Cochrane · intervention · CD005511
Endodontic procedures for retreatment of periapical lesions
Del Fabbro, M, Corbella, S, Sequeira‐Byron, P, et al. · Cochrane Database of Systematic Reviews · 2016 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
33
current version
GRADE rated
22
No studies
0
Included studies
20
as reported
No studies 0 · 0%Ungraded 11 · 33.3%Very low 10 · 30.3%Low 12 · 36.4%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | People who have had endodontic treatment of root canals of one or more teeth and who were diagnosed with a periapical condition requiring retreatment | Participants from 20 RCTs (1373 participants, 1676 teeth) conducted in Sweden (n=5), Italy (n=6), the Netherlands (n=3), Austria, Denmark, Korea, Switzerland, Turkey and the United Kingdom (n=1 each) |
| Intervention | Root canal retreatment; root-end resection following a standard protocol; root-end resection following a modern protocol (magnification, ultrasonic tips, short bevel, modern sealing materials) | Root-end resection (n=63); CBCT (n=20); antibiotic prophylaxis (n=125); loupes/microscope; PBI (n=19); ultrasonic (n=145); MTA (n=111); glass ionomer cement (n=53); IRM (n=73); calcium sulphate (n=9); GTR bovine bone (n=30); PRGF (n=18); platelet-rich fibrin (n=7); LLLT (n=24) |
| Comparison | Root canal retreatment / alternative surgical materials, devices or techniques (per comparison) | Root canal retreatment (n=63); periapical radiography (n=19); placebo (n=125); endoscope; complete mobilisation (n=19); conventional bur (n=145); IRM/SuperEBA/gutta-percha/amalgam (root-end fillers); no grafting; control |
| Outcomes | Primary: one-year healing of periapical pathosis (clinical + 2D/3D radiographic); adverse effects/sequelae after surgery; patient-reported outcomes (postoperative pain/discomfort, quality of life) in first week. Secondary: healing longer than one year | Healing at 1 year (n=126); healing at 4 years (n=82); healing at 10 years (n=95); participants reporting pain (n=87); participants reporting swelling; healing CBCT vs radiography (n=39); postoperative infection at 4 weeks (n=250); healing loupes vs endoscope (n=71 teeth); healing microscope vs endoscope (n=100 teeth); papilla height loss (n=12); pain PBI vs mobilisation (n=38); healing ultrasonic vs bur (n=290); healing MTA vs IRM (n=222); pain MTA vs IRM (n=100); healing MTA vs SuperEBA (n=192); healing MTA vs gutta-percha (n=46); pain MTA vs gutta-percha (n=42); healing glass ionomer vs amalgam (n=105); healing IRM vs gutta-percha (n=147); healing IRM vs SuperEBA (n=194); healing calcium sulphate vs no grafting (n=18); healing GTR vs no grafting (n=59); pain PRGF vs no grafting (n=36); maximum pain LLLT vs placebo vs control (n=72) |
| Study designs | Randomised controlled trials dealing with root canal retreatment of teeth presenting periapical pathosis | 20 RCTs (27 publications) |
| Timing | One year; longer than one year | 1-year follow-up; 2-year follow-up; 4-year follow-up; 5-year follow-up; 10-year follow-up; postoperative days 1-7 |
Search date: 2016-02-10. Databases: Cochrane Oral Health Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid (1946 to 10 February 2016); Embase Ovid (1980 to 10 February 2016); ClinicalTrials.gov; WHO International Clinical Trials Registry Platform
Questions and results
Current version onlyRoot-end resection (with or without root-end filling; surgical retreatment) vs Root canal retreatment (non-surgical/orthograde)
Population: People with one or more endodontically treated teeth and a periapical condition requiring retreatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Participants reporting swelling first postoperative week | Significantly higher number of participants reporting swelling in the root-end resection group than in the root canal retreatment group during the first postoperative week (Analysis 1.5); per-day totals not pooled. | 1 study | Ungraded |
Healing - 10 years 10 years | RR 1.11 [0.88, 1.41] | 1 study · 95 participants | Ungraded |
Healing - 4 years 4 years | RR 1.03 [0.89, 1.20] | 1 study · 82 participants | Ungraded |
Prevalence of pain - 1 day (participants reporting pain) 1 day (first postoperative week) | RR 3.34 [2.05, 5.43] 279 per 1000 (root canal retreatment) vs 932 per 1000 | 1 study · 87 participants | Low Downgraded: risk of bias |
Healing - 1 year 1 year | RR 1.15 [0.97, 1.35] 726 per 1000 (root canal retreatment) vs 835 per 1000 | 2 studies · 126 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Cone beam computed tomography (CBCT) preoperative evaluation vs Conventional periapical radiography
Population: People requiring retreatment of periapical lesions (failed root canal therapy)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Healing - 1 year 1 year | RR 1.02 [0.70, 1.47] 737 per 1000 (periapical radiography) vs 752 per 1000 | 1 study · 39 participants | Very low Downgraded: risk of bias, imprecision |
Preoperative antibiotic prophylaxis vs Placebo
Population: People requiring retreatment of periapical lesions (failed root canal therapy)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Occurrence of postoperative infection - 4 weeks 4 weeks | RR 0.49 [0.09, 2.64] 32 per 1000 (placebo) vs 16 per 1000 | 1 study · 250 participants | Very low Downgraded: risk of bias, imprecision |
Surgical loupes (magnification) vs Endoscope
Population: People requiring retreatment of periapical lesions (failed root canal therapy)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Healing - 1 year (loupes vs endoscope) 1 year | RR 1.05 [0.92, 1.20] 906 per 1000 (loupes/microscope) vs 952 per 1000 | 1 study · 62 participants | Low Downgraded: risk of bias |
Surgical microscope (magnification) vs Endoscope
Population: People requiring retreatment of periapical lesions (failed root canal therapy)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Healing - 2 years (microscope vs endoscope) 2 years | RR 1.01 [0.89, 1.15] 902 per 1000 (microscope) vs 911 per 1000 | 1 study · 70 participants | Low Downgraded: risk of bias |
Papilla base incision (PBI) vs Complete papilla mobilisation (sulcular incision)
Population: People requiring retreatment of periapical lesions (failed root canal therapy)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Postoperative pain (VAS 0-100) - 3 days 3 days | MD -22.00 [-26.81, -17.19] -22.00 [-26.81, -17.19] mm (VAS 0-100) | 1 study · 38 participants | Ungraded |
Postoperative pain (VAS 0-100) - 2 days 2 days | MD -1.50 [-6.34, 3.34] -1.50 [-6.34, 3.34] mm (VAS 0-100) | 1 study · 38 participants | Ungraded |
Height loss of interdental papilla - 1 year 1 year | MD -1.04 [-1.48, -0.60] -1.04 [-1.48, -0.60] mm | 1 study · 12 participants | Very low Downgraded: risk of bias |
Postoperative pain (VAS 0-100) - 1 day 1 day | MD -2.25 [-7.17, 2.67] -2.25 [-7.17, 2.67] mm (VAS 0-100) | 1 study · 38 participants | Very low Downgraded: risk of bias, imprecision |
Ultrasonic device for root-end preparation vs Conventional bur
Population: People requiring retreatment of periapical lesions (failed root canal therapy)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Healing - 1 year 1 year | RR 1.14 [1.00, 1.30] 709 per 1000 (bur) vs 809 per 1000 | 1 study · 290 participants | Low Downgraded: risk of bias |
Mineral trioxide aggregate (MTA) root-end filling vs Intermediate restorative material (IRM)
Population: People requiring retreatment of periapical lesions (failed root canal therapy)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Prevalence of pain - 1 day 1 day | RR 1.01 [0.84, 1.22] 815 per 1000 (IRM) vs 823 per 1000 | 1 study · 100 participants | Low Downgraded: risk of bias, imprecision |
Healing - 2 years 2 years | RR 1.05 [0.92, 1.20] | 1 study · 108 participants | Ungraded |
Healing - 1 year 1 year | RR 1.09 [0.97, 1.21] 806 per 1000 (IRM) vs 878 per 1000 | 2 studies · 222 participants | Low Downgraded: risk of bias, imprecision |
Mineral trioxide aggregate (MTA) root-end filling vs SuperEBA
Population: People requiring retreatment of periapical lesions (failed root canal therapy)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Healing - 1 year 1 year | RR 0.97 [0.91, 1.04] 956 per 1000 (MTA) vs 927 per 1000 | 1 study · 192 participants | Low Downgraded: imprecision |
Mineral trioxide aggregate (MTA) root-end filling vs Gutta-percha smoothing (orthograde GP root filling)
Population: People requiring retreatment of periapical lesions (failed root canal therapy)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Postoperative pain (VAS 0-100) - 1 day 1 day | MD -4.00 [-16.69, 8.69] -4.00 [-16.69, 8.69] mm (VAS 0-100) | 1 study · 42 participants | Low Downgraded: imprecision |
Healing - 1 year 1 year | RR 1.60 [1.14, 2.24] 619 per 1000 (gutta-percha) vs 990 per 1000 | 1 study · 46 participants | Low Downgraded: imprecision |
Glass ionomer cement root-end filling vs Amalgam
Population: People requiring retreatment of periapical lesions (failed root canal therapy)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Healing - 5 years 5 years | RR 1.00 [0.84, 1.20] | 1 study · 67 participants | Ungraded |
Healing - 1 year 1 year | RR 0.98 [0.86, 1.12] 904 per 1000 (amalgam) vs 886 per 1000 | 1 study · 105 participants | Very low Downgraded: risk of bias, imprecision |
Intermediate restorative material (IRM) root-end filling vs Gutta-percha
Population: People requiring retreatment of periapical lesions (failed root canal therapy)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Healing - 1 year or longer 1 year or longer | RR 0.92 [0.80, 1.05] 885 per 1000 (gutta-percha) vs 814 per 1000 | 1 study · 147 participants | Very low Downgraded: risk of bias, imprecision |
Intermediate restorative material (IRM) root-end filling vs SuperEBA
Population: People requiring retreatment of periapical lesions (failed root canal therapy)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Healing - 1 year or longer 1 year or longer | RR 1.11 [0.99, 1.24] 816 per 1000 (IRM) vs 906 per 1000 | 1 study · 194 participants | Very low Downgraded: risk of bias, imprecision |
Calcium sulphate grafting of the periapical lesion vs No grafting
Population: People requiring retreatment of periapical lesions (failed root canal therapy)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Healing - 1 year 1 year | RR 1.12 [0.83, 1.50] 889 per 1000 (no grafting) vs 996 per 1000 | 1 study · 18 participants | Low Downgraded: imprecision |
Guided tissue regeneration (GTR) with bovine bone mineral + resorbable collagen membrane vs No GTR (no grafting)
Population: People requiring retreatment of periapical lesions (failed root canal therapy)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Healing - 1 year 1 year | RR 1.12 [0.86, 1.46] 743 per 1000 (no grafting) vs 832 per 1000 | 1 study · 59 participants | Low Downgraded: imprecision |
Plasma rich in growth factors (PRGF) graft vs No grafting
Population: People requiring retreatment of periapical lesions (failed root canal therapy)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Postoperative pain (VAS 0-100) - 1 day 1 day | MD -51.60 [-63.43, -39.77] -51.60 [-63.43, -39.77] mm (VAS 0-100) | 1 study · 36 participants | Low Downgraded: imprecision |
Platelet-rich fibrin (PRF) graft vs No grafting
Population: People requiring retreatment of periapical lesions (failed root canal therapy)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Postoperative swelling up to 7 days | Swelling reported significantly less in the PRF group up to 5 days postoperatively (Angerame 2015). | 1 study · 11 participants | Ungraded |
Radiographic healing - 1 year 1 year | Angerame 2015 (7 test, 4 control): no significant difference in healing of the lesion at 1 year; significant difference only at 2- and 3-month follow-up. Small preliminary study; no robust pooled analysis. | 1 study · 11 participants | Ungraded |
Postoperative pain up to 7 days | Pain not assessed by VAS; reported significantly less in the PRF group at two time points only (2 and 6 hours after surgery). | 1 study · 11 participants | Ungraded |
Low energy level laser therapy (LLLT) vs Placebo (sham irradiation, laser inactive)
Population: People requiring retreatment of periapical lesions (failed root canal therapy)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Maximum pain (verbal rating scale, VRS) first postoperative week | Maximum pain (VRS): 0 per 1000 (placebo) vs 0 per 1000 (LLLT); effect not estimable; 52 participants. No high-pain events in either group. 0 per 1000 (placebo) vs 0 per 1000 | 1 study · 52 participants | Very low Downgraded: risk of bias |
Low energy level laser therapy (LLLT) vs Control (no laser device used)
Population: People requiring retreatment of periapical lesions (failed root canal therapy)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Maximum pain (verbal rating scale, VRS) first postoperative week | RR 0.04 [0.00, 0.71] 300 per 1000 (control) vs 0 per 1000 | 1 study · 44 participants | Very low Downgraded: risk of bias |
Placebo (sham irradiation, laser inactive) vs Control (no laser device used)
Population: People requiring retreatment of periapical lesions (failed root canal therapy)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Maximum pain (verbal rating scale, VRS) first postoperative week | RR 0.04 [0.00, 0.61] | 1 study · 48 participants | Ungraded |
Surgical re-treatment (endodontic/periradicular surgery, apicectomy) vs Non-surgical re-treatment (orthograde root canal therapy)
Population: People with one or more endodontically treated teeth and a periapical condition requiring retreatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Postoperative pain (first postoperative week) first postoperative week | Surgical re-treatment associated with significantly more pain (frequency of reporting) than non-surgical in the first postoperative week (Kvist 2000); no pooled estimate reported. | 1 study | Ungraded |
1-year treatment success (healing) rate 1 year | RR 1.13 [0.98, 1.30] | 2 studies · 126 participants | Ungraded |
Postoperative swelling (first postoperative week) first postoperative week | Surgical re-treatment associated with significantly more swelling (frequency of reporting) than non-surgical in the first postoperative week (Kvist 2000); no pooled estimate reported. | 1 study | Ungraded |
2-year treatment success (healing) rate 2 years | RR 1.05 [0.94, 1.18] | 1 study · 88 participants | Ungraded |
Consumption of analgesics and anti-inflammatory drugs first postoperative week | Greater consumption of analgesics and anti-inflammatory drugs recorded for surgically treated than non-surgically treated patients (Kvist 2000); no pooled estimate reported. | 1 study | Ungraded |
4-year treatment success (healing) rate 4 years | RR 0.97 [0.83, 1.13] | 1 study · 82 participants | Ungraded |
Surgical procedure (endodontic surgery, apicectomy, retrograde/root-end therapy) vs Non-surgical procedure (orthograde root canal re-treatment)
Population: People with one or more endodontically treated teeth and a periapical condition requiring retreatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Success (healing) of re-treatment at 1 year 1 year | Protocol only: no studies included; planned primary outcome was success of re-treatment at 1-year follow-up (clinical signs/symptoms + radiographic healing). | 0 studies | No studies |