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Flynn R, Foschi F, Maloney B, Creavin G, Duncan HF. The impact of bone grafting with/without barrier membrane placement on the outcome of apical surgery: A systematic review and meta-analysis. Int Endod J 2024. [PMID: 38491954 DOI: 10.1111/iej.14066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 02/06/2024] [Accepted: 03/06/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Regenerative techniques are increasingly being advocated in endodontic apical surgery (AS) to enhance the healing of periapical lesions. Various grafting and membrane materials are employed as adjuncts to modern AS. OBJECTIVES This systematic review aimed to answer the following PICO question: In patients with apical periodontitis (P) what is the impact of bone grafting with/without barrier membrane materials (I) compared with surgery without grafting materials (C) on the outcome of AS evaluated clinically and radiographically (O). METHODS A systematic search was conducted in four databases (Embase, Web of Science, PubMed and Cochrane Central Register of Controlled Trials) until 1 August 2023. Google Scholar was also manually searched. Studies with a prospective randomized design were included. Cochrane risk-of-bias (RoB) tool 2.0 assessed bias. Two independent reviewers performed the study selection, data extraction and appraisal of studies. Meta-analysis was performed using R3.5.1 software. RESULTS From the identified 2582 studies, eight randomized clinical trials were included for meta-analysis. Two studies had low RoB, while six had some concerns. Analysis revealed significantly better outcomes when surgery involved bone regeneration techniques than conventional surgery (OR = 2.18, 95% CI: 1.32-4.31, p = .004). Subgroup analyses on individual grafts (OR = 0.22, 95% CI: -0.99 to 1.44, p = .720) (OR = -0.09, 95% CI: -1.42 to 1.23, p = .885) and membranes (OR = -1.09, 95% CI: -2.94 to 0.76, p = .247) and their combinations (OR = 0.03, 95% CI: -1.50 to 1.55, p = .970) did not yield any significant results. The type of membrane used did not significantly impact the outcome (OR = -1.09, 95% CI: -2.94 to 0.76, p = .247) nor did altering the combination of graft/membrane. DISCUSSION This systematic review examined the effects of bone grafting with/without membrane placement on the outcome of AS. It highlights the potential advantages of regenerative techniques and the need for further research in this area. CONCLUSIONS Based on current evidence, bone grafting with/without barrier membrane placement significantly improves healing after AS. Subgroup analysis of resorbable membranes or grafting did not significantly influence the outcome. The combination of membrane and graft was also not significant. Future well-designed, randomized controlled trials in this area are essential before these materials can be recommended for routine use to enhance healing outcomes in AS. REGISTRATION PROSPERO (CRD42021255171).
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Affiliation(s)
| | - Federico Foschi
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
- Peninsula Dental School, University of Plymouth, Plymouth, UK
| | - Brian Maloney
- Dublin Dental University Hospital, Trinity College Dublin, Dublin 2, Ireland
| | | | - Henry F Duncan
- Dublin Dental University Hospital, Trinity College Dublin, Dublin 2, Ireland
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Dong X, Su Q, Li W, Yang J, Song D, Yang J, Xu X. The outcome of combined use of iRoot BP Plus and iRoot SP for root-end filling in endodontic microsurgery: a randomized controlled trial. Clin Oral Investig 2024; 28:188. [PMID: 38430316 DOI: 10.1007/s00784-024-05569-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/20/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVES Root-end filling is important for the clinical outcome of endodontic microsurgery. Our previous study showed that combined application of iRoot BP Plus Root Repair Material (BP-RRM) and iRoot SP Injectable Root Canal Sealer (SP-RCS) in root-end filling exhibited better apical sealing as compared to the application of BP-RRM alone. The aim of this randomized controlled clinical trial was to evaluate the effect of the combined use of BP-RRM and SP-RCS on the prognosis of teeth with refractory periapical diseases after endodontic microsurgery. MATERIALS AND METHODS 240 teeth with refractory periapical diseases scheduled for endodontic microsurgery were randomly divided into BP-RRM/SP-RCS group (n = 120) and BP-RRM group (n = 120). The patients were followed up at 3 months, 6 months, and 12 months after endodontic microsurgery. Pre- and post-operative clinical and radiographic examinations were performed to evaluate the treatment outcome. The 1-year success rate of endodontic microsurgery in BP-RRM/SP-RCS and BP-RRM groups was compared by Chi-square test. Factors that might impact the prognosis were further analyzed using Chi-square test or Fisher's exact test. RESULTS A total of 221 teeth completed the 12-month follow-up. The 1-year success rates of the BP-RRM/SP-RCS and BP-RRM groups were 94.5% (104/110) and 92.8% (103/111), respectively. The combined use of BP-RRM and SP-RCS achieved a clinical outcome comparable to BP-RRM alone (P = 0.784). Tooth type (P = 0.002), through-and-through/apico-marginal lesion (P = 0.049), periodontal status (P < 0.0001), and Kim's lesion classification (P < 0.0001) were critical factors associated with the 1-year success of endodontic microsurgery. CONCLUSIONS The combined use of BP-RRM and SP-RCS is a practicable method for root-end filling in endodontic microsurgery with a satisfactory 1-year clinical outcome. CLINICAL RELEVANCE The combined application of BP-RRM and SP-RCS in EMS is an effective root-end filling method with a satisfactory 1-year clinical outcome. TRIAL REGISTRATION This study was registered in the Chinese Clinical Trial Registry (ChiCTR2100052174).
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Affiliation(s)
- Xu Dong
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Stomatology, The First People's Hospital of Liangshan Yi Autonomous Prefecture, Xichang, China
| | - Qin Su
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Wen Li
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jinbo Yang
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Dongzhe Song
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jing Yang
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xin Xu
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Sabeti M, Ihsan MS, Kharat P, Azarpazhooh A. The effect of hard tissue defects on the clinical outcome of endodontic microsurgery: a systematic review and meta-analysis. Clin Oral Investig 2023; 27:7079-7089. [PMID: 37932638 PMCID: PMC10713757 DOI: 10.1007/s00784-023-05341-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/14/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES The purpose of this systematic review was to appraise the existing literature on the effect of hard tissue defects on the clinical outcome of endodontic microsurgery (EMS). METHODS MEDLINE (PubMed), Embase, Web of Science, Cochrane Library and grey literature were searched from January 2000 to May 2023. Study selection and data extraction were performed in duplicate. Eligible studies were critically appraised for the risk of bias using the Cochrane Risk of bias tool. The quality of evidence was assessed using GRADE. Review Manager (RevMan Computer program Version 5.4, The Cochrane Collaboration, 2020) was utilized and the Mantel Haenszel fixed or random effects model was applied, depending on the heterogeneity of the studies. Meta-analysis was performed to estimate the Risk ratio (RR) and 95% Confidence Interval (CIs) to correlate the effects of these factors on treatment outcomes. RESULTS Nineteen studies were included. The EMS overall pooled success rate was 84.5%. Five characteristics of hard tissue were identified. The size of the lesion (Small ≤ 5 mm: 78.4% vs. Large > 5 mm: 63.3%, RR = 1.12, 95% CI 1.00-1.26, P ≤ .05), significantly affected the outcomes of EMS. Endodontic lesions exhibited slightly better outcomes than endodontic-periodontal lesions (81.4% vs. 68.2%, RR = 1.14 95% CI 0.98-1.33, P > .05). Cases with the height of the buccal bone > 3 mm also exhibited slightly better outcomes (91.5% vs. 71.4%, RR = 1.20, 95% CI 0.88-1.62, P > .05). Additionally, through and through lesions exhibited better outcomes when grafting was completed during the EMS procedure both in 2D (RR = 1.12 95% CI 0.97-1.29, P > .05) and 3D evaluation ((RR = 1.28 95% CI 0.69-2.37 P > .05). The overall quality of evidence was graded as low to high. CONCLUSION With a low to high quality of evidence, the size of the lesion is a key prognostic variable that significantly affects the outcome of EMS, as lesions ≤ 5 mm exhibit better outcomes as compared to larger lesions. CLINICAL SIGNIFICANCE The presence of hard tissue defects can affect the outcome of endodontic microsurgery (EMS). The presented data can aid the clinicians' decision-making process by examining certain pre-operative prognostic variables, when considering EMS as a treatment option. Clinical cases with more favorable hard tissue characteristics lead to a better prognosis in EMS.
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Affiliation(s)
- Mohammad Sabeti
- Advanced Specialty Program in Endodontics, UCSF School of Dentistry, 707 Parnassus Ave. Room- D 3226, San Francisco, CA, 94143-0758, USA.
| | - Mohammad Saqib Ihsan
- UCSF Advanced Specialty Program in Endodontics, 707 Parnassus Ave. Room- D 3226, San Francisco, CA, 94143-0758, USA
| | - Piyusha Kharat
- UCSF, School of Dentistry, 707 Parnassus Ave, San Francisco, CA, 94143-0758, USA
| | - Amir Azarpazhooh
- University of Toronto, Faculty of Dentistry, 455-124 Edward St, Toronto, ON, M5G1G6, Canada
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Bieszczad D, Wichlinski J, Kaczmarzyk T. Treatment-Related Factors Affecting the Success of Endodontic Microsurgery and the Influence of GTR on Radiographic Healing-A Cone-Beam Computed Tomography Study. J Clin Med 2023; 12:6382. [PMID: 37835026 PMCID: PMC10573613 DOI: 10.3390/jcm12196382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/20/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
The primary objective of this retrospective study was to assess the correlation between treatment-related factors (resection angle, depth of retrograde filling, length of resected root and use of guided tissue regeneration-GTR) evaluated using cone-beam computed tomography (CBCT) scans and the treatment outcomes of endodontic microsurgery (EMS). The secondary purpose of this research was to evaluate the influence of the GTR technique on the radiographic healing state, taking into account the initial parameters of periapical lesions. In 161 cases, the local factors (volume of a lesion, bone destruction pattern, presence/absence of cortical bone destruction) were measured using preoperative CBCT images before undergoing EMS. At least one year after surgery, the outcome of EMS was classified as a success or a failure (based on radiographic and clinical criteria). Using postoperative CBCT, treatment-related factors (resection angle, depth of retrograde filling, and length of resected root) were measured. Additionally, the status of radiographic healing was evaluated (in accordance with modified PENN 3D criteria). Eighteen cases (11.18%) were classified as failures, and 143 were classified as successes (88.82%). Univariate analysis showed that there was no statistically significant influence of treatment-related factors on the healing outcome of EMS. An exact Fischer's test showed the significant impact of GTR on radiographic healing (P < 0.001) in apical lesions (P < 0.001), lesions with a volume between 100 mm3 and 450 mm3 (P < 0.009) and over 450 mm3 (P < 0.001), lesions with the destruction of one plate (P < 0.001), and lesions with the destruction of two plates (through and through) (P = 0.022). The use of GTR in apical lesions, lesions with volumes over 100 mm3, and lesions with the destruction of at least one plate is significantly associated with better radiographic healing.
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Affiliation(s)
- Daniel Bieszczad
- NZOZ Centrum Stomatologii s.c. Justyna Wichlinska, Jaroslaw Wichlinski, ul. 3-go Maja 16, 38-300 Gorlice, Poland; (D.B.); (J.W.)
| | - Jarosław Wichlinski
- NZOZ Centrum Stomatologii s.c. Justyna Wichlinska, Jaroslaw Wichlinski, ul. 3-go Maja 16, 38-300 Gorlice, Poland; (D.B.); (J.W.)
| | - Tomasz Kaczmarzyk
- Chair of Oral Surgery, Institute of Dentistry, Medical College, Jagiellonian University, ul. Montelupich 4, 31-155 Krakow, Poland
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Um M, Johnson B, Fayad M. Buccal plate thickness as a predictor for endodontic microsurgery outcomes: A retrospective cohort study. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 135:324-332. [PMID: 36274027 DOI: 10.1016/j.oooo.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/18/2022] [Accepted: 07/05/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of the study was to determine the relationship between preoperative buccal plate thickness (BPT) and radiographic healing at the osteotomy site after endodontic microsurgery (EMS) with and without guided tissue regeneration (GTR) using cone beam computed tomography (CBCT) imaging. STUDY DESIGN The retrospective sample of 143 individuals who had EMS with pre- and postoperative CBCT scans available were divided into 2 groups: group 1 (GTR) and group 2 (no GTR), which were further divided into teeth where BPT was >1.0 mm or ≤1.0 mm. Bone healing was assessed by subjective evaluation of bone formation at the resected root surface (I1), periapical bone formation (I2), cortical plate formation (I3), and a derived index (Author2-Author1 Indices) (I4), calculated by a composite score of I1 and I2. RESULTS There was no significant impact on surgical healing with the use of GTR when BPT is >1.0 mm. The GTR had a significant impact on surgical healing when the BPT was ≤1.0 mm. CONCLUSIONS This study supported the use of CBCT to evaluate three-dimensional healing after EMS. The Author2-Author1 index was found to be a clinically relevant method for assessing healing. To improve healing rate, the EMS cases with a preoperative BPT of ≤1.0 mm may benefit from GTR.
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Affiliation(s)
- Mary Um
- Clinical Assistant Professor, Department of Endodontics, University of Illinois-Chicago, Chicago, Illinois, USA.
| | - Bradford Johnson
- Department Head, Director of Postdoctoral Endodontics, Professor of Endodontics, University of Illinois-Chicago, Chicago, Illinois, USA
| | - Mohamed Fayad
- Clinical Associate Professor, Department of Endotontics, University of Illinois-Chigago, Chicago, Illinois, USA
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Baseri M, Radmand F, Milani AS, Gavgani LF, Salehnia F, Dianat O. The effect of periapical lesion size on the success rate of different endodontic treatments: a systematic review and meta-analysis. Evid Based Dent 2023; 24:43. [PMID: 36890256 DOI: 10.1038/s41432-023-00851-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/01/2022] [Indexed: 03/10/2023]
Abstract
INTRODUCTION This systematic review evaluated the effect of periapical lesion (PL) size on the success rate of different endodontic treatments, including root canal treatment (RCT), non-surgical retreatment (NSR), and apical surgery (AS). METHODS Cohorts and randomized controlled trials investigating the outcomes of endodontic treatment of permanent teeth with PL and its size were identified electronically through Web of Science, MEDLINE, Scopus, and Embase databases. Two reviewers independently conducted the study selection, data extraction, and critical appraisal process. The quality of the included studies was evaluated using the Newcastle-Ottawa Scale and the 11-item Critical Appraisal Skills Program checklist for randomized controlled trials. The success rates of the endodontic treatments (small lesions and large lesions) were estimated using the rate ratios (RRs) with an associated 95% confidence interval (CI). RESULTS Out of 44 included studies, 42 were cohort, and 2 were randomized controlled trials. Thirty-two studies had poor quality. For the meta-analysis, five studies in RCT, 4 in NSR, and 3 in AS were considered. The RR of the endodontic treatment success in PLs was 1.04 in RCT (95% CI, 0.99-1.07), 1.11 in NSR (95% CI, 0.99-1.24), and 1.06 in AS (95% CI, 0.97-1.16). Only sub-group analysis of long-term follow-up of RCT showed a significantly higher success rate in small lesions than in large lesions. CONCLUSIONS Considering the quality of studies and variation in outcomes and size classification, our meta-analysis demonstrated that the PL size had no significant effect on the success rate of different endodontic treatments.
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Affiliation(s)
- Milad Baseri
- Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Faraz Radmand
- Dental and Periodontal Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amin Salem Milani
- Associate Professor of Endodontics, Endodontic Department, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Leili Faraji Gavgani
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
- Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Salehnia
- Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Omid Dianat
- Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA
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Bieszczad D, Wichlinski J, Kaczmarzyk T. Factors Affecting the Success of Endodontic Microsurgery: A Cone-Beam Computed Tomography Study. J Clin Med 2022; 11:jcm11143991. [PMID: 35887756 PMCID: PMC9323724 DOI: 10.3390/jcm11143991] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/23/2022] [Accepted: 07/01/2022] [Indexed: 02/06/2023] Open
Abstract
The purpose of this retrospective study was to verify preoperative local parameters of periapical lesions evaluated on cone-beam computed tomography (CBCT) scans as a potential prognostic factor in endodontic microsurgery (EMS). Among 89 cases, local factors (dimensions of lesion, bone destruction pattern, presence/absence of cortical bone destruction, height of buccal bone plate, apical extend of root canal filling, presence/absence of communication with anatomical cavities, type of lesion restriction) were measured on preoperative CBCT images before EMS. At least one year after surgery, the outcome of EMS was classified as a success or a failure. Ten cases (11.24%) were classified as a failure and 79 as a success (88.76%). Symptomatic lesions (OR = 0.088 (95% CI 0.011-0.731); p = 0.024), apicomarginal lesions (OR = 0.092 (0.021-0.402); p = 0.001) and an association with molar teeth (OR = 0.153 (0.032-0.732); p = 0.019) were found as negative predictive factors in the univariate analysis, whereas large apicocoronal dimension (OR = 0.664 (0.477-0.926); p = 0.016), apicomarginal lesions (OR = 0.058 (0.006-0.55); p = 0.013), and an association with molar teeth (OR = 0.047 (0.003-0.869); p = 0.04) were identified as negative predictive factors in the multivariate analysis model. Symptomatic lesions, apicomarginal lesions, lesions associated with molar teeth and large apicocoronal dimensions are significantly associated with the failure of EMS.
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Affiliation(s)
- Daniel Bieszczad
- NZOZ Centrum Stomatologii s.c. Justyna Wichlinska, Jaroslaw Wichlinski, ul. 3-go Maja 16, 38-300 Gorlice, Poland; (D.B.); (J.W.)
| | - Jaroslaw Wichlinski
- NZOZ Centrum Stomatologii s.c. Justyna Wichlinska, Jaroslaw Wichlinski, ul. 3-go Maja 16, 38-300 Gorlice, Poland; (D.B.); (J.W.)
| | - Tomasz Kaczmarzyk
- Department of Oral Surgery, Jagiellonian University Medical College, ul. Montelupich 4, 31-155 Krakow, Poland
- Correspondence:
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Shah PK, El Karim IA, Duncan HF, Nagendrababu V, Chong BS. Outcomes reporting in systematic reviews on surgical endodontics: A scoping review for the development of a core outcome set. Int Endod J 2022; 55:811-832. [PMID: 35553439 DOI: 10.1111/iej.13763] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Evidence-informed decision-making in healthcare relies on the translation of research results to everyday clinical practice. A fundamental requirement is that the validity of any healthcare intervention must be supported by the resultant favourable treatment outcome. Unfortunately, differences in study design and the outcome measures evaluated often make it challenging to synthesise the available research evidence required for secondary research analysis and guideline development. Core outcome sets (COS) are defined as an agreed standardised set of outcomes which should be measured and reported as a minimum in all clinical trials on a specific topic. The benefits of COS include less heterogeneity, a reduction in the risk of reporting bias, ensuring all trials contribute data to facilitate meta-analyses, and given the engagement of key stakeholders, it also increases the chances that clinically-relevant outcomes are identified. The recognition of the need for COS for assessing endodontic treatment outcomes lead to the development of Core Outcome Sets for Endodontic Treatment modalities (COSET) protocol, which is registered (No. 1879) on the Core Outcome Measures in Effectiveness Trials (COMET) website. OBJECTIVES The objectives of this scoping review are to: (1) identify the outcomes assessed in studies evaluating surgical endodontic procedures; (2) report on the method of assessment used to measure the outcomes; (3) and assess selective reporting bias in the included studies. The data obtained will be used to inform the development of COS for surgical endodontics. METHODS A structured literature search of electronic databases and the grey literature was conducted to identify systematic reviews on periradicular surgery (PS), intentional replantation (IR) and tooth/root resection (RR), published between January 1990 and December 2020. Two independent reviewers were involved in the literature selection, data extraction and the appraisal of the studies identified. The type of intervention, outcomes measured, type of outcomes reported (clinician- or patient-reported), outcome measurement method, and follow-up period, were recorded using a standardised form. RESULTS Twenty-six systematic reviews consisting of 19 studies for PS, three studies for IR and four studies for RR were selected for inclusion. Outcome measures identified for PS and IR included pain, swelling, mobility and tenderness, outcomes related to periodontal/soft tissue healing (including sinus tract), periradicular healing, tooth survival, life impact (including Oral-Health-Related-Quality-of-Life), resource use and/or adverse effects. For RR, in addition to tooth survival, endodontic complications, and adverse effects, the outcome measures were primarily periodontal-related, including pocket depth reduction, attachment gain, periodontal disease, and periodontic-endodontic lesions. The majority of outcome measures for PS, IR, and RR were assessed clinically, radiologically and/or via patient history. Specific tools such as rating scales (Visual Analog Scale, Verbal rating Scale, Numerical Rating Scale, and other scales) were used for the assessment of pain, swelling, and tenderness, and validated questionnaires were used for the assessment of oral health-related quality of life. The range of follow-up periods were variable, dependent on the outcome measure and the type of intervention. CONCLUSIONS Outcome measures, method of assessment and follow-up periods for PS, IR and RR were identified and categorised to help standardise the reporting of outcomes for future research studies. Additional outcome measures that were not reported, but may be considered in the COSET consensus process include loss of root-end filling material, number of clinic visits, surgery-related dental anxiety and muco-gingival aesthetic-related measures, such as scarring, black triangles, root surface exposure, and tissue discolouration.
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Affiliation(s)
- Pratik Kamalkant Shah
- Institute of Dentistry, Faculty of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Ikhlas A El Karim
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Henry Fergus Duncan
- Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - Venkateshbabu Nagendrababu
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| | - Bun San Chong
- Institute of Dentistry, Faculty of Medicine & Dentistry, Queen Mary University of London, London, UK
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Lai PT, Wu SL, Huang CY, Yang SF. A retrospective cohort study on outcome and interactions among prognostic factors of endodontic microsurgery. J Formos Med Assoc 2022; 121:2220-2226. [PMID: 35450740 DOI: 10.1016/j.jfma.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/07/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND/PURPOSE Endodontic microsurgery (EMS) is a reliable treatment for teeth with non-healing apical periodontitis. This study evaluated the outcome of EMS with mineral trioxide aggregate as the retrograde filling material and identified potential prognostic factors associated with the EMS outcome. METHODS Consecutive clinical and radiographic records of EMS performed in a teaching hospital from 2013 to 2017 were reviewed. Cases of root fracture, cemental tear, re-surgery, and incomplete records were excluded. After selection, 268 EMS-treated teeth with the follow-up period more than one year were included. Surgical outcome as success or failure was evaluated according to Molven's criteria. For analysis of potential prognostic factors, multivariate logistic regression was performed followed by bivariate chi-square tests. Stratified analysis was performed to understand the interactions between two prognostic factors. RESULTS The overall EMS success rate was 89.9% in this study. Tooth type (anteriors vs. molars, odds ratio (OR) = 6.83, P = 0.001, anteriors vs. premolars, OR = 4.27, P = 0.010) and endodontic-periodontal (endo-perio) communicating defects (with vs. without, OR = 4.92, P = 0.005) both had a significant influence on the EMS outcome. The negative impact of endo-perio communicating defects was closely associated with tooth type. Premolars with endo-perio communicating defects had significantly higher rates of failure. CONCLUSION The EMS outcome is significantly affected by the tooth type and endo-perio communicating defect. The presence of endo-perio communicating defects has a greater negative influence on the success rate for premolars than for anteriors and molars.
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Affiliation(s)
- Po-Tang Lai
- Division of Endodontics and Periodontology, Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Dentistry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Shang-Liang Wu
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Yang Huang
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Biological Science and Technology, China Medical University, Taichung, Taiwan; Cardiovascular and Mitochondria Related Diseases Research Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan; Department of Biotechnology, Asia University, Taichung, Taiwan; Holistic Education Center, Tzu Chi University of Science and Technology, Hualien, Taiwan
| | - Shue-Fen Yang
- Division of Endodontics and Periodontology, Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan.
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Su C, Zhang R, Wang R, Yang C, Wang Z, Meng L. Prognostic Predictors of Endodontic Microsurgery: Radiographic Assessment. Int Dent J 2022; 72:628-633. [PMID: 35331471 PMCID: PMC9485522 DOI: 10.1016/j.identj.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to compare the healing outcomes of endodontic microsurgery (EMS) using 2-dimensional (2D) and 3-dimensional (3D) radiographic evaluation in a Chinese population. The prognostic factors of EMS were identified according to the 2D and 3D healing classifications. Materials and methods The teeth (n = 82) were studied using 2D and 3D radiographic examinations. The 2D and 3D healing criteria were used to evaluate the healing outcome. Prognostic factors were investigated based on healing outcomes. Data were analysed using SPSS, and P < .05 was considered significant. Results There were significant differences between 2D and 3D healing outcomes (P = .004). For the 3D images, age older than 45 years was found to be a significant negative predictor (P = .005). Conclusions Cone-beam computed tomographic images provided more precise evaluation of periapical lesions and healing outcomes of EMS than conventional periapical radiographs. Age (>45 years) of the patients exhibited a significant influence on the healing outcome of EMS as determined using 3D images.
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Affiliation(s)
- Chaonan Su
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, PR China
| | - Rui Zhang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, PR China
| | - Rong Wang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, PR China
| | - Chengcan Yang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, PR China
| | - Zan Wang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, PR China
| | - Liuyan Meng
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, PR China.
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Ramis-Alario A, Tarazona-Álvarez B, Peñarrocha-Diago M, Soto-Peñaloza D, Peñarrocha-Diago M, Peñarrocha-Oltra D. Is periapical surgery follow-up with only two-dimensional radiographs reliable? A retrospective cohort type sensitivity study. Med Oral Patol Oral Cir Bucal 2021; 26:e711-e718. [PMID: 34704982 PMCID: PMC8601649 DOI: 10.4317/medoral.24447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 09/20/2021] [Indexed: 11/08/2022] Open
Abstract
Background Two-dimensional (2D) radiographic techniques are commonly used for assessing lesion prognosis after endodontic surgery. The present retrospective cohort study analyzes the sensitivity and ability of different radiographic techniques in obtaining area and volume measurements of periapical lesions. Material and Methods Preoperative and follow-up (6-48 months) periapical and panoramic radiographs (index test) and cone-beam computed tomography (CBCT) images (reference standard) were selected from an endodontic microsurgery database. Sensitivity was analyzed independently by two examiners. The areas of the 2D radiographic images and CBCT volumes were studied using Itk-Snap software and Romexis viewer. Results The sample comprised 105 patients and 105 teeth, with a mean follow-up of 21 months (range 6-48). Preoperatively, CBCT detected all the periapical areas, periapical radiography detected 67, and panoramic radiography detected 60. Postoperatively, of the 52 cases in which CBCT detected remains of the periapical area, periapical radiography detected 22, and panoramic radiography detected 17. The measurements of the areas obtained by the 2D methods, and the volumes obtained by CBCT, had to be transformed into linear measures for comparison purposes. The measurements were found to be significantly different in both the preoperative and the follow-up images. Conclusions Periapical radiography showed greater sensitivity than panoramic radiography, both preoperatively and at follow-up. The lesions measured with CBCT were larger, with significant differences than as evidenced by the periapical and panoramic radiographs. Key words:Periapical radiography, panoramic radiography, CBCT, sensitivity, treatment outcome, size of periapical radiolucency, area, volume.
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Affiliation(s)
- A Ramis-Alario
- Department of Stomatology Faculty of Medicine and Dentistry, University of Valencia Gascoì Oliag, 1, 46010, Valencia, Spain
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Impact of Periodontal Attachment Loss on the Outcome of Endodontic Microsurgery: A Systematic Review and Meta-Analysis. MEDICINA-LITHUANIA 2021; 57:medicina57090922. [PMID: 34577845 PMCID: PMC8465214 DOI: 10.3390/medicina57090922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 11/28/2022]
Abstract
Background and Objectives: Endodontic microsurgery (EMS) aims to eradicate the sources of infection once the apical root resection removes most of the infected anatomical structures and repairs potential procedural errors in the apical region. An endodontic-periodontal lesion yields a pathological communication between the pulp and the periodontium. The purpose of this systematic review and meta-analysis is to evaluate the impact of periodontal attachment loss on the outcome of teeth submitted to EMS. Materials and Methods: PRISMA guidelines were followed. An electronic search was performed in EBSCOhost, Embase and PubMed databases with the following search key: (“endodontic microsurgery” AND “outcome”). No filters were used concerning the year of publication or language. Only randomized clinical trials, prospective and retrospective clinical studies in humans, with a minimum one-year follow-up, defined clinical and radiographic outcome criteria and estimable success rate for endodontic-periodontal lesion were included. Statistical analysis was performed using OpenMeta[Analyst] software. Results: Of a total of 113 articles, 34 were selected for full-text reading after duplicates deletion and title and abstract analysis. Thirteen and six studies were included in the systematic review and meta-analysis, respectively. A total of 2775 pooled teeth were submitted to EMS, of which 492 teeth and 4 roots had periodontal involvement. According to the qualitative analysis, success rates of the endodontic-periodontal group ranged from 67.6% to 88.2%. Meta-analysis revealed that the absence of periodontal attachment loss was predictive of a higher likelihood of success with an odds ratio of 3.14. Conclusions: Periodontal attachment loss presents a risk factor for EMS outcome. Although endodontic-periodontal lesions were associated with lower success rates considering a 1 to 10 years follow-up period, long-term successful prognosis following EMS has been reported, therefore presenting a fully valid and viable therapeutic option for the management of this type of lesions.
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13
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El-Gindy S, Obeid MF, Elbatouty KM, Elshaboury E, Hassanien E. Cell therapy: A potential solution for the healing of bone cavities. Heliyon 2021; 7:e05885. [PMID: 33474509 PMCID: PMC7803654 DOI: 10.1016/j.heliyon.2020.e05885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/13/2020] [Accepted: 12/24/2020] [Indexed: 11/04/2022] Open
Abstract
Aim To Explore whether the use of autologous BMMNCs as a cell therapy technique will improve the healing of bone cavities in vivo. Methodology After achieving proper anesthesia, mononuclear cells were isolated from iliac crest's bone marrow aspirates (BMMNCs). Then access cavity, root canal preparation, and filling were done in third and fourth premolars, followed by amalgam coronal restoration. After that, a flap was reflected and a standardized bone cavity was drilled, the related root-ends were resected and retrocavity was drilled and filled with MTA. Before repositioning the flap, the bone cavity was filled with the desired filling material according to its corresponding group (n = 8): CollaCote group; where collagen scaffold was used, MNC group; in which CollaCote® loaded with isolated BMMNCs were applied, Biogen group; in which BIO-GEN® graft material was applied and finally Control group; where the bone cavities were left empty to heal spontaneously. Evaluations of healing of the bone cavities were done radiographically and histologically. Results The MNC group induced the best healing potential with statistical significant difference from other groups. Conclusion cell therapy utilizing autologous BMMNCs looks to beat the conventional therapies and convey a significant improvement in the healing of the bone cavity in vivo.
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Affiliation(s)
- Sara El-Gindy
- Department of Endodontic, Faculty of Dentistry, Egyptian Russian University Cairo, Egypt
| | - Maram Farouk Obeid
- Department of Endodontic, Faculty of Dentistry, Ain Shams University Cairo, Organization of African Unity St, El-Qobba Bridge, Al Waili, Cairo Governorate, Egypt
| | - Kareim Mostafa Elbatouty
- Department of Endodontic, Faculty of Dentistry, Ain Shams University Cairo, Organization of African Unity St, El-Qobba Bridge, Al Waili, Cairo Governorate, Egypt
| | - Elham Elshaboury
- Department of Endodontic, Faculty of Dentistry, Modern Science and Arts - MSA, Egypt
| | - Ehab Hassanien
- Department of Endodontic, Faculty of Dentistry, Ain Shams University Cairo, Organization of African Unity St, El-Qobba Bridge, Al Waili, Cairo Governorate, Egypt
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Jeon KJ, Lee C, Choi YJ, Han SS. Anatomical analysis of mandibular posterior teeth for endodontic microsurgery: a cone-beam computed tomographic evaluation. Clin Oral Investig 2020; 25:2391-2397. [PMID: 32901333 DOI: 10.1007/s00784-020-03562-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/01/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze the anatomical structures relevant for endodontic microsurgery in the mandibular posterior teeth using a cone-beam computed tomography (CBCT). MATERIAL AND METHODS A total of 963 mandibular posterior teeth were analyzed in CBCT scans from 133 patients. The buccolingual and mesiodistal dimensions of the root and the buccal bone thickness overlying the root were measured at the site of root resection (apical 3 mm). At this location, the relationship between the buccal cortical bone and root was classified into three types (separated, contact, and exposed), and the distance from the root apex to the mandibular canal was measured. RESULTS The thickest buccolingual dimension of the roots was found in the mesial roots of first molars, at 5.59 ± 0.97 mm. The buccal bone thickness overlying the root became thicker in posterior tooth locations. In the first premolar and first molar mesial root, contact was the most common type of relationship between the buccal cortical bone and root. As the position of the teeth became more posterior, the distance from the apex to the mandibular canal became shorter. CONCLUSIONS As the position of the teeth became more posterior, the buccal bone thickness increased and the distance to the mandibular canal became closer; therefore, particular attention is required for posterior teeth. The first premolar and the first molar mesial root are often in contact with the buccal cortical bone, which may allow infections to spread to the buccal structure more easily and negatively affect for post-surgical healing. CLINICAL RELEVANCE When planning and performing endodontic microsurgery, understanding the anatomical structure of the surgical site will help minimize tissue damage and reduce complications.
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Affiliation(s)
- Kug Jin Jeon
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
| | - Chena Lee
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
| | - Yoon Joo Choi
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
| | - Sang-Sun Han
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea.
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Yoo YJ, Kim DW, Perinpanayagam H, Baek SH, Zhu Q, Safavi K, Kum KY. Prognostic Factors of Long-Term Outcomes in Endodontic Microsurgery: A Retrospective Cohort Study over Five Years. J Clin Med 2020; 9:jcm9072210. [PMID: 32668578 PMCID: PMC7409012 DOI: 10.3390/jcm9072210] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/03/2020] [Accepted: 07/10/2020] [Indexed: 01/23/2023] Open
Abstract
The aim of this study was to analyze the long-term outcomes of endodontic microsurgeries in a cohort and identify their association with prognostic factors. A cohort of endodontic microsurgeries followed up periodically with complete clinical and radiographic records for at least 5 years were reviewed retrospectively. Their survival and healing status and profile characteristics were analyzed by Pearson chi-square test and logistic regression (α = 0.05) to identify prognostic factors that influenced outcomes. Of 652 cases in the cohort, 225 (34.5%) were included. The mean follow-up period was 90.4 months (range, 60–168 months). The long-term success rate was 80.5%, and the 5-year survival rate was 83.5%. Logistic regression showed higher success in anteriors compared to molars (OR = 5.405, (95% CI, 1.663–17.571; p = 0.005)) and in teeth with crown restorations (OR = 10.232, (95% CI, 3.374–31.024; p < 0.001)). Conversely, lower success was found in teeth with periodontal disease (OR = 0.170, (95% CI, 0.032–0.900; p = 0.037)) and maxillary sinus involvement (OR = 0.187, (95% CI, 0.035–0.994; p = 0.049)). Endodontic microsurgery has a highly favorable long-term outcome. Tooth position, crown restoration, periodontal disease, and maxillary sinus involvement were identified as main prognostic factors.
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Affiliation(s)
- Yeon-Jee Yoo
- Department of Comprehensive Treatment Center, Seoul National University Dental Hospital, Seoul 03080, Korea;
| | - Dong-Won Kim
- Department of Conservative Dentistry, Dental Research Institute, Seoul National University Dental Hospital, Seoul National University School of Dentistry, Seoul 03080, Korea; (D.-W.K.); (S.-H.B.)
| | - Hiran Perinpanayagam
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 5C1, Canada;
| | - Seung-Ho Baek
- Department of Conservative Dentistry, Dental Research Institute, Seoul National University Dental Hospital, Seoul National University School of Dentistry, Seoul 03080, Korea; (D.-W.K.); (S.-H.B.)
| | - Qiang Zhu
- Division of Endodontology, Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, University of Connecticut Health Center, Farmington, CT 06030, USA; (Q.Z.); (K.S.)
| | - Kamran Safavi
- Division of Endodontology, Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, University of Connecticut Health Center, Farmington, CT 06030, USA; (Q.Z.); (K.S.)
| | - Kee-Yeon Kum
- Department of Conservative Dentistry, Dental Research Institute, Seoul National University Dental Hospital, Seoul National University School of Dentistry, Seoul 03080, Korea; (D.-W.K.); (S.-H.B.)
- National Dental Care Center for Persons with Special Needs, Seoul National University Dental Hospital for Persons with Special Needs, Seoul 03080, Korea
- Correspondence: ; Tel.: +82-2-2072-2656
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Allegue-Magaz S, Peñarrocha-Diago M, Chamorro-Petronacci CM, Lorenzo-Pouso AI, Blanco-Carrión A, García-García A, Pérez-Sayáns M. Quality and readability of the dental information obtained by patients on Internet: criteria for selecting medical consultation websites. Med Oral Patol Oral Cir Bucal 2020; 25:e508-e515. [PMID: 32388523 PMCID: PMC7338072 DOI: 10.4317/medoral.23521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/17/2020] [Indexed: 01/15/2023] Open
Abstract
Background The main objective of this study is to examine the quality of the information available for patients online with regards to the apicoectomy surgical procedure, both on general and critically selected websites. The hypothesis is that general websites has less quality than other that have been pre-selected.
Material and Methods A search for the English term "apicoectomy” was performed online. The first 100 websites that appeared in both Google and Yahoo were analysed. Seven validated instruments were used for these two dimensions: quality (DISCERN, JAMA and EQIP), and readability (FRES, Fog Scale, FKRGL and SMOG).
Results A total of 21 websites (10.5%) were selected. The readability of the websites in both groups was difficult or very difficult. With regards to the quality of the websites, the DISCERN instrument indicated an average value of 2.28 [2.14-2.39] for all of the websites, therefore indicating very low quality with serious defects; however, in the selected websites, the average quality was 3.16 [2.84-3.48], indicating potential, but not serious defects (p<0.001). There were statistically significant differences for the FRES values (p = 0.030), with a greater readability in the selected group of websites.
Conclusions We believe that it is very important for the population to become aware of and learn how to use certain exclusion criteria when selecting medical consultation websites, as in doing so, they will be able to obtain a higher quality of information from these websites. Key words:Apicoectomy, readability, DISCERN.
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Affiliation(s)
| | | | | | | | | | | | - M Pérez-Sayáns
- Oral Medicine, Oral Surgery and Implantology Unit Faculty of Medicine and Dentistry Santiago de Compostela University Entrerríos s/n, Santiago de Compostela C.P. 15782, Spain
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17
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The Application of “Bone Window” Technique in Endodontic Microsurgery. J Endod 2020; 46:872-880. [DOI: 10.1016/j.joen.2020.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/30/2020] [Accepted: 02/23/2020] [Indexed: 11/18/2022]
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Huang S, Chen NN, Yu VS, Lim HA, Lui JN. Long-term Success and Survival of Endodontic Microsurgery. J Endod 2020; 46:149-157.e4. [DOI: 10.1016/j.joen.2019.10.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/02/2019] [Accepted: 10/25/2019] [Indexed: 12/28/2022]
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Monaghan L, Jadun S, Darcey J. Endodontic microsurgery. Part one: diagnosis, patient selection and prognoses. Br Dent J 2019; 226:940-948. [PMID: 31253911 DOI: 10.1038/s41415-019-0415-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Historically, surgical endodontics has been viewed as a treatment of last resort, mainly due to poor outcomes as a result of limitations in materials and techniques. Contemporary techniques, modern materials and better visualisation have all led to an improvement in success rates, making endodontic microsurgery a valuable treatment option to certain patients. Such advances, however, are no substitute for skill in endodontic diagnosis and treatment planning, which can often prove challenging. A variety of tools are available to test for fractures and assess both periodontal and pulpal health. More advanced techniques such as cone beam computed tomography are often invaluable in pre-surgical assessment and diagnosis. Once an accurate diagnosis has been established, a favourable prognosis is explicitly linked to careful patient selection. Orthograde treatment, or retreatment, remains the gold standard for the majority of endodontic problems. However, there are a number of indications for surgery where orthograde treatment is either impossible, or less likely to be successful. It is paramount for any clinician undertaking endodontic surgery to have a detailed understanding of the local and systemic factors associated with successful treatment. Whilst there are few absolute medical contraindications, there are a number of conditions which may influence patient management and make treatment more challenging.
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Affiliation(s)
- Liam Monaghan
- University Dental Hospital of Manchester, Orthodontic Department, Higher Cambridge Street, Manchester, UK
| | - Sarah Jadun
- University Dental Hospital of Manchester, Oral Surgery, Higher Cambridge Street, Manchester, UK
| | - James Darcey
- University Dental Hospital of Manchester, Restorative Department, Higher Cambridge Street, Manchester, UK.
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Uğur Aydın Z, Göller Bulut D. Relationship between the anatomic structures and mandibular posterior teeth for endodontic surgery in a Turkish population: a cone-beam computed tomographic analysis. Clin Oral Investig 2019; 23:3637-3644. [PMID: 30712074 DOI: 10.1007/s00784-019-02834-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/25/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The purpose of this study is to evaluate the relationship between anatomic structures and mandibular posterior region using cone-beam computed tomography (CBCT) in terms of endodontic surgery. METHODS A total of 150 CBCT images were used to investigate the proximity of the anatomical structures and the mandibular posterior teeth. The buccal and lingual bone thickness overlying each root, buccolingual, and mesiodistal dimension of the roots were measured at the level of 3 mm apical resection, and the mental foramen (MF) distance to the premolar teeth and the distance of the mandibular canal (MC) to all the posterior teeth were measured. RESULTS The thinnest part of the buccal cortical bone was measured in the first premolar teeth (1.70 mm) and in the mesial root of the first molar (2.25 mm) while the thickest region was measured in the distal root of the second molar tooth (6.95 mm). The maximum amount of substance to be removed was measured at the distal root of the second molar tooth (11.26 mm), and at least the first premolar tooth (5.52 mm) was measured for buccal resection. The distal root of the second molar tooth was found to be the closest tooth root to the MC with a mean of 2.75 mm, and the closest distance was measured as 0 mm. CONCLUSIONS It is important to evaluate the parameters such as mandibular buccal and lingual bone thickness, location of the MC and the MF, and root size for atraumatic endodontic surgical approach. Evaluation of these data before endodontic surgery provides guidance to the clinician in the planning of endodontic surgery. CLINICAL RELEVANCE The mandibular posterior region, which is difficult to reach with traditional surgical approach, is now easily reached using an operation microscope. For this reason, endodontic surgical procedures have become popular in mandibular posterior teeth. Therefore, the relationship between the mandibular posterior teeth and anatomical structures that are important in the planning of surgical access line is examined in this study.
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Affiliation(s)
- Zeliha Uğur Aydın
- Faculty of Dentistry, Department of Endodontics, Bolu Abant Izzet Baysal University, Bolu, Turkey.
| | - Duygu Göller Bulut
- Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Bolu Abant Izzet Baysal University, Bolu, Turkey
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Outcome of Endodontic Surgery: A Meta-analysis of the Literature-Part 3: Comparison of Endodontic Microsurgical Techniques with 2 Different Root-end Filling Materials. J Endod 2018; 44:923-931. [PMID: 29681480 DOI: 10.1016/j.joen.2018.02.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/17/2018] [Accepted: 02/19/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The aim of the present study was to investigate the influence of root-end preparation and filling material on endodontic surgery outcome. A systematic review and meta-analysis was conducted to determine the outcome of resin-based endodontic surgery (RES, the use of high-magnification preparation of a shallow and concave root-end cavity and bonded resin-based root-end filling material) versus endodontic microsurgery (EMS, the use of high-magnification ultrasonic root-end preparation and root-end filling with SuperEBA [Keystone Industries, Gibbstown, NJ], IRM [Dentsply Sirona, York, PA], mineral trioxide aggregate [MTA], or other calcium silicate cements). METHODS An exhaustive literature search was conducted to identify prognostic studies on the outcome of root-end surgery. Human studies conducted from 1966 to the end of December 2016 in 5 different languages (ie, English, French, German, Italian, and Spanish) were searched in 4 electronic databases (ie, Medline, Embase, PubMed, and Cochrane Library). Relevant review articles on the subject were scrutinized for cross-references. In addition, 5 dental and medical journals (Journal of Endodontics; International Endodontic Journal; Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics; Journal of Oral and Maxillofacial Surgery; and International Journal of Oral and Maxillofacial Surgery) were hand checked dating back to 1975. All abstracts were screened by 3 independent reviewers (H.B., M.K., and F.S.). Strict inclusion-exclusion criteria were defined to identify relevant articles. Raw data were extracted from the full-text review of these selected articles independently by each of the 3 reviewers. In case of disagreement, an agreement was reached by discussion, and qualifying articles were assigned to group RES. For EMS, the same search strategy was performed for the time frame October 2009 to December 2016, whereas up to October 2009 the data were obtained from a previous systematic review with identical criteria and search strategy. Weighted pooled success rates and a relative risk assessment between RES and EMS were calculated. To make a comparison between groups, a random effects model was used. RESULTS Sixty-eight articles were eligible for full-text review. Of these, per strict inclusion exclusion criteria, 14 studies qualified, 3 for RES (n = 862) and 11 for EMS (n = 915). Weighted pooled success rates for RES were 82.20% (95% confidence interval [CI], 0.7965-0.8476) and 94.42% for EMS (95% CI, 0.9295-0.9590). This difference was statistically significant (P < .0005). CONCLUSIONS The probability for success for EMS proved to be significantly greater than the probability for success for RES, providing best available evidence on the influence of cavity preparation with ultrasonic tips and/or SuperEBA (Keystone Industries, Gibbstown, NJ), IRM (Dentsply Sirona, York, PA), MTA, or silicate cements as root-end filling material instead of a shallow cavity preparation and placement of a resin-based material. Additional large-scale randomized clinical trials are needed to assess other predictors of outcome.
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Öğütlü F, Karaca İ. Clinical and Radiographic Outcomes of Apical Surgery: A Clinical Study. J Maxillofac Oral Surg 2018; 17:75-83. [PMID: 29382999 DOI: 10.1007/s12663-017-1008-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 03/27/2017] [Indexed: 11/28/2022] Open
Abstract
Background Endodontic treatment is usually indicated when teeth with periapical lesions are encountered. However, sometimes root canal treatment results in failure. In that case, one of the treatment choices is retreatment by an orthograde approach. Surgical endodontic therapy is also an alternative to preserve the tooth. Various techniques have been suggested in the literature which has more predictable results. The introduction of modern surgical techniques have enhanced the results of apical surgery procedures. Operating microscopes, magnifying loupes, microinstruments, ultrasonic tips, and biologically acceptable root-end filling materials (such as MTA and SuperEBA) have been introduced to this field with the modern technique, thus the success rates of modern apical surgery has increased significantly. Objective The aim of the present study was to evaluate the clinical and radiographic outcomes and periotest values of apical surgery treatment. Methods A total of 112 teeth were included. SuperEBA and MTA were used as root-filling materials. The recorded parameters were gender, age, location of the tooth, the presence/absence of a post, coronal restoration of the tooth, previous surgical/nonsurgical treatment of the tooth, the size of periapical lesions, histopathology of periapical lesions, smoking habits. Also the periotest values were recorded. Results The overall success rate was 88.4%. With regard to the evaluated variables, only one parameter (tooth type) was found statistically significant. Although the periotest values were decreased after 6 months compared to immediately postoperative measurements, the values were still significantly higher than preoperative measurements. Conclusion In this study, apical surgery performed with the modern instruments has significantly successful results with 88.4% success rate.
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Affiliation(s)
- Faruk Öğütlü
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gazi University, 82. Street 06510, Emek, Ankara Turkey
| | - İnci Karaca
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gazi University, 82. Street 06510, Emek, Ankara Turkey
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Comparison of the effect of endodontic-periodontal combined lesion on the outcome of endodontic microsurgery with that of isolated endodontic lesion: survival analysis using propensity score analysis. Clin Oral Investig 2017; 22:1717-1724. [PMID: 29098442 DOI: 10.1007/s00784-017-2265-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 10/24/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The purpose of this retrospective clinical study was to evaluate the effect of lesion types related to endodontic microsurgery on the clinical outcome. MATERIALS AND METHODS Patients who underwent endodontic microsurgery between March 2001 and March 2014 with a postoperative follow-up period of at least 1 year were included in the study. Survival analyses were conducted to compare the clinical outcomes between isolated endodontic lesion group (endo group) and endodontic-periodontal combined lesion group (endo-perio group) and to evaluate other clinical variables. To reduce the effect of selection bias in this study, the estimated propensity scores were used to match the cases of the endo group with those of the endo-perio group. RESULTS Among the 414 eligible cases, the 83 cases in the endo-perio group were matched to 166 out of the 331 cases in the endo group based on propensity score matching (PSM). The cumulated success rates of the endo and endo-perio groups were 87.3 and 72.3%, respectively. The median success period of the endo-perio group was 12 years (95% CI: 5.507, 18.498). Lesion type was found to be significant according to both Log-rank test (P = 0.002) and Cox proportional hazard regression analysis (P = 0.001). Among the other clinical variables, sex (female or male), age, and tooth type (anterior, premolar, or molar) were determined to be significant in Cox regression analysis (P < 0.05). CONCLUSION Endodontic-periodontal combined lesions had a negative effect on the clinical outcome based on an analysis that utilized PSM, a useful statistical matching method for observational studies. CLINICAL RELEVANCE Lesion type is a significant predictor of the outcome of endodontic microsurgery.
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Torabinejad M, Parirokh M, Dummer PMH. Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - part II: other clinical applications and complications. Int Endod J 2017; 51:284-317. [PMID: 28846134 DOI: 10.1111/iej.12843] [Citation(s) in RCA: 201] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 08/22/2017] [Indexed: 12/16/2022]
Abstract
Mineral trioxide aggregate (MTA) is a dental material used extensively for vital pulp therapies (VPT), protecting scaffolds during regenerative endodontic procedures, apical barriers in teeth with necrotic pulps and open apices, perforation repairs as well as root canal filling and root-end filling during surgical endodontics. A number of bioactive endodontic cements (BECs) have recently been introduced to the market. Most of these materials have calcium and silicate in their compositions; however, bioactivity is a common property of these cements. These materials include the following: BioAggregate, Biodentine, BioRoot RCS, calcium-enriched mixture cement, Endo-CPM, Endocem, EndoSequence, EndoBinder, EndoSeal MTA, iRoot, MicroMega MTA, MTA Bio, MTA Fillapex, MTA Plus, Neo MTA Plus, Ortho MTA, Quick-Set, Retro MTA, Tech Biosealer, and TheraCal LC. It has been claimed that these materials have properties similar to those of MTA but without the drawbacks. In Part I of this review, the available information on the chemical composition of the materials listed above was reviewed and their applications for VPT was discussed. In this article, the clinical applications of MTA and other BECs will be reviewed for apexification, regenerative endodontics, perforation repair, root canal filling, root-end filling, restorative procedures, periodontal defects and treatment of vertical and horizontal root fractures. In addition, the literature regarding the possible drawbacks of these materials following their clinical applications is reviewed. These drawbacks include their discolouration potential, systemic effects and retreatability following use as a root filling material. Based on selected keywords, all publications were searched regarding the use of MTA as well as BECs for the relevant clinical applications. Numerous publications were found regarding the use of BECs for various endodontic applications. The majority of these investigations compared BECs with MTA. Despite promising results for some materials, the number of publications using BECs for various clinical applications was limited. Furthermore, most studies had several methodological shortcomings and low levels of evidence.
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Affiliation(s)
- M Torabinejad
- Department of Endodontics, School of Dentistry, Loma Linda University, Loma Linda, CA, USA
| | - M Parirokh
- Endodontology Research Center, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
| | - P M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Chércoles-Ruiz A, Sánchez-Torres A, Gay-Escoda C. Endodontics, Endodontic Retreatment, and Apical Surgery Versus Tooth Extraction and Implant Placement: A Systematic Review. J Endod 2017; 43:679-686. [DOI: 10.1016/j.joen.2017.01.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/01/2017] [Accepted: 01/08/2017] [Indexed: 10/19/2022]
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Zhou W, Zheng Q, Tan X, Song D, Zhang L, Huang D. Comparison of Mineral Trioxide Aggregate and iRoot BP Plus Root Repair Material as Root-end Filling Materials in Endodontic Microsurgery: A Prospective Randomized Controlled Study. J Endod 2017; 43:1-6. [DOI: 10.1016/j.joen.2016.10.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 09/07/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
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Kim D, Ku H, Nam T, Yoon TC, Lee CY, Kim E. Influence of Size and Volume of Periapical Lesions on the Outcome of Endodontic Microsurgery: 3-Dimensional Analysis Using Cone-beam Computed Tomography. J Endod 2016; 42:1196-201. [DOI: 10.1016/j.joen.2016.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/09/2016] [Accepted: 05/15/2016] [Indexed: 01/12/2023]
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