Major factors for the effectiveness of apical endodontic microsurgery: a systematic review

Abstract

Introduction: Apical endodontic microsurgery is a technique developed by the evolution of traditional apical endodontic surgery approaches and technologies. This enhancement was possible since the introduction of equipment like cone beam computed tomography, microscope, ultrasonic instruments, and biocompatibility root-end material filling, increasing the predictability and long-term success rates and survival of teeth. Objective: It explored and developed the main factors for the effectiveness of apical endodontic microsurgery. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from October to December 2023 in the 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 118 articles were found, 43 articles were evaluated in full and 36 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 28 studies with a high risk of bias and 21 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=57.5%<50%. It was concluded that the success of apical endodontic surgery in terms of healing existing periapical pathology, together with a good long-term prognosis, depends on correct diagnosis and planning, as well as the association of surgical techniques, well-executed protocols, and biocompatible materials. The apical endodontic microsurgical approach is predictable and has a high success rate, which resulted from the introduction of cone beam computed tomography, microscope, ultrasonic instruments, and materials such as MTA and bioceramics for retro-fillings.