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.
OBJECTIVE: 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.
CONCLUSIONS: 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.
BACKGROUND: PROSPERO (CRD42021255171).
OBJECTIVE: 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.
CONCLUSIONS: 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.
BACKGROUND: PROSPERO (CRD42021255171).
摘要：
背景：再生技术在根尖手术（AS）中越来越被提倡，以增强根尖周病变的愈合。各种接枝和膜材料被用作现代AS的助剂。
目的：本系统综述旨在回答以下PICO问题：在根尖周炎（P）患者中，有/没有屏障膜材料的骨移植（I）与没有移植材料的手术（C）相比，对临床和影像学（O）评估的AS结果的影响。
方法：在四个数据库中进行了系统搜索（Embase，WebofScience,PubMed和Cochrane中央对照试验登记册）至2023年8月1日。谷歌学者也被手动搜索。包括前瞻性随机设计的研究。Cochrane偏倚风险(RoB)工具2.0评估偏倚。两名独立的审核员进行了研究选择，研究的数据提取和评估。采用R3.5.1软件进行Meta分析。
结果：从确定的2582项研究中，纳入8项随机临床试验进行荟萃分析.两项研究的RoB水平较低,而六个人有一些顾虑。分析显示，与传统手术相比，手术涉及骨再生技术的结果明显更好（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）的亚组分析结果无统计学意义使用的膜类型没有显着影响结果（OR=-1.09，95％CI：-2.94至0.76，p=0.247），也没有改变移植物/膜的组合。
结论：本系统综述研究了有/没有膜放置的植骨对AS预后的影响。它强调了再生技术的潜在优势以及在这一领域进一步研究的必要性。
结论：根据目前的证据，有/没有屏障膜放置的骨移植显着改善了AS后的愈合。可吸收膜或移植的亚组分析没有显着影响结果。膜和移植物的组合也不显著。未来精心设计，在推荐常规使用这些材料以提高AS的愈合效果之前,这方面的随机对照试验是必不可少的.
背景：PROSPERO（CRD42021255171）。
目的：本系统综述旨在回答以下PICO问题：在根尖周炎（P）患者中，有/没有屏障膜材料的骨移植（I）与没有移植材料的手术（C）相比，对临床和影像学（O）评估的AS结果的影响。
方法：在四个数据库中进行了系统搜索（Embase，WebofScience,PubMed和Cochrane中央对照试验登记册）至2023年8月1日。谷歌学者也被手动搜索。包括前瞻性随机设计的研究。Cochrane偏倚风险(RoB)工具2.0评估偏倚。两名独立的审核员进行了研究选择，研究的数据提取和评估。采用R3.5.1软件进行Meta分析。
结果：从确定的2582项研究中，纳入8项随机临床试验进行荟萃分析.两项研究的RoB水平较低,而六个人有一些顾虑。分析显示，与传统手术相比，手术涉及骨再生技术的结果明显更好（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）的亚组分析结果无统计学意义使用的膜类型没有显着影响结果（OR=-1.09，95％CI：-2.94至0.76，p=0.247），也没有改变移植物/膜的组合。
结论：本系统综述研究了有/没有膜放置的植骨对AS预后的影响。它强调了再生技术的潜在优势以及在这一领域进一步研究的必要性。
结论：根据目前的证据，有/没有屏障膜放置的骨移植显着改善了AS后的愈合。可吸收膜或移植的亚组分析没有显着影响结果。膜和移植物的组合也不显著。未来精心设计，在推荐常规使用这些材料以提高AS的愈合效果之前,这方面的随机对照试验是必不可少的.
背景：PROSPERO（CRD42021255171）。
