Influence of the Retrograde Filling Material on the Success of Periapical Surgery. Systematic Review and Meta-Analysis by Groups

Abstract

Periapical surgery is a procedure indicated for the treatment of persistent apical periodontitis in an endodontically treated tooth and when retreatment has not been successful or not feasible. Various materials have been suggested and tested for this purpose: amalgam, MTA, and zinc-eugenol oxide cements, among others. The objective of the present study was to evaluate the results regarding the success of the periapical surgery and if the retrograde filling material used influences this success rate. A systematic review of the literature on the prognosis of periapical surgery was performed. The following PICO question was asked: “In patients who require periapical surgery (patient), is the retrograde filling (comparison) material used in apicoectomy (intervention) determining for the success of the treatment (outcome)?” Periapical surgery achieves successful results in 84% of cases. All the materials compared obtain satisfactory results. The results of the meta-analysis show that there are no statistically significant differences between MTA compared to SuperEBA (1.37 (95% CI: 0.87, 2.15)) or RRM (0.99 (95% CI: 0.51, 1.94)) but with MRI (1.93 (95% CI: 1.22, 3.05)), where the results favour MTA. In general, the most modern materials obtain better results than amalgam. Surgical techniques with magnification obtain better results (12.3% failure) than conventional techniques (22.93% failure). Periapical surgery is a procedure with a high success rate. The use of all the materials compared obtains satisfactory results. Magnification surgery techniques perform better than conventional techniques.