Objective To systematically review the effectiveness of different therapies for chronic periapical lesion (CPL), such as different root canal surgeries and conventional root canal obturation. Methods The following databases such as The Cochrane Library, MEDLINE, EMbase, VIP, CNKI, CMB and WanFang Data were searched to collect the randomized controlled trials (RCTs) and concurrent controlled trials (CCTs) on CPL treated by both conventional root canal obturation and different root canal surgeries such as periapical curettage, retrograde obturation and apicoectomy. The references of the included studies were also retrieved, and the retrieval time was from inception to October 2012. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the quality. Then after cross-checking, the meta-analyses were performed by using RevMan 5.0 software. Results A total of 7 RCTs and 11 CCTs involving 1 663 patients were included. Among all 1 727 teeth, 1 661 met the inclusion criteria which contained 1 151 in the root canal surgeries groups, and 510 in the conventional groups. The methodological quality of all included studies was low. The results of meta-analysis showed that, in general, different root canal surgeries plus conventional root canal obturation were more effective than root canal obturation alone (RR=1.12, 95%CI 1.08 to 1.18, Plt;0.000 01). The results of sub-group analysis revealed that, the total effective rate of both retrograde obturation (RR=1.3, 95% CI 1.15 to 1.46, Plt;0.000 1) and apicoectomy (RR=1.23, 95% CI 1.04 to 1.46, P=0.02) was superior to that of periapical curettage, with significant differences in both sub-groups. But retrograde obturation took similar effect as apicoectomy did, without a significant difference (RR=0.96, 95% CI 0.83 to 1.11, P=0.61). Conclusion This systematic review suggests that, root canal obturation plus root canal surgeries is superior to root canal obturation alone in treating chronic periapical lesions. The comparison among different root canal surgeries reveals that, both apicoectomy and retrograde obturation are superior to periapical curettage. For the quantity and quality limitation of the included studies, additionally, the possibly existing bias because it is difficult to conduct surgeon and patient blind methods in root canal obturation and root canal surgeries in clinic, so the above conclusion has to be further proved by performing more well-designed and high quality RCTs.
Objective To evaluate the effectiveness of four-handed dentistry versus two-handed dentistry in root canal therapy. Methods The CBM, VIP, CNKI, Wanfang, PubMed, EMbase, and CENTRAL were searched for collecting relevant randomized controlled trails (RCTs) in English or Chinese from establishment dates to August 31, 2011. After quality evaluation and data extraction independently conducted by two authors, the meta-analyses were performed using the RevMan 5.1, and the evidences were graded using the GRADEprofile 3.6. Results Fourteen studies involving 2 906 patients were included. The results of qualitative analysis and meta-analyses showed that compared with two-handed dentistry, four-handed dentistry could obviously shorten operating time, improve satisfaction of patients and doctors, lower the risk of hole pollution, and improve treatment quality, all the differences were significant; but there was no significant difference in postoperative pain during the first week. Based on the GRADE system, the importance of outcomes was “important” or “critical”, while the level of evidences was from “extremely low” to “high”. Conclusion Current evidence shows that four-handed dentistry is superior to two-handed dentistry, but it suggests a weak recommendation to dental workers. Due to the limitations of included studies, more large-sample and high-quality RCTs, and especially performing “cost-effectiveness analysis” as the key outcome are required.
ObjectiveTo systematically review the healing rate of single-versus multiple-visit root canal treatment for teeth with infected root canals. MethodsPubMed, EMbase, EBSCO, MEDLINE, The Cochrane Library (Issue 3, 2015), CNKI, VIP, CBM and WanFang Data databases were searched from inception to March 2015, to collect randomized controlled trials (RCTs) concerning single-versus multiple-visit root canal treatment for teeth with infected root canals. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3.5 software. ResultsA total of 9 RCTs involving 1 146 teeth were included. The results of meta-analysis showed that:the healing rates were 88.98% in the single-visit group, and 85.61% in the multiple-visit group, respectively. There were no significant difference between two groups (OR=1.36, 95%CI 0.95 to 1.96, P=0.09). ConclusionCurrent evidence shows that, the healing rate of single- and multiple-visit root canal treatment is similar for infected root canals. Due to the limited quantity of included studies, more high quality studies are needed to validate the above conclusion.
ObjectivesTo systematically review the efficacy of photodynamic therapy (PDT) and sodium hypochlorite (NaClO) for removal of Enterococcus faecalis (E. faecalis) in root canal therapy.MethodsWe searched PubMed, EMbase, The Cochrane Library, CBM, WanFang Data, CNKI and VIP databases to collect randomized controlled trials (RCTs) on PDT versus NaClO for removal of E. faecalis from inception to October, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software.ResultsA total of 17 RCTs were included. The results of meta-analysis showed that, comparing PDT with 5.25%NaClO, there was no significant difference in the remaining colony-forming units (CFUs) of E. faecalis between both groups (MD=0.55, 95%CI −0.72 to 1.83, P=0.40); comparing PDT with 2.5%NaClO, there was no significant difference in the remaining CFUs of E. faecalis between both groups (MD=0.54, 95%CI −0.32 to 1.41, P=0.22).ConclusionsThe current evidence indicates that PDT and NaClO show similar efficacy against the intracanal E. faecalis. Due to the limited quality and quantity of included studies, more high quality studies are required to verify the above conclusions.