in root canal treatment failure; the non-surgical endodontic retreatment presents a success rate of 80% [4]. Endodontic microsurgery procedures have been recommended after unsuccessful non-surgical endodontic retreatment, when non-surgical endodontic retreatment is impossible or has an unfavorable prognosis [5], when orthograde access to the apical portion of the root canal system is not effective or technically possible. Endodontic microsurgery procedures comprise the removal of necrotic and infected periapical tissues, resection of the apical part of the tooth (apicoectomy), and preparation of the root-end cavity for the insertion of a retrograde filling material [7]. The outcome of conventional endodontic microsurgery has reported 90% complete healing of periapical tissues [8]; the inaccuracy of root apex location may cause intraoperative complications as root perforation, maxillary sinus affection, or weakened dental structure [4]. The development of the computer-aided static (SN) navigation technique allows a drilling guidance during the endodontic microsurgery procedures [10], improving the accuracy of root apex location and allowing an accurate and safe endodontic microsurgery, especially in posterior and lingual/palatal roots with compromised access or location [4,10]

Methods

Results

Discussion

Conclusion