Institute of Endodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal.
Institute of Periodontology, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal.
Medicina (Kaunas). 2021 Sep 1;57(9):922. doi: 10.3390/medicina57090922.
: 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. : 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. : 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. : 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.
牙髓显微外科（EMS）旨在消除感染源，一旦根尖切除去除了大部分感染的解剖结构，并修复根尖区域的潜在操作错误。牙周牙髓联合病变导致牙髓和牙周组织之间存在病理性交通。本系统评价和荟萃分析的目的是评估牙周附着丧失对接受 EMS 治疗的牙齿的预后的影响。
遵循 PRISMA 指南。在 EBSCOhost、Embase 和 PubMed 数据库中进行电子检索，使用以下搜索词：（“牙髓显微外科”和“预后”）。未针对出版年份或语言使用过滤器。仅纳入随机临床试验、前瞻性和回顾性的人类临床研究，随访时间至少为 1 年，定义了临床和影像学的预后标准和可估计的牙周牙髓联合病变的成功率。使用 OpenMeta[Analyst]软件进行统计分析。
在总共 113 篇文章中，删除重复项并分析标题和摘要后，有 34 篇文章被选入全文阅读。有 13 项和 6 项研究分别被纳入系统评价和荟萃分析。共有 2775 颗牙接受了 EMS 治疗，其中 492 颗牙和 4 颗根有牙周病。根据定性分析，牙周牙髓组的成功率范围为 67.6%至 88.2%。荟萃分析显示，牙周附着丧失的缺失与更高的成功率相关，优势比为 3.14。
牙周附着丧失是 EMS 预后的一个危险因素。尽管在 1 至 10 年的随访期内，牙周牙髓联合病变与较低的成功率相关，但长期成功的预后已经被报道，因此，EMS 是治疗这种病变的一种完全有效和可行的治疗选择。
