The Effect of Regeneration Techniques on Periapical Surgery With Different Protocols for Different Lesion Types: A Meta-Analysis

Purpose: To evaluate the effect of regeneration techniques (RTs) on the outcome of periapical surgery with different protocols for different lesion types. Materials and Methods: PubMed, the Cochrane Library, and Embase were searched from the beginning of time until December 30, 2014. Studies that met the inclusion criteria were systematically evaluated, and a meta-analysis was performed. Results: Eight randomized controlled trials met the inclusion criteria. A significantly better outcome was found in the combination group (membranes plus bone replacement analogues) (risk ratio [RR], 0.41; 95% confidence interval [CI], 0.22 to 0.77; P = .005) and bone replacement analogue-only group (RR, 0.48; 95% CI, 0.23 to 0.98; P = .04), whereas no significant beneficial effect was found in the membrane-only group (RR, 0.59; 95% CI, 0.29 to 1.17; P = .13). The use of RTs favorably affected the outcome of periapical through-and-through lesions (RR, 0.38; 95% CI, 0.18 to 0.84; P = .02) and large lesions ($10 mm) (RR, 0.52; 95% CI, 0.28 to 0.97; P = .04), whereas there was no significant benefit of using RTs for 4-wall lesions (RR, 0.54; 95% CI, 0.27 to 1.07; P = .08). Conclusions: Both the isolated use of bone replacement analogues and the combination of membranes and bone replacement analogues can improve the outcome of periapical surgery, whereas using membranes alone does not have significantly favorable effects. The use of RTs for through-and-through and large lesions should be recommended. (C) 2016 American Association of Oral and Maxillofacial Surgeons