Guided tissue regeneration techniques involving blood-derived products in periradicular surgery: a systematic review and meta-analysis

Abstract

Background: Guided tissue regeneration (GTR) has been gaining popularity in dentistry as an aid to surgical techniques since 1982. The latest advancement in the GTR discipline examines the use of blood-derived products, but no systematic review had been carried out to date on its use in periradicular surgery. Therefore, the objective of this review was to evaluate the clinical outcomes of standard periradicular surgery versus periradicular surgery employing GTR techniques involving blood-derived products. Methods: Randomised controlled trials investigating the outcomes of GTR techniques involving blood-derived products versus standard periradicular surgery technique, were included for review. Studies were excluded if they contain patients who have previously undergone periradicular surgery or treatment was carried out on unrestorable teeth (i.e., due to periodontal disease or root fractures). The databases MEDLINE, Embase, Dentistry and Oral Sciences Source, and Cochrane CENTRAL were used to locate published reports of studies, last searched on 16th December 2022. Reference lists of relevant past systematic reviews were used to identify further studies. Unpublished studies were sought using international trials registries and repositories. Two blinded reviewers carried out independent screening of records for inclusion and the selected studies were critically appraised using Joanna Briggs Institute critical appraisal tool prior to data extraction and synthesis. The results are presented in accordance with PRISMA guidelines. Results: Two-hundred and sixty-one records were screened on title and abstract, and 17 studies were further screened against full text. Fourteen studies were excluded at this stage and 3 randomised controlled trials were included in the systematic review with a total of 85 patients. Meta-analysis was undertaken for the outcome of healing. The overall treatment effect was 0.78 (95% CI 0.18 to 3.34), favouring control group. Discussion: The meta-analysis of 3 studies showed no significant difference in healing between intervention and control groups. Critical appraisal of the included trials identified deficiencies in indirectness and imprecision, downgrading the overall certainty to ‘low’. Therefore, more strong evidence is required to recommend routine use blood derived products to improve the clinical outcomes of periradicular surgery in conjunction with guided tissue regeneration.