Endodontic treatment and retreatment: a large systematic review

Abstract

Introduction: In the context of treatment endodontics, endodontic surgery encompasses various procedures for the treatment of teeth with a history of endodontic treatment failures, such as apical surgery, crown and root resections, surgical repair of perforations, and intentional replantation. Endodontic microsurgery is the evolution of traditional apicectomy techniques and incorporates high magnification, ultrasonic preparation of the root end, and filling of the root end with biocompatible materials. Objective: It was to carry out a vast literature review in a systematic way to show the main considerations of endodontic treatment and retreatment. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from September to November 2022 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 120 articles were found, and 75 articles were evaluated and 35 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 20 studies with a high risk of bias and 13 studies that did not meet GRADE. Most studies showed homogeneity in their results, with I2 =96.2% >50%. Modern endodontic surgery uses the dental operating microscope and cone beam computed tomography for preoperative diagnosis and treatment planning. In the presence of persistent endodontic lesions or endodontic failure, endodontic treatment or endodontic surgery is required. In the long term, the risk of failure is identical for both groups, with only a slightly higher risk of failure for non-surgical endodontic retreatments when only two years of follow-up are considered.