The guided tissue regeneration principle in endodontic surgery: one‐year postoperative results of large periapical lesions

Abstract

Twenty patients with large endodontic lesions, which failed to respond to conventional endodontic therapy, were selected for this study. The lesions had a radiographic diameter of at least 10 mm, were removed by periradicular surgery, before retrofilling the apices with either super EBA or dessicated zinc oxide-eugenol. In 10 test sites large e-PTFE membranes (Gortex) were placed to cover the lesions, while at the control sites the lesions were not covered before resuturing. Radio-graphic analysis of the lesions at 3, 6, 9 and 12 months revealed that lesions covered with the membranes healed quicker than the control lesions, and that the quality and quantity of the regenerated bone was superior when membranes were used. Results of the study indicate that guided tissue regeneration (GTR) principles can be effectively applied to the healing of large periapical lesions, especially in through-and-through lesions.

Effect of Guided Tissue Regeneration on the Outcome of Surgical Endodontic Treatment: A Systematic Review and Meta-analysis

“…Large-scale prospective clinical studies are needed to further evaluate possible benefits of GTR techniques in endodontic surgery. Throughand-through Four walls Pecora, 1995 …”

“…A possible explanation may be related to the colonization of the healing wound by periodontal progenitor cells, a prerequisite for the formation of new cementum, a new periodontal ligament apparatus, and new alveolar bone (6,9,18,21,46). A key factor for this process is the periosteum because it may act both as a source of osteocompetent cells and as a barrier against the infiltration of epithelial cells into the healing site (6,9).…”

“…Table 2 shows the main features and the outcomes of the five studies included in the analysis. According to the methodologic quality assessment, one study (18) was judged to be at high risk of bias (category C), whereas the other four studies were considered at moderate risk of bias (category B).…”

“…Eventually, five articles (6,9,10,18,21) were included in the meta-analysis and were subject to data extraction, methodologic quality assessment, and data synthesis and analysis. Figure 1 presents a flow chart of the systematic review process.…”

“…The use of guided tissue regeneration (GTR) techniques has been proposed as an adjunct to endodontic surgery in order to promote bone healing (7)(8)(9)(10). Numerous studies on the clinical effectiveness of GTR techniques to promote healing and improve the outcome of surgical endodontic treatments have been published (5)(6)(7)(8)(9)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). However, significant variability in their study designs, treatment protocols, follow-up periods, and inclusion and exclusion criteria generated inconsistent and confusing results (5)(6)(7)(8)(9)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22).…”