Influence of Guided Tissue Regeneration Techniques on the Success Rate of Healing of Surgical Endodontic Treatment: A Systematic Review and Network Meta-Analysis

Abstract

Several regeneration techniques and materials have been proposed for the healing of bone defects after surgical endodontic treatment; however, the existing literature does not provide evidence on the most recommended techniques or materials. The aim of the present systematic review and network meta-analysis (NMA) is to summarize the clinical evidence on the efficacy of guided tissue regeneration techniques (GRTs). The PRISMA recommendations were followed. Four databases were searched up to December 2021. Randomized clinical trials (RCTs) with a minimum follow-up of 6 months were included. The risk of bias was assessed using the Cochrane Collaboration tool. A fixed effects model and frequentist approach were used in the NMA. Direct GRT technique comparisons were combined to estimate indirect comparisons, and the estimated effect size of the comparisons was analyzed using the odds ratio (OR). Inconsistency was assessed with the Q test, with a significance level of p < 0.01, and a net heat plot. A total of 274 articles was identified, and 11 RCTs (6 direct comparisons of 15 techniques) were included in the NMA, which examined 6 GRT techniques: control, Os, PL, MB, MB + Os, and MB + PL. The MB + Os group compared to the control (OR = 3.67, 95% CI: 1.36–9.90) and to the MB group (OR = 3.47, 95% CI: 1.07–11.3) showed statistically significant ORs (p ˂ 0.05). The MB + Os group presented the highest degree of certainly (P-score = 0.93).

Effect of amniotic membrane and platelet‐rich fibrin membrane on bone healing post endodontic surgery: An ultrasonographic, randomized controlled study

“…GTR in endodontic surgeries has been a promising technique to enhance the ideal regeneration after endodontic surgeries and enhance the overall clinical outcome, especially in cases with cortical defects or cases with a periodontal component, such as deep probings on the tooth or a connection between concomitant periodontal and endodontic defects (Setzer & Kratchman, 2022. ; Zubizarreta‐Macho et al., 2022)Since the current study's criteria included lesions from isolated endodontic disease as well as cases with cortical defects or cases that have combined periodontal involvement, the authors decided on GTR approach.…”

Effect of guided tissue regeneration on the success of surgical endodontic treatment of teeth with endodontic‐periodontal lesions: A systematic review

“…A previous systematic review of the literature (Tsesis et al, 2011) reported that GTR techniques could improve bone regeneration following surgical endodontic treatment particularly in cases with large and throughand-through periapical lesions (Tsesis et al, 2011). Other, more recent, both narrative and systematic reviews of the literature confirmed that GTR procedure could promote bone healing after surgical endodontic treatment, confirming that their efficacy is higher in presence of large periapical lesions (Corbella et al, 2016;Zubizarreta-Macho et al, 2022). However, those reviews did not performed a specific analysis on endodontic-periodontal lesions, leaving the prognosis of such cases unknown, and not systematically explored in literature.…”

Present status and future directions: Surgical endodontics

“…These findings concurred with the meta-analysis by Deng et al (2016), who confirmed the increased effectiveness of combinations of membranes and bone replacement analogues. However, the same study also concluded that the singular use of bone replacement materials improved the surgical outcome for endodontic surgery, which was not confirmed by a recent network meta-analysis for bone graft materials alone (Zubizarreta-Macho et al, 2022). Zubizarreta-Macho et al (2022) appraised the clinical evidence on the efficacy of GTR techniques and included 11 randomized clinical trials comparing six GRT techniques, including bone graft, membrane, membrane plus bone graft, platelet-rich plasma or membrane plus platelet-rich plasma.…”

“…However, the same study also concluded that the singular use of bone replacement materials improved the surgical outcome for endodontic surgery, which was not confirmed by a recent network meta-analysis for bone graft materials alone (Zubizarreta-Macho et al, 2022). Zubizarreta-Macho et al (2022) appraised the clinical evidence on the efficacy of GTR techniques and included 11 randomized clinical trials comparing six GRT techniques, including bone graft, membrane, membrane plus bone graft, platelet-rich plasma or membrane plus platelet-rich plasma. Both the membrane and the membrane plus bone graft techniques demonstrated statistically significant odds ratios compared to procedures conducted without GTR.…”

“…GTR for endodontic surgery was subject to review (Corbella et al, 2015;Deng et al, 2016;Lin et al, 2010;Sumangali et al, 2021;Tsesis et al, 2011;Zubizarreta-Macho et al, 2022). For the application of GTR in endodontic surgery, a distinction can be made between F I G U R E 4 3 Histology of a root-end surface after retrograde filling with RRM and 6-month healing period in canines.…”