A systematic review on the outcome of surgical vs non-surgical procedure for the retreatment of periapical lesions

Department of Odontology, University of Milan, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
Minerva stomatologica 01/2007; 56(11-12):621-32.
Source: PubMed


The most common therapeutical options for the retreatment of teeth with periapical pathosis are orthograde treatment and periapical surgery. The aim of this review was to evaluate the outcomes of surgical versus non-surgical retreatment, in order to provide clinicians with evidence-based information for decision making process. Articles were retrieved by electronic search strategy and traditional searching. Articles were selected based on strict inclusion criteria. The first criterion was the success of retreatment, as determined by clinical and radiographic criteria. The outcomes were further dichotomized according to functionality criteria. Two randomized trials (RCTs) were found. One hundred and twenty-six teeth were followed up after one year, and 82 after 4 years. The success rate for surgical treatment after one year was slightly better than non-surgical: 90.7% vs 80.6%, respectively, according to functional criteria. At the four-year evaluation (40 surgically treated and 42 non-surgically treated cases from 1 RCT) the outcomes were similar. A higher early post-operative discomfort was reported for surgically treated cases. There is no apparent advantage of using a surgical or non-surgical approach for the retreatment of periapical lesions in terms of long-term outcome. The choice between the two procedures should rely upon factors other than the mere treatment outcome, such as patient's initial clinical situation, patient's preference, operator's experience and skill, complication risk, technical feasibility, and overall treatment cost. More well-designed RCTs should be performed with a large sample size and at least 4 years follow-up, using modern instrumentation and materials, to detect a true difference in the long term between the outcomes of the two alternative treatments, if any exists.

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    • "The surgical endodontic treatment group included 9 articles. Papers were excluded due to: a followup period of time was less than 4 years, [18, 19], success rate was not described [20, 21], paper did not state the success rate at the exact time of 4 years [22], papers limited to case series [23, 24] literature or systematic reviews [25, 26]. Six implant papers were excluded two of which did not state success rate [27, 28], success rate not at four years [29] and review studies [30–32]. "
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    ABSTRACT: Dentists and patients are facing a perplexity between saving a compromised tooth through endodontic treatment and restoration or by extraction and replacement with an implant. The purpose of this paper was to compare the success rates of these two treatments. Success was measured as the longevity of the tooth or implant. Studies which met strict inclusion criteria to ensure best evidence were included. Searches were performed in Ovid Medline, Pubmed, Scopus database, and the Cochrane Library. Evidence-based groups were formed following the assessment of inclusion/exclusion criteria. The overall success rates for primary endodontic, nonsurgical retreatment, and surgical treatment were (86.02%), (78.2%), and (63.4%), respectively, implants was 90.9%. In conclusion, choice between implant and endodontic therapy cannot be exclusively based on outcome as both treatments differ in the biological process, diagnostic modalities, failure patterns, and patients preferences. More research is required with improved study designs before long-term success rates can be compared.
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    ABSTRACT: The historical pathway to current surgical endodontic procedures and their applications has been tortuous and tumultuous. Influenced heavily in their development by the European sector, these surgical procedures faced many challenges over the decades. Fortunately for today's practitioners, influential members of the oral surgery community, and a few staunch believers in retaining devitalized teeth, persisted in their investigation of and search for improved procedures that had predictable outcomes. Many so-called "revolutionary" or newer techniques practiced today are but a re-emergence of surgical concepts that were lost in the archives of time. With the advent of evidence-based endodontics, these procedures are now supported extensively by science and by the integration of science into materials usage, technique applications and outcomes research. However, in many respects, this story is just beginning, as the "roots" of surgical endodontics are explored.
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