Impact of different regenerative techniques and materials on the healing outcome of endodontic surgery: a systematic review and meta-analysis.
Int Endod J
; 54(4): 536-555, 2021 Apr.
Article
em En
| MEDLINE
| ID: mdl-33159322
ABSTRACT
BACKGROUND:
Regenerative techniques are increasingly applied in endodontic surgery, but different materials used in regenerative techniques may have varying impacts on wound healing.OBJECTIVES:
This study evaluated the effects of different regenerative techniques and materials on the outcome of endodontic surgery.PARTICIPANTS:
patients with persistent periapical lesions, treated with root-end surgery. CONTROL endodontic surgery without the use of regenerative techniques/materials. INTERVENTION endodontic surgery with the use of regenerative techniques/materials.OUTCOME:
combined clinical and radiographic results.METHODS:
PubMed, Web of Science, Embase, SinoMed and the CENTRAL Cochrane were searched up to 10th July 2020, followed by a manual search. Detailed eligibility criteria were applied. Cochrane's risk-of-bias tool 2.0 was used to assess the risk of bias of the eligible studies. Meta-analysis was conducted using RevMan software. Subgroup analyses were performed based on the regenerative materials used in endodontic surgery.RESULTS:
Eleven eligible randomized controlled trials (RCTs) were included in the meta-analysis:
two had a low risk of overall bias, and nine had some concerns of overall bias. Generally, the use of regenerative techniques significantly improved the outcome of endodontic surgery (risk ratio [RR] 0.42; 95% confidence interval [CI], 0.26-0.68; P < 0.001). On subgroup analysis, the use of expanded polytetrafluoroethylene (e-PTFE) membranes alone had no added benefits (RR 2.00; 95% CI, 0.22-18.33; P = 0.54). The application of collagen membranes or autologous platelet concentrates (APCs) alone was associated with a trend for better outcomes (RR 0.51; 95% CI, 0.20-1.25; P = 0.14) (RR 0.55; 95% CI, 0.18-1.71; P = 0.30). The combined use of collagen membranes and bovine-derived hydroxyapatite significantly improved the outcome (RR 0.35; 95% CI, 0.17-0.75; P = 0.007).DISCUSSION:
This systematic review evaluated the effects of collagen membranes, e-PTFE membranes, APCs and bone grafting materials, providing detailed information about the risks and benefits of using each regenerative technique/material or its combination in endodontic surgery.CONCLUSIONS:
Regenerative techniques improve periapical lesion healing after endodontic surgery. The combined use of collagen membranes and bovine-derived hydroxyapatite may be beneficial as an adjunct to endodontic surgery. In contrast, the positive efficacy of e-PTFE membranes or APCs alone remains doubtful.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Cicatrização
/
Colágeno
Tipo de estudo:
Clinical_trials
/
Guideline
/
Systematic_reviews
Limite:
Animals
/
Humans
Idioma:
En
Revista:
Int Endod J
Ano de publicação:
2021
Tipo de documento:
Article
País de afiliação:
China