Traditional root-end surgery or endodontic microsurgery for best outcomes?

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The aim of this systematic review was to compare the outcomes of two different approaches to endodontic surgery, traditional (TRS) or microsurgical (EMS).

The databases, Medline, PubMed and Embase were searched along with the following journals: Journal of Endodontics, International Endodontic Journal, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics, Journal of Oral and Maxillofacial Surgery, International Journal of Oral and Maxillofacial Surgery.  Longitudinal studies published in English, French, German, Italian, or Spanish, with a minimum follow-up of 6 months were included. Assessment and data abstraction was carried out independently. Weighted pooled success rates and relative risk assessment between TRS and EMS were calculated and a meta-analysis was carried out using a random effects model.

Twenty one studies were included. Weighted pooled success rates calculated from extracted raw data showed 59% positive outcome for TRS (95% confidence interval, 0.55-0.6308) and 94% for EMS (95% confidence interval, 0.8889-0.9816). This difference was statistically significant (P < .0005). The relative risk ratio showed that the probability of success for EMS was 1.58 times the probability of success for TRS.

They concluded:

On the basis of the meta-analysis presented here, the probability of success for EMS proved significantly greater than the probability of success for TRS.

Setzer FC,Shah SB,Kohli MR,Karabucak B,Kim S. Outcome of endodontic surgery:a meta-analysis of the literature-part 1: Comparison of traditional root-end surgery and endodontic microsurgery. J Endod. 2010 Nov;36(11):1757-65.Epub 2010 Sep 17. Review. PubMed PMID: 20951283

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Derek Richards

Derek Richards is the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Dundee & Glasgow Dental Schools. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal. He has been involved with teaching EBD and a wide range of evidence-based initiatives both nationally and internationally since 1994.

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