Use of higher magnification provides better outcomes in endodontic microsurgery

shutterstock_2296216-root canal xray

This systematic review is the second part of a review we first highlighted in Dental Elf on the 7th July. The  aim of this part was to assess whether root-end surgery techniques with microinstruments but only loupes or no visualization aids (contemporary root-end surgery [CRS]) compared with endodontic microsurgery using the same instruments and materials but with high-power magnification as provided by the surgical operating microscope or the endoscope (endodontic microsurgery [EMS]) produced better outcomes.

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 CRS and EMS  overall as well as for molars, premolars, and anteriors were calculated and a meta-analysis was carried out using a random effects model.

14 studies were included  and they found

[table id=12 /]

Relative risk ratio analysis showed that the probability of success for EMS was 1.07 times the probability of success for CRS.

Seven studies provided information on the individual tooth type  there was a statistically significant difference   between two groups for molars (n = 193, P = .011) but not for premolars or anterior teeth

The authors concluded

The probability for success for EMS proved to be significantly greater than the probability for success for CRS, providing best available evidence on the influence of high-power magnification rendered by the dental operating microscope or the endoscope. Large-scale randomized clinical trials for statistically valid conclusions for current endodontic questions are needed to make informed decisions for clinical practice.

Setzer FC, Kohli MR, Shah SB, Karabucak B, Kim S.  Outcome of Endodontic Surgery: A Meta-analysis of the Literature—Part 2: Comparison of Endodontic Microsurgical Techniques with and without the Use of Higher Magnification. J of Endod

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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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