Table 2.
Regenerative techniques in cases with apical surgery of through-and-through (“tunnel”) lesions.
| Author(s) | Species (initial n/final n) | Teeth (initial n/final n) | Study design | Follow-up | Assessment | Regenerative technique (n sites) | Successful outcome | Comments | Strengths of study | Weaknesses of study |
|---|---|---|---|---|---|---|---|---|---|---|
| Pecora et al. (2001) | Humans (20/18) | 20/18 | Randomized clinical trial | 12 months | Radiographic healing | Test: Calcium sulfate (Surgiplaster®) (9); Control (9) | Test: complete healing (7/9), incomplete healing (2/9); Control: complete healing (3/9), incomplete healing (5/9), unsatisfactory healing (1/9) | Randomization of treatment | Small sample size per group; no standardization of radiographic evaluation | |
| Taschieri et al. (2007) | Humans (NAa/NA) | NA/21 | Randomized clinical trial | 12 months | Clinical and radiographic healing | Test: IBBMa (Bio-Oss®) and collagen membrane (Bio-Gide®) buccally only (8);Control (13) | Test: 75.0%; Control: 61.5% (p N/A) | Data extracted from pooled results of apical and through-and-through lesions | Randomization of treatment | Initial sample size per group not specified; two centers involved; small final sample size per group; no standardization of radiographic evaluation |
| Taschieri et al. (2008) | Humans (27/25) | 34/31 | Randomized clinical trial | 12 months | Clinical and radiographic healing | Test: IBBM (Bio-Oss®) and collagen membrane (Bio-Gide®) buccally only (17); Control (14) | Test: 88.0%, Control: 57.1% (p = 0.02) | Cases with incomplete and uncertain radiographic healing were pooled because of difficult differentiation due to opacity of filler material | Randomization of treatment | Some patients had more than one tooth treated; no standardization of radiographic evaluation |
| Dahlin et al. (1990) | Monkeys (7/6) | 14/12 (maxillary lateral incisors) | Experimental, split-mouth (non-randomized) | 3 months | Histology | Test: ePTFEa (Gore-Tex®) membrane facially and palatally (6); Control (6) | Test: all defects had healed with almost complete closure by newly formed bone; Control: defects were filled with fibrous connective tissue | Maxillary lateral incisors were treated endodontically 3 months before apicectomy and creation of transosseous defects (Ø 8 mm) | Control group; standardization of defects | Short study period; small sample size per group; surgically created defects; no root-end fillings placed |
| Baek and Kim (2001) | Ferrets (8/8) | 16/16 (mandibular premolars) | Experimental | Two subgroups of healing: 6 weeks and 12 weeks | Histology, radiography | Test 1: ePTFE membrane (Gore-Tex®) buccally and lingually (4); Test 2: Polyglactin 910 (PGLAa) membrane (Vicryl®) buccally and lingually (4);Test 3: polylactide membrane (Guidor®) buccally and lingually (4); Control (4) | Histology at 12 weeks: Test 1: defects were filled with regenerated immature bone, Test 2: defects showed extensive lamellar bone healing, Test 3: only limited fibered bone regeneration, Control: connective tissue infiltration Radiography (%) of tissue regeneration after 12 weeks: Test 1: 95%, Test 2: 95%, Test 3: 90%, Control: 80% | Root-canal treatment, creation of transosseous defects, and apicectomies were all carried out in the same session | Control group; standardization of defects | Short study period; small sample size per group; surgically created defects; no root-end fillings placed |
| Murashima et al. (2002) | Dogs (11/11) | 22/22 (mandibular premolars #4) | Experimental split-mouth (randomized) | Two subgroups of healing: 8 weeks and 16 weeks | Histology, histomorphometry | Test: Calcium sulfate (Surgiplaster®) (11); Control (11) | Histology at 16 weeks: Test and control defects almost closed with newly formed bone; cortical bone in control sites more concave than in test sites. Histomorphometry: Bone volume per tissue volume at 8 weeks: Test: 68.4%, Control: 51.6% (p < 0.001); Bone volume per tissue volume at 16 weeks: Test: 81.3%, Control: 64.5% (p < 0.001) | Root-canal treatment, creation of periapical defects, and apical surgery with root-end filling were all carried out in the same session. This study also assessed periapical defects (see Table 1) and apico-marginal defects (see Table 3) | Control group; standardization of defects | Short study period; surgically created defects; different types of lesions tested within same study |
a
IBBM, inorganic bovine bone mineral; ePTFE, expanded polytetrafluoroethylene; NA, not available; PLGA, polylactic-co-glycolic-acid.