A systematic review on the outcome of surgical vs non-surgical procedure for the retreatment of periapical lesions.
ABSTRACT 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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ABSTRACT: This paper sought to determine the levels of evidence associated with treatment for specific diagnostic categories and the prognosis of treatment. A review of the literature was conducted using MEDLINE, PubMed, Google Scholar and the Cochrane Database. The Journal of Endodontics, International Journal of Endodontics, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, Endodontic Topics, and Dental Traumatology were also searched. The bibliographies of relevant articles were manually searched. The review found a low level of evidence to assess clinical treatment modalities. The development of higher levels of evidence to facilitate the selection of appropriate treatment modalities for each diagnostic category is recommended.Journal of endodontics 12/2009; 35(12):1675-94. DOI:10.1016/j.joen.2009.09.027 · 2.79 Impact Factor
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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.Journal of the history of dentistry 01/2010; 58(1):1-42.
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ABSTRACT: This article presents the procedures that must be considered for periapical cyst repair by nonsurgical endodontic treatment. The case of a periapical cyst associated with 21 and 22 is reported. Nonsurgical root canal therapy was performed and lesion healing was observed radiographically after 14 months. Diagnosis, endodontic infection control, apical foramen enlargement, irrigation of the cystic cavity with iodine saline solution and a calcium hydroxide paste intracanal dressing were important procedures for case resolution.