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Title EndoSequence Root Repair Material Is Not Superior to Mineral Trioxide Aggregate as a Root-End Filling Material in Endodontic Microsurgery
Clinical Question In teeth that undergo endodontic microsurgery (EMS), would use of EndoSequence Root Repair Material (RRM) as a root-end filling material result in higher success when compared to mineral trioxide aggregate (MTA)?
Clinical Bottom Line There is no significant difference in EMS success rate when RRM and MTA are used as root-end filling materials. This conclusion is based on a randomized trial of 120 teeth with an average follow-up of 15 months.
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) 31078325Safi/2019120 adult EMS teeth Randomized Controlled Trial
Key resultsThe overall success rate was 93.3% for periapical (PA) evaluation and 85% for cone beam computed tomography (CBCT) evaluation. No significant difference was observed between the RRM (92% PA, 84% CBCT) and MTA groups (94.7% PA, 86% CBCT). Microsurgical classification, quality of root canal filling, depth of root-end filling material, and root fracture had a significant influence on outcome.
Evidence Search root repair material AND endodontic microsurgery AND mineral trioxide aggregate
Comments on
The Evidence
Validity: The minimum sample size determined for this study based on a 20% mean difference between groups and power = 0.80 (P < .05) was 124. The final sample size was only 120, resulting in a wide confidence interval (CI) and compromised precision and power of results. Only 52% of the enrolled patients returned. Given the high attrition rate, an intention-to-treat analysis would have been beneficial. Seventeen subjects with teeth extracted could neither recall nor return for follow-up to assess reasons for extractions. These were considered lost to follow-up. Knowing which group these subjects belonged to and their respective preoperative prognostic factors would be valuable information. A major strength of this study was comparison of 2-dimensional PA and 3-dimensional CBCT scores to assess outcomes of RRM vs. MTA. Substantial agreement was found between the two scores (Cohen kappa = 0.63; 95% CI = 0.397-0.862; P < .001). Additional strengths included randomization of teeth into the RRM and MTA groups, blinded operators and examiners, and adequate follow-up time. Perspective: While MTA has been the root-end filling material of choice for EMS, it has its limitations. Having an alternative material that can overcome MTA’s limitations while demonstrating a similar success rate is beneficial to both the operator and patient.
Applicability Use of CBCT for post-surgical evaluation of healing is not currently the standard of care. This study confirms that CBCT shows lower success rates than PA radiography for the time frame investigated. Despite this disparity, no statistically significant difference in success rates between RRM and MTA were found when using either PA or CBCT evaluation. An extension of this study with a longer follow-up period will provide insight into the importance or, lack thereof, of CBCT for post-surgical evaluation of EMS. At this time, we conclude that RRM is a viable alternative to MTA when used as a root-end filling material in EMS teeth.
Specialty/Discipline (Endodontics) (General Dentistry) (Oral Surgery)
Keywords endodontic microsurgery, modern apical surgery, mineral trioxide aggregate, EndoSequence Root Repair Material, bioceramic
ID# 3412
Date of submission: 12/03/2019spacer
E-mail buniag@livemail.uthscsa.edu
Author Arianne G. Buniag, DDS
Co-author(s) e-mail
Faculty mentor/Co-author Allen M. Pratt, DMD
Faculty mentor/Co-author e-mail allen.m.pratt2.mil@mail.mil
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