Surgical endodontic treatment under magnification has high success rates

Abstract

The advancement in surgical endodontics (eg, the use of the dental operative microscope, no or minimal bevel of the root-end resection, and ultrasonic retrograde canal preparation to a depth of 3-4 mm) has resulted in more precise and predictable surgical procedures, which could not normally be achieved using the traditional surgical endodontic treatment (by means of root-end resection with a 45-degree bevel, retrograde preparation of the canal with bur, and root-end filling under no magnification and inadequate illumination). Therefore, assuming a higher outcome for the modern versus the traditional procedure, 3 this study pooled six RCT and five prospective case-series to evaluate the outcome of the modern surgical endodontic treatment as well as the factors influencing the outcome.In order to critically appraise this paper, the PRISMA checklist (Preferred Reporting Items for Systematic Reviews and Metaanalyses) 4 was utilised. The search strategy appears to be exhaustive, although it was limited to English publications. The eligibility criteria and data collection process were detailed. Three reviewers worked independently in identifying and appraising the included studies and extracting the data. Such methodology would reduce bias in a review. With regards to the eligibility criteria of the level of evidence and study design, it should be noted that because of the nature of the question (outcome of only modern surgical endodontics), no control group is necessary. Therefore, even though the authors included six RCT, in fact for the purpose of the data synthesis, such RCT had to be handled as prospective case series, ie, only the results of the RCT arm(s) that utilised the modern endodontic surgery procedure and met the other inclusion criteria were considered for the data synthesis.No report was mentioned of attempting to contact authors of papers that partially met the inclusion criteria for further results (eg, Saunders 2008 5 for the outcome of cases with at least one year followup). Moreover, in some cases, the reasons for excluding a paper seem to be erroneous, since the paper by Gagliani et al. (2005) 6 was rejected for not using Rud 1 criteria even though it did so.There is no indication of risk of bias assessment of individual studies at the study or outcome level (eg, masking and/ or calibration of the examiners) and, thus, no sensitivity analysis was performed for the data synthesis. Moreover, no measure of consistency (eg, I 2 for testing heterogeneity) 7 was reported.In this meta-analysis, the radiographic healing categories of incomplete healing (scar) and complete healing were combined into one category of "success" with a pooled estimate of 91.6% (95% Surgical endodontic treatment under magnification has high success rates Data extraction and synthesis Studies were reviewed and data extracted independently by three observers, with disagreements resolved by discussion. Studies included were combined to estimate the pooled successes and 95% confidence intervals (CI), where success was considered ...

Endodontic performance by Flemish dentists: have they evolved?

“…Although it is presently unknown if and how the type of magnification may affect endodontic treatment outcome (Del Fabbro & Taschieri 2010), it is known that the use of magnification increases the accuracy of the operative procedures and improves diagnostic capability, due to a better visualization of the treatment field. For example, it allows detection of isthmuses, accessory canals or microfractures of the root, which are otherwise difficult to recognize and treat in the absence of proper magnification (de Carvalho & Zuolo 2000, Schwarze et al 2002, von Arx et al 2003, Slaton et al 2003, von Arx 2005, Azarpazhooh 2010. In the present study sample, magnification was reported to be widely used (50% of the respondents using magnification on a regular basis and 21% always).…”

“…, Slaton et al . , von Arx , Azarpazhooh ). In the present study sample, magnification was reported to be widely used (50% of the respondents using magnification on a regular basis and 21% always).…”