Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China.
Int Endod J. 2021 Apr;54(4):536-555. doi: 10.1111/iej.13440. Epub 2020 Nov 28.
Regenerative techniques are increasingly applied in endodontic surgery, but different materials used in regenerative techniques may have varying impacts on wound healing.
This study evaluated the effects of different regenerative techniques and materials on the outcome of endodontic surgery.
patients with persistent periapical lesions, treated with root-end surgery.
endodontic surgery without the use of regenerative techniques/materials.
endodontic surgery with the use of regenerative techniques/materials.
combined clinical and radiographic results.
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.
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).
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.
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.
再生技术越来越多地应用于牙髓根尖周病的治疗，但不同的再生技术材料对创伤愈合的影响可能不同。
本研究评估了不同再生技术和材料对牙髓根尖周病治疗效果的影响。
接受根管治疗后仍有根尖病变的患者。
不使用再生技术/材料的根管治疗。
使用再生技术/材料的根管治疗。
联合临床和影像学结果。
检索 PubMed、Web of Science、Embase、SinoMed 和 Cochrane 中央数据库，检索截至 2020 年 7 月 10 日，随后进行手动检索。应用详细的纳入标准。使用 Cochrane 偏倚风险工具 2.0 评估合格研究的偏倚风险。使用 RevMan 软件进行荟萃分析。根据牙髓根尖周病治疗中使用的再生材料进行亚组分析。
纳入了 11 项随机对照试验（RCT）的荟萃分析：2 项研究总体偏倚风险较低，9 项研究总体偏倚存在一定顾虑。总体而言，使用再生技术可显著改善根管治疗的效果（风险比 [RR]：0.42；95%置信区间 [CI]：0.26-0.68；P<0.001）。亚组分析显示，单独使用膨体聚四氟乙烯（e-PTFE）膜无额外获益（RR：2.00；95%CI：0.22-18.33；P=0.54）。单独应用胶原膜或自体血小板浓缩物（APCs）与更好的结果相关（RR：0.51；95%CI：0.20-1.25；P=0.14）（RR：0.55；95%CI：0.18-1.71；P=0.30）。胶原膜联合牛源性羟磷灰石显著改善了结果（RR：0.35；95%CI：0.17-0.75；P=0.007）。
本系统评价评估了胶原膜、e-PTFE 膜、APCs 和骨移植材料等再生技术的效果，提供了关于每种再生技术/材料或其组合在牙髓根尖周病治疗中的风险和获益的详细信息。
再生技术可改善根管治疗后根尖周病变的愈合。胶原膜联合牛源性羟磷灰石的联合应用可能有益于根管治疗的辅助治疗。相比之下，单独使用 e-PTFE 膜或 APCs 的积极疗效仍值得怀疑。
