Impact of different regenerative techniques and materials on the healing outcome of endodontic surgery: a systematic review and meta-analysis.

BACKGROUND: Regenerative techniques are increasingly applied in endodontic surgery, but different materials used in regenerative techniques may have varying impacts on wound healing. OBJECTIVES: This study evaluated the effects of different regenerative techniques and materials on the outcome of endodontic surgery. PARTICIPANTS: patients with persistent periapical lesions, treated with root-end surgery. CONTROL: endodontic surgery without the use of regenerative techniques/materials. INTERVENTION: endodontic surgery with the use of regenerative techniques/materials. OUTCOME: combined clinical and radiographic results. METHODS: PubMed, Web of Science, Embase, SinoMed and the CENTRAL Cochrane were searched up to 10th July 2020, followed by a manual search. Detailed eligibility criteria were applied. Cochrane's risk-of-bias tool 2.0 was used to assess the risk of bias of the eligible studies. Meta-analysis was conducted using RevMan software. Subgroup analyses were performed based on the regenerative materials used in endodontic surgery. RESULTS: Eleven eligible randomized controlled trials (RCTs) were included in the meta-analysis: two had a low risk of overall bias, and nine had some concerns of overall bias. Generally, the use of regenerative techniques significantly improved the outcome of endodontic surgery (risk ratio [RR]: 0.42; 95% confidence interval [CI], 0.26-0.68; P < 0.001). On subgroup analysis, the use of expanded polytetrafluoroethylene (e-PTFE) membranes alone had no added benefits (RR: 2.00; 95% CI, 0.22-18.33; P = 0.54). The application of collagen membranes or autologous platelet concentrates (APCs) alone was associated with a trend for better outcomes (RR: 0.51; 95% CI, 0.20-1.25; P = 0.14) (RR: 0.55; 95% CI, 0.18-1.71; P = 0.30). The combined use of collagen membranes and bovine-derived hydroxyapatite significantly improved the outcome (RR: 0.35; 95% CI, 0.17-0.75; P = 0.007). DISCUSSION: This systematic review evaluated the effects of collagen membranes, e-PTFE membranes, APCs and bone grafting materials, providing detailed information about the risks and benefits of using each regenerative technique/material or its combination in endodontic surgery. CONCLUSIONS: Regenerative techniques improve periapical lesion healing after endodontic surgery. The combined use of collagen membranes and bovine-derived hydroxyapatite may be beneficial as an adjunct to endodontic surgery. In contrast, the positive efficacy of e-PTFE membranes or APCs alone remains doubtful.

Treatment of Hemophilic Ankle Arthropathy with One-Step Arthroscopic Bone Marrow-Derived Cells Transplantation.

OBJECTIVE: Ankle arthropathy is a frequent and invalidating manifestation of hemophilia. Arthrodesis is the gold standard surgical procedure in end-stage disease, with many drawbacks in young patients. Recent literature has shown increase interest in regenerative procedures in hemophilic arthropathy, which may be desirable to delay or even avoid arthrodesis. The aim of this article is to present five cases of osteochondral lesions in ankle hemophilic arthropathy treated with a regenerative procedure: bone marrow-derived cells transplantation (BMDCT). DESIGN: We report five hemophilic patients (four cases with hemophilia type A; one case with hemophilia type B) who have undergone BMDCT treatment, synovectomy, and arthroscopic debridement, with the use of autologous platelet-rich fibrin, to treat osteochondral lesions in hemophilic ankle arthropathy. The patients, included within this retrospective study, were clinically and radiologically evaluated with serial follow-ups, using the American Orthopaedic Foot and Ankle Society (AOFAS) scores, radiographs, and magnetic resonance imaging (MRI). RESULTS: The mean preoperative AOFAS score was 35. After a mean follow-up of 2 years, the mean postoperative AOFAS score was 81, which included three patients returning back to sporting activities. The MRI Mocart score demonstrated signs of regeneration of chondral and bony tissue. No progression of joint degeneration was shown radiographically. CONCLUSION: BMDCT is a promising regenerative treatment for osteochondral lesions in mild ankle hemophilic arthropathy, which may be useful to delay or even avoid ankle arthrodesis. Nevertheless, longer follow-ups and a larger case series are required.

Osteochondral repair in hemophilic ankle arthropathy: from current options to future perspectives.

Young hemophilic patients are frequently affected by ankle arthropathy. At the end stage of the disease, the current treatments are arthrodesis and arthroplasty, which have significant drawbacks. Validated procedures capable of slowing down or even arresting the progression towards the end stage are currently lacking. This review aims to discuss the rationale for and feasibility of applying, in mild hemophilic ankle arthropathy, the main techniques currently used to treat osteochondral defects, focusing in particular on ankle distraction, chondrocyte implantation, mesenchymal stem cell transplantation, allograft transplantation and the use of growth factors. To date, ankle distraction is the only procedure that has been successfully used in hemophilic ankle arthropathy. The use of mesenchymal stem cells have recently been evaluated as feasible for osteochondral repair in hemophilic patients. There may be a rationale for the use of growth factors if they are combined with the previous techniques, which could be useful to arrest the progression of the degeneration or delay end-stage procedures.

The use of regenerative techniques in apical surgery: A literature review.

Apical surgery has become a standard of care for tooth maintenance if conventional endodontic retreatment is not possible or associated with risks. However, in certain situations, the outcome of apical surgery may be compromised due to the extent or location of the periapical or periradicular lesions. The present review article including clinical and experimental studies reports and discusses the outcome of regenerative techniques (RT) in conjunction with apical surgery, with regard to the type of periradicular lesions: APICAL LESIONS: The majority of studies have shown no benefit for healing in test sites treated with RT compared to control sites treated without RT. The use of a radio-opaque bone filler/substitute may even compound the radiographic interpretation of periapical healing. Currently, the use of RT for lesions <10 mm limited to the apical area is not warranted. THROUGH-AND-THROUGH LESIONS: All reviewed studies demonstrated a better outcome for test sites with RT compared to the control sites without RT; hence the use of RT for treatment of tunnel lesions in apical surgery is recommended. APICO-MARGINAL LESIONS: All clinical studies assessed cohorts without controls, and, therefore, no firm conclusion about the benefit of RT for treatment of apico-marginal lesions in conjunction with apical surgery can be drawn. However, the experimental animal studies have shown that healing of teeth with apico-marginal lesions appears to benefit from RT.

Avaliação histológica de película alternativa para técnicas regenerativas: estudo experimental em mandíbula de ratos / Histological evaluation of alternative film for regenerative techniques: experimental study in rat mandibles

Introdução: Atualmente o Teflon possui várias aplicações biológicas e é utilizado tanto em medicina como em odontologia. Na odontologia, é empregado principalmente como barreira, nas técnicas de regeneração tecidual guiada (RTG) e regeneração óssea guiada (ROG), apresentando diferentes níveis de sucesso. Objetivo: O objetivo do presente estudo foi avaliar histologicamente o uso de uma película de Teflon sobre defeitos ósseos intraorais criados cirurgicamente em ratos. Material e métodos: Foram usados 16 ratos machos (Wistar) adultos, os quais foram divididos em 2 grupos: grupo T (teste) e grupo C (controle). Dois tempos experimentais foram analisados, com 1 e 3 semanas. Os defeitos ósseos foram cirurgicamente criados na mandíbula, unilateralmente, por ação de broca esférica multilaminada (Carbide) de 3 mm de diâmetro anteriormente à região mentoniana dos animais. No grupo T, o defeito ósseo foi recoberto com uma película de Teflon (politetrafluoretileno expandido, PTFE-e). No grupo C, o defeito foi preenchido somente com coágulo sanguíneo. Esperou-se o tempo necessário e realizou-se a eutanásia dos animais. Resultados: Em virtude da alta maleabilidade, a película de Teflon acabou por preencher os defeitos experimentais, o que gerou uma reação tecidual local caracterizada pela presença de infiltrado inflamatório crônico e agudo, tanto no grupo T de 1 semana como no grupo T de 3 semanas. No grupo T de 3 semanas observou-se o desenvolvimento de tecido ósseo com mineralização inicial da matriz apenas a partir das bordas do defeito. O desenvolvimento ósseo a partir das bordas também aconteceu no grupo C, com ausência de processos inflamatórios intensos; no entanto a manutenção do volume tecidual foi baixa. Conclusão: No modelo experimental apresentado, concluiu-se que o preenchimento do defeito ósseo pela película de Teflon foi prejudicial ao reparo ósseo local. Para uso dessa película em técnicas regenerativas é necessário melhorar as propriedades física...

Introduction: Today, Teflon is used for many biological applications in medicine and dentistry. In dentistry, it is used especially as a barrier, in the guided tissue regeneration (GTR) and guided bone regeneration (GBR) techniques, presenting different levels of success. Objective: The objective of the present study was to evaluate through histological analysis the use of a Teflon film placed over intra-oral bone defects surgically created in rats. Material and methods: 16 adult male rats (WISTAR) were divided in two groups: group T (test) and C (control). Two experimental monitoring periods were analyzed: one and three weeks. Bone defects were surgically created in the right mandible, with the use of a carbide bur (3 mm diameter), anterior to the mentonian region. In T group, bone defect was covered with a film of Teflon (expanded polytetrafluoroethylene, e-PTFE). In C group, defect was filled only with blood clot. After monitoring periods went through, animals were euthanized. Results: Due to the high malleability Teflon film filled the experimental defects, which caused a local tissue response characterized by the presence of a chronicle and acute inflammatory infiltrate, either at 1 or 3 weeks T groups. In 3-week T group, it was possible to observe the development of bone tissue with initial matrix mineralization only from the edges of the defect. Bone development from the edges also happened in C group, with absence of intense inflammatory processes. However, maintenance of tissue volume was poor. Conclusion: In the presented experimental model it was possible to conclude that filling bone defect with Teflon film was prejudicial to local bone repair. To use Teflon film for regenerative techniques it is necessary to improve physical properties, diminishing its malleability.