Impact of different regenerative techniques and materials on the healing outcome of endodontic surgery: a systematic review and meta‐analysis.

Background: Regenerative techniques are increasingly applied in endodontic surgery, but different materials used in regenerative techniques may have varying impacts on wound healing. Objectives: This study evaluated the effects of different regenerative techniques and materials on the outcome of endodontic surgery. Participants: patients with persistent periapical lesions, treated with root‐end surgery. Control: endodontic surgery without the use of regenerative techniques/materials. Intervention: endodontic surgery with the use of regenerative techniques/materials. Outcome: combined clinical and radiographic results. Methods: PubMed, Web of Science, Embase, SinoMed and the CENTRAL Cochrane were searched up to 10th July 2020, followed by a manual search. Detailed eligibility criteria were applied. Cochrane's risk‐of‐bias tool 2.0 was used to assess the risk of bias of the eligible studies. Meta‐analysis was conducted using RevMan software. Subgroup analyses were performed based on the regenerative materials used in endodontic surgery. Results: Eleven eligible randomized controlled trials (RCTs) were included in the meta‐analysis: two had a low risk of overall bias, and nine had some concerns of overall bias. Generally, the use of regenerative techniques significantly improved the outcome of endodontic surgery (risk ratio [RR]: 0.42; 95% confidence interval [CI], 0.26–0.68; P < 0.001). On subgroup analysis, the use of expanded polytetrafluoroethylene (e‐PTFE) membranes alone had no added benefits (RR: 2.00; 95% CI, 0.22–18.33; P = 0.54). The application of collagen membranes or autologous platelet concentrates (APCs) alone was associated with a trend for better outcomes (RR: 0.51; 95% CI, 0.20–1.25; P = 0.14) (RR: 0.55; 95% CI, 0.18–1.71; P = 0.30). The combined use of collagen membranes and bovine‐derived hydroxyapatite significantly improved the outcome (RR: 0.35; 95% CI, 0.17–0.75; P = 0.007). Discussion: This systematic review evaluated the effects of collagen membranes, e‐PTFE membranes, APCs and bone grafting materials, providing detailed information about the risks and benefits of using each regenerative technique/material or its combination in endodontic surgery. Conclusions: Regenerative techniques improve periapical lesion healing after endodontic surgery. The combined use of collagen membranes and bovine‐derived hydroxyapatite may be beneficial as an adjunct to endodontic surgery. In contrast, the positive efficacy of e‐PTFE membranes or APCs alone remains doubtful. [ABSTRACT FROM AUTHOR]