Influence of Guided Tissue Regeneration Techniques on the Success Rate of Healing of Surgical Endodontic Treatment: A Systematic Review and Network Meta-Analysis

Analysis of the Prognostic Factors That Influence the Outcome of Periapical Surgery, including Biomimetic Membranes for Tissue Regeneration: A Review

The objective of this study was to analyze the prognostic factors that influence the outcome of periapical surgery. A systematic search of the literature was carried out using PubMed and Scopus databases between January 2000 and December 2023 with no language limitations. The PICO question of the present systematic review was: What prognostic factors may influence the outcome of periapical surgery? The most relevant randomized controlled clinical trials (RCTs), prospective clinical trials, retrospective studies, and meta-analyses (n = 44) were selected from 134 articles. The reviewed literature evidenced that bone-lesion healing could significantly be improved by the absence of deep periodontal pockets (>4 mm), localization in anterior teeth, the absence of pain and/or preoperative symptoms, a size of bone lesion < 5 mm, the use of ultrasound, the correct placement of retrograde filling material, and the use of different biomimetic membranes for guided tissue regeneration (GTR). Some preoperative and intraoperative factors could significantly improve the prognosis of periapical surgery. However, these results were not conclusive, and further high-quality research is required.

Microsurgical management of radicular cyst using guided tissue regeneration technique: A case report

BACKGROUND

Radicular cyst is a lesion of odontogenic origin that arises from epithelial remains due to periapical periodontitis caused by inflammatory reactions generated at the apex of affected teeth with infected or necrotic pulps. The therapeutic management of radicular cysts is controversial. There is only one case report of enucleation of a radicular cyst managed with microsurgery and apicoectomy, but without the use of the guided tissue regeneration (GTR) technique in the same surgical procedure. The present clinical case describes the management of a radicular cyst with microsurgical approach, performance of an apicoectomy of the tooth associated with the entity, application of GTR technique, use of a resorbable membrane of type I bovine collagen, and bovine xenograft.

CASE SUMMARY

A 68-year-old patient presented with a radicular cyst from an upper lateral incisor. The microsurgical management used was aimed at enucleating the chemical membrane, performing apicoectomy of the tooth along with careful and precise retrograde filling, and implementing GTR technique using a resorbable collagen membrane and bovine xenograft. The diagnosis of radicular cyst was confirmed using histopathological analysis. The patient underwent follow-up evaluations at 10 and 30 d postoperatively. At 4 months postoperative evaluation, she remained asymptomatic, and radiographs showed significant periapical healing with adequate bone formation.

CONCLUSION

These results suggest that microsurgical management using the GTR technique with collagen membrane and xenograft, contributes to bone regeneration.

Blocking CXCR1/2 attenuates experimental periodontitis by suppressing neutrophils recruitment

Periodontitis (PD) is a common chronic oral inflammatory disease that cause alveolar bone loss. Current strategies for bone regeneration achieve limited results in PD. The aberrant host osteoimmunity to pathogenic bacteria is responsible for the destruction of alveolar bone in PD. We aimed to investigate the distinctive activity of immune cells in PD to create more effective and precise therapeutic approaches for treating PD. In this study, we revealed that neutrophils in the inflamed alveolar bone of PD patients expressed higher levels of CXCR1/2 and had a stronger pro-inflammatory capacity and chemotactic ability than that in healthy individuals. Suppressing the recruitment of neutrophils to inflamed sites with the CXCR1/2 inhibitor reparixin reduced alveolar bone loss in PD mice. In this study, we not only revealed that neutrophils exhibit a heterogeneously stronger pro-inflammatory capacity in the inflamed alveolar bone of PD patients but also provided a precise therapeutic treatment for PD involving the suppression of neutrophil recruitment.

Combined surgical and conservative endodontic management of Oehler's type 3b dens invaginatus aided by guided tissue regeneration

The present case describes the successful healing of a periapical lesion associated with the left maxillary lateral incisor (# 22, Federation Dentaire Internationale) having a type 3b dens invaginatus tooth morphology. The treatment was complicated by the presence of blunderbuss root apex and large periapical lesion (>10 mm) with through and through bone defect (Bucco palatal cortical bone perforation, Von Arx Type 1b). An adolescent boy reported palatal swelling and pus discharge in relation to tooth #22. A thorough clinical and radiographic examination revealed tooth #22 as having a type 3b dens invaginatus with an open apex and a diagnosis of pulp necrosis and acute apical abscess. The case was managed by non-surgical root canal treatment followed by endodontic surgery using principles of guided tissue regeneration. A 5-year recall revealed an asymptomatic functional tooth with complete healing.

Effect of amniotic membrane and platelet-rich fibrin membrane on bone healing post endodontic surgery: An ultrasonographic, randomized controlled study

The use of membrane barriers and bone grafting materials in endodontic surgery promotes healing by regeneration rather than repair by scar tissue. Due to its valuable regenerative and therapeutic properties, the human amniotic membrane can support ideal periapical rehabilitation and promote better healing after surgery. The current trial aimed to evaluate the amniotic membrane's healing potential and compare it with platelet-rich fibrin using color doppler sonography. The current study is a randomized, double-blinded, parallel-group, single-center study. Thirty-four systematically healthy individuals requiring endodontic surgery who fulfilled all inclusion and exclusion criteria were selected and randomly placed in two groups. Surgical curettage of the bony lesion was performed and filled with hydroxyapatite graft. Amniotic membrane (Group 1) and platelet-rich fibrin (Group 2) were placed over the bony crypt, and the flap was sutured back. The lesion's surface area and vascularity were the parameters assessed with ultrasound and color doppler. and observations: The groups found a significant difference in mean vascularity at 1 month and mean vascularity change from baseline to 1 month (p < 0.05). Mean surface area had no statistically significant difference between the groups. However, in terms of the percentage change in surface area, a significant difference was found from baseline to 6 months (p < 0.05). Amniotic membrane was a significantly better promoter of angiogenesis than platelet-rich fibrin in the current trial. The osteogenic potential of both materials was similar. However, the clinical application, availability, and cost-effectiveness of amniotic membrane support it as a promising therapeutic alternative in clinical translation. Further large-scale trials and histologic studies are warranted.

Present Status and Future Directions - Surgical Endodontics

Endodontic surgery encompasses several procedures for the treatment of teeth with a history of failed root canal treatment, such as root-end surgery, crown- and root resections, surgical perforation repair, and intentional replantation. Endodontic microsurgery is the evolution of the traditional apicoectomy techniques and incorporates high magnification, ultrasonic root-end preparation and root-end filling with biocompatible filling materials. Modern endodontic surgery uses the dental operating microscope, incorporates cone-beam computed tomography (CBCT) for preoperative diagnosis and treatment planning, and has adopted piezoelectric approaches to osteotomy and root manipulation. Crown- and root resection techniques have benefitted from the same technological advances. This review focuses on the current state of root-end surgery by comparing the techniques and materials applied during endodontic microsurgery to the most widely used earlier methods and materials. The most recent additions to the clinical protocol and technical improvements are discussed, and an outlook on future directions is given. While non-surgical retreatment remains the first choice to address most cases with a history of endodontic failure, modern endodontic microsurgery has become a predictable and minimally invasive alternative for the retention of natural teeth.