Elsevier

Journal of Endodontics

Volume 37, Issue 8, August 2011, Pages 1039-1045
Journal of Endodontics

Systematic Review
Effect of Guided Tissue Regeneration on the Outcome of Surgical Endodontic Treatment: A Systematic Review and Meta-analysis

https://doi.org/10.1016/j.joen.2011.05.016Get rights and content

Abstract

Introduction

The use of guided tissue regeneration (GTR) techniques has been proposed as an adjunct to endodontic surgery in order to promote bone healing. Studies assessing the added benefits of GTR for the outcome of endodontic surgery are significantly variable in their treatment protocols, follow-up periods, and inclusion criteria, thus generating inconsistent and confusing results. The aim of this study was to evaluate the influence of GTR on the outcome of surgical endodontic treatment by means of a systematic review of the literature and meta-analysis.

Methods

An exhaustive literature search combined with strict inclusion and exclusion criteria was undertaken to identify clinical studies that assessed the added benefit of GTR in endodontic surgery.

Results

A trend of better outcome was found when GTR was used compared to control cases, but the results were not statistically significant. Lesion size, lesion type, and membrane type were identified as factors significantly affecting the outcome of GTR versus control cases. GTR techniques favorably affected the outcome of surgical endodontic treatments in cases of large periapical lesions and through-and-through lesions. A favorable outcome was found when using a resorbable membrane over using a nonresorbable membrane or graft alone.

Conclusions

GTR techniques may improve the outcome of bone regeneration after surgical endodontic treatments of teeth with certain lesions. Additional large-scale prospective clinical studies are needed to further evaluate possible benefits of GTR techniques in endodontic surgery.

Section snippets

Criteria for Considering Studies for This Review

This systematic review included clinical studies that reported the use of guided tissue regeneration in surgical endodontic treatment in patients with apical periodontitis in endodontically treated teeth.

The inclusion criteria included the following: (1) randomized clinical trials (RCTs), (2) a lesion location in the periapical area, (3) inclusion of GTR as a part of the surgical protocol (for the treatment group), (4) at least 1 year of follow-up, and (5) outcome evaluated according to Rud

Selection of Studies

The articles were initially evaluated for relevance based on their titles and abstracts by three observers independently (IT, AT, and ER). Possibly relevant studies were subject to a full text evaluation. The full texts of the studies were obtained and reviewed for suitability based on the inclusion and exclusion criteria of this meta-analysis. Cases of disagreement were discussed together until agreement was reached. Eventually, the identified suitable articles were subject to data extraction,

Results

The search in MEDLINE database using the PubMed search engine resulted in 168 articles, of which 11 6, 9, 10, 14, 15, 16, 18, 20, 21, 29, 30 were eligible for inclusion on the basis of their titles and abstracts and were subject to full-text evaluation. The other 157 articles were rejected based on the following: 23 were review articles, 24 were case reports, 4 were animal studies, and 106 articles were not relevant to the topic of the current study. The search with Scopus database resulted in

Discussion

GTR techniques have been suggested as an adjunct to endodontic surgery in order to promote bone healing 7, 8, 9, 10, 21. Several biomaterials were used as an osteoconductive scaffold in periapical surgery 10, 11, 12, 13, 14, 17, 22, 32, 33, 34, none of which achieved worldwide consensus. The aim of the present study was to search and evaluate the available literature concerning the influence of GTR on the outcome of surgical endodontic treatment by means of a systematic review of the literature

Conclusions

Based on the currently available data, GTR techniques may improve the outcome of bone regeneration after surgical endodontic treatment preformed in cases with certain periapical lesions, such as large periapical lesions, and through-and-through lesions. A favorable outcome is expected for using a resorbable membrane over a nonresorbable membrane or a graft alone. Large-scale prospective clinical studies are needed to further evaluate possible benefits of GTR techniques in endodontic surgery.

Acknowledgments

The authors deny any conflicts of interest related to this study.

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