Sabeti M, Chung Y J, Aghamohammadi N, Khansari A, Pakzad R, Azarpazhooh A
Department of Preventive and Restorative Dental Sciences, Advanced Specialty Program in Endodontics, University of California, San Francisco School of Dentistry, San Francisco, California.
Faculty of Arts and Science, Queen's University, Kingston, Ontario.
J Endod. 2024 Apr;50(4):414-433. doi: 10.1016/j.joen.2024.01.013. Epub 2024 Jan 26.
The success rates of NS-ReTx have varied across decades of prior research. Nonetheless, recent endodontic advances have substantially enhanced case management. This systematic review aimed to identify rigorous studies on contemporary NS-ReTx, investigating both periapical healing-evaluated strictly for complete resolution or loosely for size reduction of periapical radiolucency-and success, denoting clinical normalcy combined with periapical healing.
We systematically searched MEDLINE, Embase, Web of Science, the Cochrane Library, and gray literature from January 1988 to December 2022. Article selection and data extraction were independently conducted by 3 reviewers. Selected studies underwent risk of bias assessment, and evidence quality using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Meta-analysis and meta-regression established pooled outcome rates, 95% confidence intervals (CIs), and significant clinical prognostic factors (P < .05).
Twenty-nine articles were included. Pooled periapical healing rates using strict and loose criteria were 78.8% (95% CI: 75.2-82.4) and 87.5% (95% CI: 83.8-91.2), respectively. Pooled success rates using strict and loose criteria were 78.0% (95% CI: 74.9-81.2) and 86.4% (95% CI: 82.6-90.1), respectively. Meta-regression analyses revealed significant influences on NS-ReTx outcomes (P < .05), including periapical status, lesion size, apical root filling extent, and follow-up duration.
Contemporary NS-ReTx shows encouraging outcomes, achieving periapical healing and success rates ranging from approximately 78% (strict criteria) to 87% (loose criteria). The absence of or smaller preoperative lesions, adequate root filling length, and extended follow-ups significantly improve NS-ReTx outcomes. Integrating these factors into treatment planning is pivotal for optimizing the outcome of NS-ReTx.
在过去几十年的研究中，非手术根管再治疗（NS-ReTx）的成功率有所不同。尽管如此，近期牙髓病学的进展显著改善了病例管理。本系统评价旨在识别关于当代NS-ReTx的严谨研究，调查根尖周愈合情况（严格评估为完全消退，或宽松评估为根尖周透射影大小减小）以及成功率（定义为临床正常并伴有根尖周愈合）。
我们系统检索了1988年1月至2022年12月期间的MEDLINE、Embase、科学网、Cochrane图书馆和灰色文献。文章筛选和数据提取由3名评审员独立进行。对选定的研究进行偏倚风险评估，并采用推荐分级、评估、制定和评价方法评估证据质量。荟萃分析和荟萃回归确定了合并结局率、95%置信区间（CI）和显著的临床预后因素（P <.05）。
纳入29篇文章。使用严格和宽松标准的合并根尖周愈合率分别为78.8%（95%CI：75.2 - 82.4）和87.5%（95%CI：83.8 - 91.2）。使用严格和宽松标准的合并成功率分别为78.0%（95%CI：74.9 - 81.2）和86.4%（95%CI：82.6 - 90.1）。荟萃回归分析显示对NS-ReTx结局有显著影响（P <.05），包括根尖周状态、病变大小、根尖根充程度和随访时间。
当代NS-ReTx显示出令人鼓舞的结局，根尖周愈合率和成功率在约78%（严格标准）至87%（宽松标准）之间。术前无病变或病变较小、根充长度足够以及随访时间延长可显著改善NS-ReTx结局。将这些因素纳入治疗计划对于优化NS-ReTx的结局至关重要。
