Though success rates of endodontic initial treatment have been improving over the years, persistence of periapical disease is far from being a rare condition. The most common therapeutical options for the re-treatment of teeth with periapical pathosis are non-surgical orthograde treatment and surgical treatment. Selection between alternative treatments should be based on assessment of respective benefits (mainly healing) and risks from studies consistent with a high level of evidence.
To test the null hypothesis of no difference in outcome between surgical and non-surgical therapy for endodontic re-treatment of periradicular lesions.
The Cochrane Oral Health Group Trials Register, CENTRAL, MEDLINE and EMBASE were searched with appropriate search strategies. Handsearching included eight dental journals. The bibliographies of relevant clinical trials and relevant articles were checked for identifying studies outside the handsearched journals. Seven manufacturers of instruments in the field of endodontics or endodontic surgery or both, as well as the authors of the identified randomised controlled trials (RCTs) were contacted in order to identify unpublished or ongoing RCTs. No language restriction was placed. The last electronic search was conducted on 3rd April 2007.
All RCTs about re-treatment of teeth with periapical pathosis in which both surgical and non-surgical approaches were used and having a follow up of at least 1 year were considered for the analysis.
Data collection and analysis
A quality assessment of the included RCTs was carried out and the authors were contacted for missing information. We independently extracted the data in duplicate. We followed the Cochrane Collaboration's statistical guidelines.
Three RCTs were identified, two of them reporting different data from the same clinical study. The risk of bias was judged as moderate for one study and high for the other one. 126 cases were followed up for at least 1 year, and 82 had a follow up of 4 years. At the 1-year follow up the success rate for surgical treatment was slightly better than non-surgical (risk ratio (RR) 1.13; 95% confidence interval (CI) 0.98 to 1.30). When the follow up was extended to 4 years (only one RCT made it) the outcome for the two procedures became similar.
The finding that healing rates can be higher for cases treated surgically as compared to those treated non-surgically, at least in the short term, is based on two RCTs only. A single RCT reported that in the medium to long term healing rates for the two procedures are very similar. There is currently scarce evidence for a sound decision making process among alternative treatments for the re-treatment of a periradicular pathosis. More well-designed RCTs should be performed with follow up of at least 4 years, and with a consistent sample size, to detect a true difference in the long term between the outcomes of the two alternative treatments, if any exist.
Cochrane Oral Health Group Trials Register, CENTRAL, MEDLINE 以及 EMBASE有計畫的進行了各種搜尋方式。手動搜尋了8本期刊。並且利用目錄方式搜尋了相關臨床試驗與相關文獻。此外,聯絡了七位與根管治療根管手術有關的器械製造廠商與已知的隨機對照試驗(randomised controlled trials；RCTs)作者連絡,來確認有無未發表或者是正在進行中之隨機對照試驗。 搜尋中未設定語言限制。最新的電子式搜尋日期至2007年4月3號。
對於這些隨機對照試驗會進行品質的評估,並且會聯絡作者以尋求些不詳盡之資訊。我們獨立地檢視實驗數據且重複進行。且依照Cochrane Oral Health Group之統計準則。
三項隨機對照試驗中有兩項發表的不同數據是來自同一個臨床研究；其中之一的偏差風險被認定為中度，另一個則有高度偏差風險；共有126件至少追蹤一年的案例，和82件追蹤四年的案例； 在追蹤一年的案例中發現，手術治療的治癒率略高於非手術治療(risk ratio (RR) 1.13; 95% confidence interval (CI) 0.98 to 1.30) ；當追蹤時間拉長為四年時(只有一項隨機對照試驗符合)，手術與非手術治療的治癒率趨近相等。
在短期追蹤的案例中發現手術治療的癒合率高於非手術治療，資料只緣自於兩項隨機對照試驗； 在一項隨機對照試驗中發現兩者的治癒率其實是相當的；近來有一有力的證據，可用來決定在重新治療一個牙根尖病灶時，如何在許多治療方式中作出適當的選擇；設計更精良的隨機對照試驗應該包含至少追蹤四年以上，及有適當的樣本大小， 才可用來評估這兩種不同治療方法在長期追蹤下的結果，是否有任何具有意義的差異產生。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。
於牙根尖病灶進行手術與非手術根管再治療 長期追蹤治療結果發現，使用手術或非手術方式治療有牙根尖病灶的根管再治療病例，並沒有明顯的幫助； 即使接受手術治療的病例在一年後追蹤發現有較好的治癒率，長期追蹤下來這樣的優勢也消失了；手術治療的方式在術後初期會有較明顯的不舒適感；具有有力的統計上差異的高品質的長期隨機試驗，和標準化所有會影響結果的相關因子是必須的。