PDF(Pubmed)
Abstract：
OBJECTIVE: The purpose of this systematic review was to appraise the existing literature on the effect of hard tissue defects on the clinical outcome of endodontic microsurgery (EMS).
METHODS: MEDLINE (PubMed), Embase, Web of Science, Cochrane Library and grey literature were searched from January 2000 to May 2023. Study selection and data extraction were performed in duplicate. Eligible studies were critically appraised for the risk of bias using the Cochrane Risk of bias tool. The quality of evidence was assessed using GRADE. Review Manager (RevMan Computer program Version 5.4, The Cochrane Collaboration, 2020) was utilized and the Mantel Haenszel fixed or random effects model was applied, depending on the heterogeneity of the studies. Meta-analysis was performed to estimate the Risk ratio (RR) and 95% Confidence Interval (CIs) to correlate the effects of these factors on treatment outcomes.
RESULTS: Nineteen studies were included. The EMS overall pooled success rate was 84.5%. Five characteristics of hard tissue were identified. The size of the lesion (Small ≤ 5 mm: 78.4% vs. Large > 5 mm: 63.3%, RR = 1.12, 95% CI 1.00-1.26, P ≤ .05), significantly affected the outcomes of EMS. Endodontic lesions exhibited slightly better outcomes than endodontic-periodontal lesions (81.4% vs. 68.2%, RR = 1.14 95% CI 0.98-1.33, P > .05). Cases with the height of the buccal bone > 3 mm also exhibited slightly better outcomes (91.5% vs. 71.4%, RR = 1.20, 95% CI 0.88-1.62, P > .05). Additionally, through and through lesions exhibited better outcomes when grafting was completed during the EMS procedure both in 2D (RR = 1.12 95% CI 0.97-1.29, P > .05) and 3D evaluation ((RR = 1.28 95% CI 0.69-2.37 P > .05). The overall quality of evidence was graded as low to high.
CONCLUSIONS: With a low to high quality of evidence, the size of the lesion is a key prognostic variable that significantly affects the outcome of EMS, as lesions ≤ 5 mm exhibit better outcomes as compared to larger lesions.
CONCLUSIONS: The presence of hard tissue defects can affect the outcome of endodontic microsurgery (EMS). The presented data can aid the clinicians\' decision-making process by examining certain pre-operative prognostic variables, when considering EMS as a treatment option. Clinical cases with more favorable hard tissue characteristics lead to a better prognosis in EMS.
METHODS: MEDLINE (PubMed), Embase, Web of Science, Cochrane Library and grey literature were searched from January 2000 to May 2023. Study selection and data extraction were performed in duplicate. Eligible studies were critically appraised for the risk of bias using the Cochrane Risk of bias tool. The quality of evidence was assessed using GRADE. Review Manager (RevMan Computer program Version 5.4, The Cochrane Collaboration, 2020) was utilized and the Mantel Haenszel fixed or random effects model was applied, depending on the heterogeneity of the studies. Meta-analysis was performed to estimate the Risk ratio (RR) and 95% Confidence Interval (CIs) to correlate the effects of these factors on treatment outcomes.
RESULTS: Nineteen studies were included. The EMS overall pooled success rate was 84.5%. Five characteristics of hard tissue were identified. The size of the lesion (Small ≤ 5 mm: 78.4% vs. Large > 5 mm: 63.3%, RR = 1.12, 95% CI 1.00-1.26, P ≤ .05), significantly affected the outcomes of EMS. Endodontic lesions exhibited slightly better outcomes than endodontic-periodontal lesions (81.4% vs. 68.2%, RR = 1.14 95% CI 0.98-1.33, P > .05). Cases with the height of the buccal bone > 3 mm also exhibited slightly better outcomes (91.5% vs. 71.4%, RR = 1.20, 95% CI 0.88-1.62, P > .05). Additionally, through and through lesions exhibited better outcomes when grafting was completed during the EMS procedure both in 2D (RR = 1.12 95% CI 0.97-1.29, P > .05) and 3D evaluation ((RR = 1.28 95% CI 0.69-2.37 P > .05). The overall quality of evidence was graded as low to high.
CONCLUSIONS: With a low to high quality of evidence, the size of the lesion is a key prognostic variable that significantly affects the outcome of EMS, as lesions ≤ 5 mm exhibit better outcomes as compared to larger lesions.
CONCLUSIONS: The presence of hard tissue defects can affect the outcome of endodontic microsurgery (EMS). The presented data can aid the clinicians\' decision-making process by examining certain pre-operative prognostic variables, when considering EMS as a treatment option. Clinical cases with more favorable hard tissue characteristics lead to a better prognosis in EMS.
摘要：
目的：本系统综述的目的是评估现有的关于硬组织缺损对牙髓显微手术（EMS）临床结果影响的文献。
方法：MEDLINE（PubMed），Embase,WebofScience,从2000年1月至2023年5月检索了Cochrane图书馆和灰色文献。研究选择和数据提取一式两份。使用Cochrane偏倚风险工具对合格研究的偏倚风险进行了严格评估。使用GRADE评估证据质量。ReviewManager(RevManComputerprogramVersion5.4,TheCochraneCollaboration,利用了2020年)，并应用了MantelHaenszel固定或随机效应模型，取决于研究的异质性。进行荟萃分析以估计风险比（RR）和95％置信区间（CI），以关联这些因素对治疗结果的影响。
结果：纳入19项研究。EMS总体汇集成功率为84.5%。确定了硬组织的五个特征。病变的大小（小≤5mm：78.4%vs.大>5毫米：63.3%，RR=1.12，95%CI1.00-1.26，P≤0.05），显著影响EMS的结果。牙髓病变的预后略好于牙髓-牙周病变（81.4％vs.68.2%,RR=1.1495%CI0.98-1.33，P>0.05）。颊骨高度>3mm的病例也表现出略好的结果（91.5%与71.4%,RR=1.20，95%CI0.88-1.62，P>0.05）。此外,当在EMS手术期间在2D(RR=1.1295%CI0.97-1.29,P>.05)和3D评估(RR=1.2895%CI0.69-2.37P>.05)中完成移植时,通过和通过病变表现出更好的结果。总体证据质量从低到高。
结论：证据质量低到高，病变的大小是一个关键的预后变量，显著影响EMS的结果，与较大的病变相比，病变≤5mm表现出更好的结局。
结论：硬组织缺损的存在会影响牙髓显微手术（EMS）的结果。所提供的数据可以通过检查某些术前预后变量来帮助临床医生的决策过程，当考虑EMS作为一种治疗选择时。具有更有利的硬组织特征的临床病例在EMS中导致更好的预后。
方法：MEDLINE（PubMed），Embase,WebofScience,从2000年1月至2023年5月检索了Cochrane图书馆和灰色文献。研究选择和数据提取一式两份。使用Cochrane偏倚风险工具对合格研究的偏倚风险进行了严格评估。使用GRADE评估证据质量。ReviewManager(RevManComputerprogramVersion5.4,TheCochraneCollaboration,利用了2020年)，并应用了MantelHaenszel固定或随机效应模型，取决于研究的异质性。进行荟萃分析以估计风险比（RR）和95％置信区间（CI），以关联这些因素对治疗结果的影响。
结果：纳入19项研究。EMS总体汇集成功率为84.5%。确定了硬组织的五个特征。病变的大小（小≤5mm：78.4%vs.大>5毫米：63.3%，RR=1.12，95%CI1.00-1.26，P≤0.05），显著影响EMS的结果。牙髓病变的预后略好于牙髓-牙周病变（81.4％vs.68.2%,RR=1.1495%CI0.98-1.33，P>0.05）。颊骨高度>3mm的病例也表现出略好的结果（91.5%与71.4%,RR=1.20，95%CI0.88-1.62，P>0.05）。此外,当在EMS手术期间在2D(RR=1.1295%CI0.97-1.29,P>.05)和3D评估(RR=1.2895%CI0.69-2.37P>.05)中完成移植时,通过和通过病变表现出更好的结果。总体证据质量从低到高。
结论：证据质量低到高，病变的大小是一个关键的预后变量，显著影响EMS的结果，与较大的病变相比，病变≤5mm表现出更好的结局。
结论：硬组织缺损的存在会影响牙髓显微手术（EMS）的结果。所提供的数据可以通过检查某些术前预后变量来帮助临床医生的决策过程，当考虑EMS作为一种治疗选择时。具有更有利的硬组织特征的临床病例在EMS中导致更好的预后。
