The impact of bone grafting with/without barrier membrane placement on the outcome of apical surgery: A systematic review and meta-analysis

IF 5.4 1区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE International endodontic journal Pub Date : 2024-03-16 DOI:10.1111/iej.14066

Richard Flynn, Federico Foschi, Brian Maloney, Greg Creavin, Henry F. Duncan

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Abstract

Background

Regenerative techniques are increasingly being advocated in endodontic apical surgery (AS) to enhance the healing of periapical lesions. Various grafting and membrane materials are employed as adjuncts to modern AS.

Objectives

This systematic review aimed to answer the following PICO question: In patients with apical periodontitis (P) what is the impact of bone grafting with/without barrier membrane materials (I) compared with surgery without grafting materials (C) on the outcome of AS evaluated clinically and radiographically (O).

Methods

A systematic search was conducted in four databases (Embase, Web of Science, PubMed and Cochrane Central Register of Controlled Trials) until 1 August 2023. Google Scholar was also manually searched. Studies with a prospective randomized design were included. Cochrane risk-of-bias (RoB) tool 2.0 assessed bias. Two independent reviewers performed the study selection, data extraction and appraisal of studies. Meta-analysis was performed using R3.5.1 software.

Results

From the identified 2582 studies, eight randomized clinical trials were included for meta-analysis. Two studies had low RoB, while six had some concerns. Analysis revealed significantly better outcomes when surgery involved bone regeneration techniques than conventional surgery (OR = 2.18, 95% CI: 1.32–4.31, p = .004). Subgroup analyses on individual grafts (OR = 0.22, 95% CI: −0.99 to 1.44, p = .720) (OR = −0.09, 95% CI: −1.42 to 1.23, p = .885) and membranes (OR = −1.09, 95% CI: −2.94 to 0.76, p = .247) and their combinations (OR = 0.03, 95% CI: −1.50 to 1.55, p = .970) did not yield any significant results. The type of membrane used did not significantly impact the outcome (OR = −1.09, 95% CI: −2.94 to 0.76, p = .247) nor did altering the combination of graft/membrane.

Discussion

This systematic review examined the effects of bone grafting with/without membrane placement on the outcome of AS. It highlights the potential advantages of regenerative techniques and the need for further research in this area.

Conclusions

Based on current evidence, bone grafting with/without barrier membrane placement significantly improves healing after AS. Subgroup analysis of resorbable membranes or grafting did not significantly influence the outcome. The combination of membrane and graft was also not significant. Future well-designed, randomized controlled trials in this area are essential before these materials can be recommended for routine use to enhance healing outcomes in AS.

Registration

PROSPERO (CRD42021255171).

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带/不带屏障膜的植骨对根尖手术结果的影响：系统回顾与荟萃分析。

背景：牙髓根尖手术（AS）中越来越多地采用再生技术来促进根尖周病变的愈合。各种移植材料和膜材料被用作现代牙髓根尖外科手术的辅助手段：本系统综述旨在回答以下 PICO 问题：在根尖牙周炎（P）患者中，有/无屏障膜材料（I）的植骨与无植骨材料（C）的手术相比，对临床和影像学评估（O）的 AS 结果有何影响：在四个数据库（Embase、Web of Science、PubMed 和 Cochrane Central Register of Controlled Trials）中进行了系统检索，检索期至 2023 年 8 月 1 日。谷歌学术也进行了人工搜索。纳入了采用前瞻性随机设计的研究。Cochrane 偏倚风险（RoB）工具 2.0 对偏倚进行了评估。两名独立审稿人对研究进行了筛选、数据提取和评估。使用 R3.5.1 软件进行了 Meta 分析：从已确定的 2582 项研究中，纳入了 8 项随机临床试验进行荟萃分析。其中两项研究的RoB较低，六项研究存在一些问题。分析显示，采用骨再生技术进行手术的疗效明显优于传统手术（OR = 2.18，95% CI：1.32-4.31，p = .004）。对单个移植物（OR = 0.22，95% CI：-0.99 至 1.44，p = .720）（OR = -0.09，95% CI：-1.42 至 1.23，p = .885）和膜（OR = -1.09，95% CI：-2.94 至 0.76，p = .247）及其组合（OR = 0.03，95% CI：-1.50 至 1.55，p = .970）进行的亚组分析未得出任何显著结果。使用的膜类型对结果没有显著影响（OR = -1.09, 95% CI: -2.94 to 0.76, p = .247），改变移植物/膜的组合也没有显著影响：本系统性综述研究了有/无膜置入的骨移植对强直性脊柱炎治疗效果的影响。讨论：这篇系统性综述研究了有膜/无膜植骨对强直性脊柱炎治疗效果的影响，强调了再生技术的潜在优势以及在这一领域开展进一步研究的必要性：根据目前的证据，有/无屏障膜植入的骨移植可显著改善强直性脊柱炎术后的愈合。可吸收膜或植骨的亚组分析对结果没有明显影响。膜和移植的组合也没有显著影响。在推荐常规使用这些材料来提高强直性脊柱炎的愈合效果之前，必须在这一领域开展设计良好的随机对照试验：prospero（CRD42021255171）。

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来源期刊

International endodontic journal 医学-牙科与口腔外科

CiteScore

10.20

自引率

28.00%

发文量

195

审稿时长

4-8 weeks

期刊介绍： The International Endodontic Journal is published monthly and strives to publish original articles of the highest quality to disseminate scientific and clinical knowledge; all manuscripts are subjected to peer review. Original scientific articles are published in the areas of biomedical science, applied materials science, bioengineering, epidemiology and social science relevant to endodontic disease and its management, and to the restoration of root-treated teeth. In addition, review articles, reports of clinical cases, book reviews, summaries and abstracts of scientific meetings and news items are accepted. The International Endodontic Journal is essential reading for general dental practitioners, specialist endodontists, research, scientists and dental teachers.