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Meta-Analysis
. 2022 Jul 4;58(7):894.
doi: 10.3390/medicina58070894.

Comparison of Endodontic Failures between Nonsurgical Retreatment and Endodontic Surgery: Systematic Review and Meta-Analysis with Trial Sequential Analysis

Mario Dioguardi  1 , Camilla Stellacci  1 , Lucia La Femina  1 , Francesca Spirito  1 , Diego Sovereto  1 , Enrica Laneve  1 , Massimo Francesco Manfredonia  1 , Alfonso D'Alessandro  1 , Andrea Ballini  2 , Stefania Cantore  3 , Lorenzo Lo Muzio  1 , Giuseppe Troiano  1
Affiliations
Meta-Analysis

Comparison of Endodontic Failures between Nonsurgical Retreatment and Endodontic Surgery: Systematic Review and Meta-Analysis with Trial Sequential Analysis

Mario Dioguardi et al. Medicina (Kaunas). .

Abstract

Background and Objectives: In the presence of a persistent endodontic lesion or endodontic failure, the alternative for the recovery of the dental element is endodontic retreatment or endodontic surgery, which consists in the surgical removal of the root apices with retrograde closure of the endodontium. The objective of this systematic review and meta-analysis was to provide an updated value of the Risk Ratio between the two types of treatment in order to offer to clinicians who propose a non-surgical endodontic retreatment or an endodontic surgery a direct comparison. Materials and Methods: The revision was performed according to PRISMA indications: three databases (PubMed, Scopus and Cochrane register) were consulted through the use of keywords relevant to the revision topic: surgical endodontic retreatment, endodontic retreatment, apicoectomy. This search produced 7568 records which, after eliminating duplicates and applying the inclusion and exclusion criteria, resulted in a total of seven included articles. The meta-analyses were conducted by applying fixed-effects models, given the low percentage of heterogeneity. In addition, trial sequency analysis (TSA) was performed for the analysis of the statistical power of the results and GRADE for the quality of the evidence. Results: The results of the meta-analyses' data report an aggregate risk ratio (RR) between non-surgical endodontic retreatment and surgical endodontic retreatment of: 1.05 [0.74, 1.47] at one year of follow-up; RR 2.22 [1.45, 3.41] at two years of follow-up; an RR 1.08 [0.73 1.62] for a follow-up period of 3-4 years; and an RR 0.92 [0.53, 1.61] for a follow-up period of 8-10 years. Conclusions: The results of the present meta-analysis show that in the long term, the risk of failure is identical for the two groups, and there is only a slightly higher risk of failure for non-surgical endodontic retreatments, when only two years of follow-up are considered.

Keywords: apicoectomy; endodontic; endodontic failure; endodontic retreatment; endodontic surgery; endodontically; surgical endodontic retreatment; trial sequential analysis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Entire selection and screening procedures as described in the PRISMA flowchart.
Figure 2
Figure 2
Forest plot of the fixed effects model of the meta-analysis; RR = 1.05, 95% CI: [0.74,1.47]; df = degrees of freedom; I2 = Higgins heterogeneity index, I2 < 50%, heterogeneity irrelevant; I2 > 75%, significant heterogeneity; C.I. = confidence intervals; p = p value; ER = non-surgical endodontic retreatment; A = surgical endodontic retreatments (apicoectomy). The graph for each study shows the first author and the date of publication, Risk Ratio with confidence intervals, the number of failures for each type of retreatment, the number of non-surgical and surgical endodontic retreatments and the weight of each study expressed as a percentage. The final value was expressed in bold with the relative confidence intervals, the blue squares in the center of the confidence intervals represent the effect of the study in the meta-analysis and its size represents the weight of the study. The black line shows the position of the average value, and the rhombus in light black shows the measure of the average effect.
Figure 3
Figure 3
Forest plot of the fixed-effects model of the meta-analysis of the failure data within the 2-year follow-up. RR 2.22 [1.45, 3.41].
Figure 4
Figure 4
Forest plot of the fixed-effects model of the meta-analysis of the failure data within the 3–4-year follow-up. RR 1.08 [ 0.73 1.62] Chi2 = 0.85, df = 2 (p = 0.66).
Figure 5
Figure 5
Forest plot of the fixed-effects model of the meta-analysis of the failure data within the 8–10-year follow-up. RR 0.92 [ 0.53, 1.61] Chi2 = 0.85, df = 2 (p = 0.66).
Figure 6
Figure 6
Funnel plot: (A) follow-up 1 year; (B) follow-up 2 years; (C) follow-up 3–4 years; (D) Follow-up 8–10 years. RR risk rate; SE standard error. Graphically, there are no sources of heterogeneity.
Figure 7
Figure 7
(A,B) Follow-up 1 year; (C,D) follow-up 2 year; light green line (Z = 1.98), dashed red line (monitoring boundary), blue line (cumulative z curve), red line (sample size). AIS (accrued information size (A,C)); APIS (a priori information size (B,D)).
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