Abstract
Background and objectives: The long-term outcome of endodontic microsurgery (EMS) performed on root-filled teeth affected by post-treatment apical periodontitis (AP) has been a matter of debate, re-launched by the introduction of novel root-end filling materials which have been proven to improve the short-term outcome of EMS. The purpose of this systematic review and meta-analysis is to evaluate the clinical and radiographic long-term outcome of endodontic microsurgery in teeth diagnosed with secondary AP through radiographic evaluation. Materials and Methods: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion and exclusion criteria were defined a priori to select the best longitudinal evidence. Only randomized clinical trials (RCT) and prospective clinical studies (PCS), with a follow-up ≥ 2-year, and exhibiting well-established clinical and radiographic outcome criteria, were selected. Results: A total of 573 articles were obtained, from which 10 fulfill inclusion criteria: 6 PCS and 4 RCT. Meta-analysis showed a pooled proportion of success rate of 91.3%, from an overall amount of 453 treated teeth included in RCT; from overall 839 included teeth in PCS, a pooled success rate of 78.4% was observed, with the follow-up time ranging from 2 to 13-years. Survival rate outcomes varied from 79 to 100% for the same follow-up period. Five prognostic factors with influence on the outcome were disclosed: smoking habits, tooth location and type, absence/presence of dentinal defects, interproximal bone level, and root-end filling material. Conclusions: High success rates and predictable results can be expected when EMS is performed by trained endodontists, allowing good prognosis and preservation of teeth affected by secondary AP.
Highlights
The main etiology of post-treatment apical periodontitis (AP) is persistent or secondary intraradicular infection, and the preferable treatment option to manage this clinical situation is nonsurgical endodontic retreatment (NSER) [1]
The development of this review aims to achieve a more reliable outcome result through the search of studies with a high level of external validity of the results, concerning the follow-up period evaluated and the conditions in which endodontic microsurgery (EMS) was performed
The purpose of this systematic review and meta-analysis is to evaluate the clinical and radiographic long-term outcome of endodontic microsurgery in teeth diagnosed with secondary AP through radiographic evaluation
Summary
The main etiology of post-treatment apical periodontitis (AP) is persistent or secondary intraradicular infection, and the preferable treatment option to manage this clinical situation is nonsurgical endodontic retreatment (NSER) [1]. Endodontic microsurgery (EMS) is a current SER approach characterized by modern microsurgical techniques that integrate the use of an operation microscope [6] or an endoscope [7], root-end cavity preparation with ultrasonic tips, and more biocompatible root-end filling material [3,8]. With the aim of preventing the outgrowth of bacteria and promote periapical tissue healing [11], an ideal root-end filling material must have biocompatibility, dimensional stability [6], and resistance to resorption [11] It should be bactericidal, bacteriostatic, easy to manage, and offer an exceptional seal capacity [6,11]. The purpose of this systematic review and meta-analysis is to evaluate the clinical and radiographic long-term outcome of endodontic microsurgery in teeth diagnosed with secondary AP through radiographic evaluation.
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