Outcomes of surgical endodontic treatment performed by a modern technique: An updated meta-analysis of the literature

Introduction: Numerous studies on outcomes of surgical endodontic treatment have been published to date. However, study designs, treatment protocols, follow-up periods, and inclusion and exclusion criteria have been extremely heterogeneous. Thus, inconsistent and confounding results have been reported. The aim of this systematic review of the literature was to assess the outcomes of surgical endodontic treatment performed using a modern technique, and to evaluate factors potentially influencing the outcome. Methods: Strict inclusion and exclusion criteria were adopted in order to identify randomized clinical trials, controlled trials, and prospective case series that studied surgical endodontic treatments. Treatment success rates were pooled, and the effect of various factors on treatment outcomes was evaluated. Results: In a follow-up of 1 year postoperatively, a successful outcome was achieved in 89.0% of patients. The outcomes obtained in studies using an operative microscope versus an endoscope were not significantly different, but both magnification devices were associated with significantly better outcomes than loupes. The use of MTA and of an operative microscope was associated with better outcomes compared with other retrofilling materials or magnification devices, respectively. Conclusions: Surgical endodontic treatment performed in a modern technique is a viable treatment option. The type of retrofilling material and magnification device may affect the outcome. Additional large-scale prospective clinical studies are needed to further evaluate possible predictors of success and failure.