ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Guided Tissue Regeneration Techniques May Be Beneficial in Improving Outcomes of Surgical Endodontic Treatment of Large, Through-and-Through Periapical Lesions
Clinical Question In teeth requiring endodontic microsurgery, does guided tissue regeneration (GTR) therapy improve the chance of a successful outcome as compared to no GTR therapy following surgery?
Clinical Bottom Line GTR techniques show a trend of better outcomes in teeth with large, through-and-through lesions, but the results are not statistically significant.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 21763891Tsesis/20115 randomized controlled trials (78 teeth total)Meta-Analysis
Key resultsGuided tissue regeneration, when used to treat large through-and-through lesions, shows a trend of better outcomes (healing) as compared to no guided tissue regeneration following periapical surgery, but the results are not statistically significant. Based on their results, using a resorbable membrane with bone graft yielded the best outcome in these cases.
Evidence Search Endodontic[All Fields] AND ("surgery"[Subheading] OR "surgery"[All Fields] OR "surgical procedures, operative"[MeSH Terms] OR ("surgical"[All Fields] AND "procedures"[All Fields] AND "operative"[All Fields]) OR "operative surgical procedures"[All Fields] OR "surgery"[All Fields] OR "general surgery"[MeSH Terms] OR ("general"[All Fields] AND "surgery"[All Fields]) OR "general surgery"[All Fields]) AND gtr[All Fields]
Comments on
The Evidence
Validity: The authors performed a comprehensive search of relevant articles in Medline, Scopus, and Embase electronic databases. After the initial search, articles that did not fit their strict criteria were filtered out and the remaining articles were subject to full-text evaluation. Their criteria required relevancy to their clinical question, GTR therapy, recall of at least 1 year, and being a randomized controlled trial. The studies were grouped into low, moderate, and high risk of bias depending on how much or little of the researchers main criteria was met. The articles were evaluated independently and by two reviewers. Perspective: Endodontic microsurgery using modern techniques with microscopes, ultrasonic instruments, and materials such as MTA have resulted in very high success rates (94%, Setzer/2010). However, there is always a desire to improve outcomes, and in answering this clinical question, this meta-analysis shows that GTR may increase successful outcomes in large through-and-through lesions, possibly giving GTR value for the patient in these types of cases.
Applicability The findings in this meta-analysis are relevant to all practitioners performing endodontic microsurgery. One concern is the increased cost involved when using GTR therapy (membrane and bone graft) versus no GTR, and while there is a trend in research results showing better healing, this article states that the difference is not statistically significant.
Specialty/Discipline (Endodontics)
Keywords microsurgery, guided tissue regeneration, apicoectomy, root end surgery, retrograde surgery, periradicular surgery, endodontic surgery
ID# 2939
Date of submission: 11/02/2015spacer
E-mail dennisonm@livemail.uthscsa.edu
Author Mathew Dennison, DDS
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Nikita Ruparel, DDS
Faculty mentor/Co-author e-mail Ruparel@uthscsa.edu
Basic Science Rationale
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