Abstract
Objectives: Analyse the effectiveness of different materials and techniques used in guided tissue regeneration (GTR) applied in periapical surgery, comparing the success rate obtained in 4-wall defects and in through-and-through bone lesions as well as to establish prognostic factors. Material and Methods: A Cochrane, PubMed-MEDLINE and Scopus database search (October 2012 to March 2013) was conducted with the search terms “periapical surgery”, “surgical endodontic treatment”, “guided tissue regeneration”, “bone regeneration”, “bone grafts”, “barrier membranes” and “periapical lesions” individually and next, using the Boolean operator “AND”. The inclusion criteria were the use of GTR (bone graft and/or membrane barrier), clinical studies including at least 10 patients, 10 years aged articles published in English or French. The exclusion criteria were case reports and nonhuman studies. Results: 34 publications were selected from a total of 483. 9 of the 34 were excluded. Finally, the systematic review included 25 articles: 2 metaanalysis, 8 reviews, 13 prospective studies and 2 retrospective studies. They were stratified according to their level of scientific evidence using the SORT criteria. The 4-wall periapical and through-and-through lesions improve more their prognosis by combining bone grafts and barrier membranes than using these materials exclusively, respect to the control groups. The results show lower failure rates in 4-wall lesions than in through-and-through lesions using GTR. Conclusions: The combined GTR technique (filling material and membranes) obtains a greater success rate both in 4-wall lesions and in through-and-through lesions, respect to the control groups. The use of regeneration materials seems to be more necessary in through-and-through lesions,> 5mm lesions, lower teeth and apicomarginal lesions as they have the worst healing prognosis. In function of the articles scientific quality, a type B recommendation is given in favour to the use of GTR in association of periapical surgery in case of 4-wall and through-and-through lesions. Key words:Periapical surgery, surgical endodontic treatment, guided tissue regeneration, bone regeneration, bone grafts, barrier membranes.
Highlights
Endodontic treatment attempts to eliminate bacterial infection in the radicular duct
Guided tissue regeneration (GTR) with the use of barrier membranes and/or bone grafts has been successfully used in different surgical techniques in oral surgery, just like in periapical surgery to enhance new tissue formation in the defect created by the lesion and by the surgical technique (2,9-16)
The aim of the present systematic review is to analyze the materials and results of guided tissue regeneration (GTR) techniques applied in periapical surgery, comparing the success rates obtained in 4-wall defects and through-and-through lesions as well as to establish prognostic factors
Summary
Endodontic treatment attempts to eliminate bacterial infection in the radicular duct. The indications for periapical surgery, based on the protocol proposed by the Spanish Society of Oral Surgery (6-8) are: i) periapical disease affecting a permanent tooth subjected to endodontic treatment (of good quality), with pain and inflammation; ii) periapical pathology with prosthodontic or conservative restoration proven to be difficult to remove; iii) a radiotransparent lesion measuring over 8 to 10 mm in diameter; iv) symptomatic guttapercha overfilling, or presence of a foreign body not amenable to orthograde removal (eg, fractured file); v) other indications (patient requiring endodontic treatment and periapical surgery in a single session, fracture of the apical third, etc.) These points agree in their majority with those established by the European Society of Endodontology (5), this one includes one more indication for periapical surgery: perforation of the root or the floor of the pulp chamber. The available studies in the literature are very heterogeneous, so that it could not be possible to add a statistical study
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