Effectiveness of root resection techniques compared with root canal retreatment or apical surgery for the treatment of apical periodontitis and tooth survival: A systematic review

Stefano Corbella, Clemens Walter, Igor Tsesis

Research output: Contribution to journalReview articlepeer-review

Abstract

Background: To manage apical periodontitis in root filled maxillary and mandibular molars, root resection techniques may be employed to avoid the loss of the tooth. Objectives: The objectives of the study were to systematically analyse the effectiveness of root resection techniques (root resection/crown resection/root amputation) for the management of apical periodontitis with non-surgical root canal retreatment or apical surgery by the evaluation of clinical and patient-related outcomes (PROMS), in human experimental studies and longitudinal studies. Methods: An electronic literature search in PubMed, MEDLINE via OVID interface, EMBASE and Cochrane Central, supplemented by a manual hand search of the grey literature, was performed up to 25th September 2021. Randomized controlled trials, comparative clinical trials and observational studies reporting on the outcome (tooth survival and patient-reported outcome measures with a minimum follow-up of 1 year) of root resection techniques for treating apical periodontitis were identified. The risk of bias was evaluated using the Newcastle–Ottawa scale. Results: From a total of 2098 reports, 36 were considered for further screening. Three retrospective studies, published between 2018 and 2020, were included in this systematic review. A high heterogeneity in terms of protocols, study design and the reported outcomes were observed. The risk of bias was scored as low to moderate. These three studies consisted of data from 305 resected teeth, from 254 patients, with a follow-up period of 1–16.8 years. Overall, 151 teeth were extracted during the follow-up period. In these studies, root resection treatment was carried out on 42 teeth exclusively for endodontic reasons. One of these studies reported 12 out of 23 teeth lost at follow-up. None of the studies reported on PROMS. Discussion: Although root resection techniques may be used for treating teeth with apical periodontitis, the data are limited. Furthermore, the studies are very heterogeneous and associated with high risk of bias. Conclusions: Given the current level of available evidence, it is not possible to recommend, or dismiss, root resection techniques for managing apical periodontitis. Registration: PROSPERO database (CRD42021260306).

Original languageEnglish
Pages (from-to)487-498
Number of pages12
JournalInternational Endodontic Journal
Volume56
Issue numberS3
DOIs
StatePublished - Oct 2023

Keywords

  • apical periodontitis
  • root resection
  • surgical endodontics
  • systematic review
  • tooth resection

All Science Journal Classification (ASJC) codes

  • General Dentistry

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