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 a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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