Materiales para la obturación retrógrada en el tratamiento del conducto radicular
Referencias
Referencias de los estudios incluidos en esta revisión
Referencias de los estudios excluidos de esta revisión
Referencias de los estudios en curso
Referencias adicionales
Referencias de otras versiones publicadas de esta revisión
Characteristics of studies
Characteristics of included studies [ordered by study ID]
| Study characteristics | ||
| Methods | Study type: RCT Sample size calculation: yes Follow‐up period: 12 and 24 months Loss to follow‐up: 61 patients with 61 teeth were lost at 12 months, and 75 patients with 75 teeth were lost at 24 months Intention‐to‐treat analysis: not reported Funding: DHSC London. Research & Development, Responsive Funding Programme | |
| Participants | Country: UK Centres: 1 Inclusion criteria: tooth with apical periodontitis, diagnosed radiologically; the tooth could not be adequately and better managed by root canal retreatment; the tooth had an adequate root canal filling; the crown of the tooth was adequately restored; and periodontal probing depths were < 4 mm except for an unilocular sinus tract Exclusion criteria: participants who failed to satisfy the entry requirements Total recruited: number of participants: 183; number of teeth: 183; age range: unclear; mean age: unclear; gender (male/female): unclear
(Note: the number of participants in each group at baseline was not reported in the article. And the numbers of participants in each group at 12‐month and 24‐month follow‐ups were recorded as following
| |
| Interventions | Materials
Preparation of the cavity: ultrasonically using CT tips | |
| Outcomes | Success rate: assessed by Guidelines of the European Society of Endodontology (1994) and Molven 1987 which required an assessment with the combination of clinical and radiological methods Adverse events: not reported | |
| Notes | Study author contact failed | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "The randomisation process was carried out on the day of the surgery; one of the two research team members performing the surgery picked a sealed envelope from a pack to reveal which material to use" Comment: low risk |
| Allocation concealment (selection bias) | Low risk | Quote: "The randomisation process was carried out on the day of the surgery; one of the two research team members performing the surgery picked a sealed envelope from a pack to reveal which material to use" Comment: low risk |
| Blinding of participants and personnel (performance bias) | High risk | Comment: high risk. It is not possible to blind the personnel |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "The observers were unaware of the group from which the radiographs were taken" Comment: low risk. None of the outcomes were patient‐reported outcomes, so once the observers were blinded to the treatment, there would be no assessment bias |
| Incomplete outcome data (attrition bias) | High risk | Comment: high risk. Follow‐up was not reported clearly. The study authors did not report the number of participants in each group at baseline. Also, the number of participants lost to follow‐up in the 1st year and 2nd year follow‐ups is too high (61 (33%) participants lost to follow‐up in the 1st year and another 36 participants with 97 in total (53%) lost to follow‐up in the 2nd year, with the total number of participants at baseline reported as 183) |
| Selective reporting (reporting bias) | Low risk | Comment: low risk. The outcomes were reported as planned |
| Other bias | Unclear risk | Comment: unclear risk. The baseline numbers of each group were not clearly reported, and the numbers of lost to follow‐up were unclear |
| Study characteristics | ||
| Methods | Study type: RCT Sample size calculation: unclear Follow‐up period: 12 months Loss to follow‐up: 12 teeth of 12 participants Intention‐to‐treat analysis: not reported Funding: unclear | |
| Participants | Country: Denmark Centres: 1 Inclusion criteria: unclear Exclusion criteria: teeth previously subjected to periapical surgery and teeth with apicomarginal communication Total recruited: number of participants: 134; number of teeth: 134; number of roots: 178; age range: unclear; mean age: 49 years; gender (male/female): 48/86
| |
| Interventions | Materials
Preparation of the cavity: with a ball‐shaped diamond bur | |
| Outcomes | Success rate: assessed with criteria from Zuolo 2000 which required an assessment with the combination of clinical and radiological methods. And the study authors also assessed the success rate of each root with the Rud 1972 criteria which only required radiological assessment Adverse events: not reported | |
| Notes | The study author was contacted and details about randomisation, blinding, and allocation concealment were confirmed | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote (author's reply): "A randomisation scheme was created using the SAS system" Comment: low risk |
| Allocation concealment (selection bias) | Unclear risk | Quote (author's reply): "The surgeon knew at the beginning of the surgery, which materials that would be used for that specific operation" Comment: unclear risk |
| Blinding of participants and personnel (performance bias) | High risk | Quote (author's reply): "It was not possible to blind the operator and the clinician since the materials looked differently clinically and radiographically. However, the patients and the statistical assessor were blinded" Comment: high risk |
| Blinding of outcome assessment (detection bias) | High risk | Quote (author's reply): "It was not possible to blind the operator and the clinician since the materials looked differently clinically and radiographically. However, the patients and the statistical assessor were blinded" Comment: high risk. None of the outcomes were patient‐reported outcomes, so once the observers were not blinded to the treatment, there would be a risk of assessment bias |
| Incomplete outcome data (attrition bias) | Low risk | Comment: low risk. 12 participants lost to follow‐up. The lost to follow‐up rate < 10% |
| Selective reporting (reporting bias) | Low risk | Comment: low risk. The outcomes were reported as planned |
| Other bias | Low risk | Comment: low risk |
| Study characteristics | ||
| Methods | Study type: RCT Sample size calculation: unclear Follow‐up period: 12 and 60 months Loss to follow‐up: 18 participants with 23 teeth were lost at 60‐month follow‐up Intention‐to‐treat analysis: not reported Funding: unclear | |
| Participants | Country: Sweden Centres: 1 Inclusion criteria: teeth indicated for periapical surgery (i.e. teeth with periapical lesions not accessible to conventional endodontic treatment) Exclusion criteria: participants who failed to satisfy the entry requirements Total recruited: number of participants: 85; number of teeth: 105; age range: unclear; mean age: unclear; gender (male/female): unclear. (The numbers in this item only indicate the numbers in 12‐month follow‐up, the exact number of participants/teeth in each group was unclear)
| |
| Interventions | Materials
Preparation of the cavity: with a number 33.5 inverted cone bur | |
| Outcomes | Success rate: with criteria from Zetterqvist 1991 which required an assessment with the combination of clinical and radiological methods Adverse events: not reported | |
| Notes | Study author contact failed | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "Each tooth was then filled with either AM (Amalcap non‐gama‐2; Vivadent, Schaan, Liechtenstein) or GC (Chem‐Fil, De Trey, Zurich, Switzerland) in a randomised fashion" Comment: unclear risk |
| Allocation concealment (selection bias) | Unclear risk | Comment: unclear risk |
| Blinding of participants and personnel (performance bias) | High risk | Comment: high risk. It was not possible to blind the personnel |
| Blinding of outcome assessment (detection bias) | Unclear risk | Comment: unclear risk |
| Incomplete outcome data (attrition bias) | Unclear risk | Comment: unclear risk. 18 of 85 participants lost to follow‐up at 60 months; the lost to follow‐up ratio was between 10% and 20% and we decided to rate this domain as at unclear risk of attrition bias |
| Selective reporting (reporting bias) | Low risk | Comment: low risk. The outcomes were reported as planned |
| Other bias | Unclear risk | Comment: unclear risk. The study authors did not clearly report the demographic characteristics of the participants in each group and they did not mention whether the 2 groups were comparable |
| Study characteristics | ||
| Methods | Study type: RCT Sample size calculation: yes Follow‐up period: 12 and 48 months Loss to follow‐up: 68 participants with 68 teeth lost at 12 months, 78 participants with 78 teeth lost at 48 months Intention‐to‐treat analysis: no Funding: the National Research Foundation of Korea | |
| Participants | Country: South Korea Centres: 1 Inclusion criteria: all root‐filled cases with symptomatic or asymptomatic apical periodontitis Exclusion criteria: teeth with Class II mobility or greater, horizontal and vertical fractures, and perforations. Through endodontic microsurgery, teeth with a through‐and‐through lesion and/or a lesion of combined periodontal endodontic origin were also excluded Total recruited: number of participants: 260; number of teeth: 260; age range: unclear; mean age: unclear; gender (male/female): unclear
| |
| Interventions | Materials
Preparation of the cavity: ultrasonic apical preparation, with microscope | |
| Outcomes | Success rate: using criteria from Molven 1987 and Molven 1996 which required an assessment with the combination of clinical and radiological methods Adverse events: not reported | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "They [teeth] were randomly assigned to either the Super‐EBA group or the MTA group (130 teeth per group) using the 'minimization method' as described by Pocock" Comment: low risk |
| Allocation concealment (selection bias) | Unclear risk | Quote: "The random allocation sequence was generated by an assistant." Author's reply: "When the patient registered, we gave the patient information regarding sex, age, tooth type and got the assignment group" Comment: unclear risk |
| Blinding of participants and personnel (performance bias) | High risk | Quote (author's reply): "Patients and statistician do not know but the operators know the allocated intervention because the MTA and Super‐EBA is different by just looking" Comment: high risk |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "The radiographic findings were evaluated blindly and independently by 2 examiners using the same criteria" Comment: low risk |
| Incomplete outcome data (attrition bias) | High risk | Quotes: "Among the 260 teeth included in this randomized controlled trial, 192 teeth were examined at the 12‐month follow‐up;" "Among the 260 teeth included in this randomized controlled trial, 182 were examined at the 4‐year follow‐up" Comment: teeth/participants lost to follow‐up reached to 26.1% at 1‐year and 30% at 4‐year; assessed as high risk |
| Selective reporting (reporting bias) | Low risk | Comment: low risk. The outcomes were reported as planned |
| Other bias | Low risk | Quote: "The following 3 randomization factors were considered: sex, age, and tooth type" Comment: low risk |
| Study characteristics | ||
| Methods | Study type: RCT Sample size calculation: unclear Follow‐up period: 12 months Loss to follow‐up: none Intention‐to‐treat analysis: yes Funding: unclear | |
| Participants | Country: the Netherlands Centres: 1 Inclusion criteria: teeth with a dental history of a root canal treatment and demonstrated a periradicular lesion of strictly endodontic origin with or without clinical signs or symptoms. Only single‐rooted teeth were included in this study Exclusion criteria: teeth with perforations of the lateral canal walls, periodontal attachment loss (pocket depth < 5 mm), teeth with vertical fractures, and teeth exhibiting radiographic lesions exceeding 1 cm Total recruited: number of participants: 90; number of teeth: 100; age range: 17 to 64 years; mean age: 43.4 years; gender (male/female): 33/57
| |
| Interventions | Materials
Preparation of the cavity: ultrasonic apical preparation | |
| Outcomes | Success rate: using combined criteria (Molven 1987; Rud 1972) which required an assessment with the combination of clinical and radiological methods Adverse events: not reported | |
| Notes | The study author was contacted and details about blinding, follow‐up, and baseline status were provided | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Randomization was carried out by a nurse who picked a sealed envelope and opened it at the time of placement of the retrograde filling. On a label the filling material was written" Comment: low risk |
| Allocation concealment (selection bias) | Low risk | Quote: "Randomization was carried out by a nurse who picked a sealed envelope and opened it at the time of placement of the retrograde filling. On a label the filling material was written" Comment: low risk |
| Blinding of participants and personnel (performance bias) | High risk | Quote (author's reply): "The patients, assessors and statisticians were blinded for the materials, surgeons were not blinded for the filling material (since obviously there is a clinical difference between the materials)" Comment: high risk |
| Blinding of outcome assessment (detection bias) | Low risk | Quote (author's reply): "The patients, assessors and statisticians were blinded for the materials, surgeons were not blinded for the filling material (since obviously there is a clinical difference between the materials)" Comment: low risk |
| Incomplete outcome data (attrition bias) | Low risk | Quote (author's reply): "None of the patients were lost for follow‐up, although this required an extra effort from the researchers since phone‐call or home visits had to be made in order to get the patient info/x‐ray" Comment: low risk |
| Selective reporting (reporting bias) | Low risk | Comment: adequate. The outcomes were reported as planned |
| Other bias | Low risk | Quote (author's reply): "The gender, age and severity of disease were comparable in both groups" Comment: low risk |
| Study characteristics | ||
| Methods | Study type: RCT Sample size calculation: yes Follow‐up period: the minimum follow‐up period for all cases was 12 months; the mean follow‐up time was 15 months Loss to follow‐up: 123 teeth lost at 12 months Intention‐to‐treat analysis: no Funding: unclear | |
| Participants | Country: USA Centres: 1 Inclusion criteria: age 18 years and older consenting to the surgical procedure as well as agreeing to preoperative and at least 1 follow‐up CBCT evaluation after 12 months; non‐contributory medical history (American Society of Anesthesiologists Class I and II); a history of previous endodontic treatment with radiographic presence of apical periodontitis; a true endodontic lesion: no, small and large lesion; lesion size less than 10 mm in diameter Exclusion criteria: non‐consenting patients and patients younger than 18 years of age; medical history with American Society of Anesthesiologists Class III to V; insufficient coronal restoration; non‐restorability or traumatized teeth; teeth classified as small lesion periodontal pocket, small lesion periodontal communication and total buccal fenestration; mobility.1; radiographic presence of non‐apical root resorption; resurgery; vertical root fracture; lesions ≥ 10 mm in diameter Total recruited: number of participants: 243; number of teeth: 243; age range: unclear; mean age: unclear; gender (male/female): unclear
| |
| Interventions | Materials
Preparation of the cavity: unclear | |
| Outcomes | Success rate: using combined criteria (Molven 1987; Rud 1972) which required an assessment with the combination of clinical and radiological methods Adverse events: not reported | |
| Notes | Control group: bioceramic root repair material (BCRRM): a kind of material similar to iRoot BP Plus Root Repair Material (BP‐RRM) | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Teeth were randomly assigned to the groups using an online randomization program developed by the information technology department of the University of Pennsylvania" Comment: low risk |
| Allocation concealment (selection bias) | Low risk | Quote: "The program can be accessed only with a username and password; the patient's chart number was added to this specific Consolidated Standards of Reporting Trials trial within the program, and the program randomly picked the material to be used. MTA was assigned a value of 0, whereas RRM was assigned" Comment: low risk |
| Blinding of participants and personnel (performance bias) | High risk | Quote: "The operator was aware what he or she was using only after it was dispensed to him or her during the procedure" Comment: high risk |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "The examiners were blinded to the material used and to the time of follow‐up" Comment: low risk |
| Incomplete outcome data (attrition bias) | High risk | Quote: "One hundred fourteen failed to attend any of the follow‐up visits" Comment: high risk. Teeth/participants lost to follow‐up reached 50.6% |
| Selective reporting (reporting bias) | Low risk | Comment: adequate. The outcomes were reported as planned |
| Other bias | Unclear risk | Comment: unclear risk |
| Study characteristics | ||
| Methods | Study type: RCT Sample size calculation: no Follow‐up period: 12 months Loss to follow‐up: 7 participants with 8 teeth were lost at 12 months Intention‐to‐treat analysis: no Funding: unclear | |
| Participants | Country: Sweden Centres: 1 Inclusion criteria: all teeth were included except those with obvious root fractures or advanced periodontal disease Exclusion criteria: teeth with obvious root fractures or advanced periodontal disease Total recruited: number of participants: 164; number of teeth: 206; age range: unclear; mean age: unclear; gender (male/female): 65/99
| |
| Interventions | Materials
Preparation of the cavity: ultrasonic apical preparation using × 2.3 magnification operation loupes | |
| Outcomes | Success rate: using combined criteria (Molven 1987; Rud 1972) which required an assessment with the combination of clinical and radiological methods Adverse events: not reported | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "The randomization procedure was performed using a standard randomization table" Comment: low risk |
| Allocation concealment (selection bias) | High risk | Quote (author's reply): "The allocation to either material group was performed according to a randomization table and thus not concealed" Comment: high risk |
| Blinding of participants and personnel (performance bias) | High risk | Quote (author's reply): "The patients were informed/consented about the study at the surgery appointment and the operator got the information of which material to use at the start of the surgery. The statistician just received all numbers/figures after the study was completed" Comment: high risk |
| Blinding of outcome assessment (detection bias) | Unclear risk | Comment: unclear risk. No information on blinding of outcome assessment was provided |
| Incomplete outcome data (attrition bias) | Low risk | Comment: low risk. 7 participants lost to follow‐up. The lost to follow‐up rate < 10% |
| Selective reporting (reporting bias) | Low risk | Comment: low risk. The outcomes were reported as planned |
| Other bias | Low risk | Comment: low risk |
| Study characteristics | ||
| Methods | Study type: RCT Sample size calculation: yes Follow‐up period: 12 months Loss to follow‐up: 82 teeth were lost at 12 months Intention‐to‐treat analysis: no Funding: unclear | |
| Participants | Country: China Centres: 1 Inclusion criteria: patients who had root canal treatment but presented with symptomatic or asymptomatic apical periodontitis Exclusion criteria: teeth with Class II mobility or greater, horizontal and vertical fractures, or through‐and‐through lesions Total recruited: number of participants: 240; number of teeth: 240; age range: unclear; mean age: unclear; gender (male/female): unclear
| |
| Interventions | Materials
Preparation of the cavity: the root‐end cavity was prepared along the long axis of the root with ultrasonic tips (Acteon, Merignac, France) | |
| Outcomes | Success rate: using combined criteria (Molven 1987; Rud 1972; Shinbori 2015) which required an assessment with the combination of clinical and radiological methods Adverse events: not reported | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "The randomization process involved a selection of 1 from among 240 sealed envelopes by the operator immediately before the surgery; this revealed to the operator which material to use" Comment: low risk |
| Allocation concealment (selection bias) | Low risk | Quote: "The randomization process involved a selection of 1 from among 240 sealed envelopes by the operator immediately before the surgery; this revealed to the operator which material to use" Comment: low risk |
| Blinding of participants and personnel (performance bias) | High risk | Comment: high risk. It was not possible to blind the personnel |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "Neither of the 2 observers knew into which group the radiographs fell" Comment: low risk |
| Incomplete outcome data (attrition bias) | High risk | Quote: "Among the 240 teeth included in this study, a total of 82 teeth were lost to follow‐up" Comment: high risk. The lost to follow‐up rate was > 30% |
| Selective reporting (reporting bias) | Low risk | Comment: low risk. The outcomes were reported as planned |
| Other bias | Unclear risk | Comment: unclear risk |
CBCT = cone‐beam computed tomography; CT = computed tomography scan; RCT = randomised controlled trial.
Characteristics of excluded studies [ordered by study ID]
| Study | Reason for exclusion |
| Study design: unclear The study author did not mention randomisation. We have tried to contact the authors, but no response was obtained | |
| Study design: the control group does not have retrograde obturation with any material Quote: "The aim of the present study was to compare periapical healing after root‐end resection followed by a root‐end filling with MTA or smoothing of the orthograde gutta‐percha (GP) root filling only" | |
| Inadequate study design: no radiological outcome was recorded | |
| Study design: the control group received orthograde gutta percha filling Quote: "A comparison was made between 2 treatment modalities in which 1 group of patients (MTA group) received a retrograde root‐end filling of MTA, and the patients in the other group (GP group) had a smoothing of the orthograde gutta percha filling after the apicectomy" | |
| Study design: insufficient follow‐up period (6 months) | |
| Study design: unclear The study author did not mention randomisation. We have tried to contact the authors, but no response was obtained | |
| Study design: retrospective Quote: "The study is retrospective and the materials consisted of 186 teeth from 131 consecutive patients who had undergone endodontic surgery during 1993–2003 at a specialist endodontic clinic in Västerås, Sweden" | |
| Study design: unclear The study author did not mention randomisation. We have tried to contact the authors, but no response was obtained | |
| Inadequate study design: the methods used to prepare the cavity differed in both randomised groups Quote: "A shallow concave apical preparation was filled with a light‐cured compomer with a light‐cured dental adhesive. As a control, a chemically cured glass ionomer was used with a conventional root‐end preparation" | |
| Study design: retrospective study Quote: "388 cases with retrograde amalgam fillings were selected randomly among patients previously treated by one of the authors (JR) and all controlled 1 year after the operation" | |
| Study design: unclear The study author did not mention randomisation. We have tried to contact the authors, but no response was obtained | |
| Study design: retrospective Quote: "Retrospective. The study collected 228 patients with 262 endodontically treated teeth between 1994 and 1999, operated by 2 oral surgeons" | |
| Study design: insufficient follow‐up period Quote: "The teeth and surrounding tissues were assessed clinically and by CT scan at the 6‐month follow‐up" | |
| Study design: clinical controlled study The study was not a real RCT after we contacted the author | |
| Study design: cohort study Quote: "To further elucidate the prognosis of apical microsurgery and the outcome predictors, the purpose of this prospective longitudinal study was to provide evidence for the 5‐year outcome of apical microsurgery in a cohort of patients for whom we previously reported the 1‐year outcome" | |
| Study design: quasi‐RCT Quote: "160 teeth in 139 consecutive patients (58 men and 81 women) were randomly allocated into 2 groups according to the date of birth" |
CT = computed tomography scan; MTA = mineral trioxide aggregate; RCT = randomised controlled trial.
Characteristics of ongoing studies [ordered by study ID]
| Study name | Periapical healing evaluation after root end surgery with different retro filling materials with or without platelet rich fibrin |
| Methods | Study type: RCT Sample size calculation: unknown Follow‐up period: 12 months Loss to follow‐up: unknown Intention‐to‐treat analysis: unknown Funding: self |
| Participants | Country: India Centres: unknown Inclusion criteria: 25 to 45 years old; males and females; endodontic lesions not responding to conventional root canal treatments; non‐contributory medical history (American Society of Anesthesiologists Class I and II); lesion involving 1 to 3 roots; overfilled canals; separated instrument in the apical half; ledge formation or transportation in the canal anatomically complex root canal configurations Exclusion criteria: medically compromised patient (American Society of Anesthesiologists Class III to VI); fractured tooth; periodontally compromised patients; through and through defects; close proximity to critical anatomical structures Total recruited: number of participants: 60; number of teeth: unclear; age range: 25 to 45 years; mean age: unclear; gender (male/female): unclear
|
| Interventions | Materials:
Preparation of the cavity: unclear |
| Outcomes | Wound healing will be evaluated radiographically by measuring the volume of the lesion using CBCT |
| Starting date | Unknown |
| Contact information | Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, SGT University, Budhera, Gurugram‐Badli Road, Gurugram Haryana 122505 India Phone: 8867901392 Email: [email protected] |
| Notes | ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=39590&EncHid=&userName=CTRI/2020/02/023443 |
CBCT = cone‐beam computed tomography; RCT = randomised controlled trial.
Data and analyses
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Success rate ‐ 1‐year outcome (tooth as unit of analysis) Show forest plot | 2 | 222 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.09 [0.97, 1.22] |
| Analysis 1.1  Comparison 1: MTA versus IRM, Outcome 1: Success rate ‐ 1‐year outcome (tooth as unit of analysis) | ||||
| 1.2 Success rate ‐ 2‐year outcome (tooth as unit of analysis) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| Analysis 1.2  Comparison 1: MTA versus IRM, Outcome 2: Success rate ‐ 2‐year outcome (tooth as unit of analysis) | ||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2.1 Success rate ‐ 1‐year outcome (tooth as unit of analysis) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| Analysis 2.1  Comparison 2: MTA versus Super‐EBA, Outcome 1: Success rate ‐ 1‐year outcome (tooth as unit of analysis) | ||||
| 2.2 Success rate ‐ 4‐year outcome (tooth as unit of analysis) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| Analysis 2.2  Comparison 2: MTA versus Super‐EBA, Outcome 2: Success rate ‐ 4‐year outcome (tooth as unit of analysis) | ||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3.1 Success rate ‐ 1‐year outcome (tooth as unit of analysis) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| Analysis 3.1  Comparison 3: Super‐EBA versus IRM, Outcome 1: Success rate ‐ 1‐year outcome (tooth as unit of analysis) | ||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 4.1 Success rate ‐ 1‐year outcome PP analysis (tooth as unit of analysis) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| Analysis 4.1  Comparison 4: Dentine‐bonded resin composite versus glass ionomer cement, Outcome 1: Success rate ‐ 1‐year outcome PP analysis (tooth as unit of analysis) | ||||
| 4.2 Success rate ‐ 1‐year outcome ITT analysis (tooth as unit of analysis) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| Analysis 4.2  Comparison 4: Dentine‐bonded resin composite versus glass ionomer cement, Outcome 2: Success rate ‐ 1‐year outcome ITT analysis (tooth as unit of analysis) | ||||
| 4.3 Success rate ‐ 1‐year outcome PP analysis (root as unit of analysis) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| Analysis 4.3  Comparison 4: Dentine‐bonded resin composite versus glass ionomer cement, Outcome 3: Success rate ‐ 1‐year outcome PP analysis (root as unit of analysis) | ||||
| 4.4 Success rate ‐ 1‐year outcome ITT analysis (root as unit of analysis) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| Analysis 4.4  Comparison 4: Dentine‐bonded resin composite versus glass ionomer cement, Outcome 4: Success rate ‐ 1‐year outcome ITT analysis (root as unit of analysis) | ||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 5.1 Success rate ‐ 1‐year outcome (tooth as unit of analysis) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| Analysis 5.1  Comparison 5: Glass ionomer cement versus amalgam, Outcome 1: Success rate ‐ 1‐year outcome (tooth as unit of analysis) | ||||
| 5.2 Success rate ‐ 5‐year outcome (tooth as unit of analysis) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| Analysis 5.2  Comparison 5: Glass ionomer cement versus amalgam, Outcome 2: Success rate ‐ 5‐year outcome (tooth as unit of analysis) | ||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 6.1 Success rate ‐ 1‐year outcome (tooth as unit of analysis) Show forest plot | 2 | 278 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.00 [0.94, 1.07] |
| Analysis 6.1  Comparison 6: MTA versus RRM, Outcome 1: Success rate ‐ 1‐year outcome (tooth as unit of analysis) | ||||
A: an infected tooth. The inner space of the tooth is the root canal system, where the pulp is located. The pulp of this tooth is irreversibly inflamed from bacterial infection due to decay.
B and C: the process of root canal therapy. B: a hole has been drilled from the top of the crown of the tooth. The dentist could then remove the infected tissues and toxic irritants by a combination of mechanical cleaning and irrigation in the root canal system through the hole. C: after cleaning and irrigation, the dentist fills the space with an inert packing material and seals the opening.
D and E: the process of retrograde filling. D: when retrograde filling is indicated, the dentist needs to cut a flap in the gum and creates a hole in the bone to get access to the bottom tip of the root. E: after cutting off the tip, then thorough preparation, the apex is sealed (the apical seal) and the hole made by the dentist filled with a dental material.
Study flow diagram.
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Comparison 1: MTA versus IRM, Outcome 1: Success rate ‐ 1‐year outcome (tooth as unit of analysis)
Comparison 1: MTA versus IRM, Outcome 2: Success rate ‐ 2‐year outcome (tooth as unit of analysis)
Comparison 2: MTA versus Super‐EBA, Outcome 1: Success rate ‐ 1‐year outcome (tooth as unit of analysis)
Comparison 2: MTA versus Super‐EBA, Outcome 2: Success rate ‐ 4‐year outcome (tooth as unit of analysis)
Comparison 3: Super‐EBA versus IRM, Outcome 1: Success rate ‐ 1‐year outcome (tooth as unit of analysis)
Comparison 4: Dentine‐bonded resin composite versus glass ionomer cement, Outcome 1: Success rate ‐ 1‐year outcome PP analysis (tooth as unit of analysis)
Comparison 4: Dentine‐bonded resin composite versus glass ionomer cement, Outcome 2: Success rate ‐ 1‐year outcome ITT analysis (tooth as unit of analysis)
Comparison 4: Dentine‐bonded resin composite versus glass ionomer cement, Outcome 3: Success rate ‐ 1‐year outcome PP analysis (root as unit of analysis)
Comparison 4: Dentine‐bonded resin composite versus glass ionomer cement, Outcome 4: Success rate ‐ 1‐year outcome ITT analysis (root as unit of analysis)
Comparison 5: Glass ionomer cement versus amalgam, Outcome 1: Success rate ‐ 1‐year outcome (tooth as unit of analysis)
Comparison 5: Glass ionomer cement versus amalgam, Outcome 2: Success rate ‐ 5‐year outcome (tooth as unit of analysis)
Comparison 6: MTA versus RRM, Outcome 1: Success rate ‐ 1‐year outcome (tooth as unit of analysis)
| MTA versus IRM for retrograde filling in root canal therapy | ||||||
|---|---|---|---|---|---|---|
| Patient or population: patients needing retrograde filling in root canal therapy | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | Number of teeth | Certainty of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| IRM | MTA | |||||
| Success rate ‐ 1‐year outcome (tooth as unit of analysis) | 806 per 1000 | 879 per 1000 | RR 1.09 | 222 | ⊕⊝⊝⊝ | There may be little to no effect of MTA compared to IRM on success rate at 1 year but the evidence is very uncertain |
| Adverse events | Outcome was not assessed by the included studies | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) CI: confidence interval; IRM: intermediate restorative material; MTA: mineral trioxide aggregate; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect | ||||||
| aDowngraded by 3 levels due to high risk of bias (downgraded by 1 level; both studies had the personnel unblinded due to the nature of the study design, and Chong 2003 had incomplete outcome data reported) and imprecision (downgraded by 2 levels; small number of participants and wide confidence intervals including both benefit and no benefit). | ||||||
| MTA versus Super‐EBA for retrograde filling in root canal therapy | ||||||
|---|---|---|---|---|---|---|
| Patient or population: patients needing retrograde filling in root canal therapy | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | Number of teeth | Certainty of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Super‐EBA | MTA | |||||
| Success rate ‐ 1‐year outcome (tooth as unit of analysis) | 931 per 1000 | 959 per 1000 | RR 1.03 | 192 | ⊕⊝⊝⊝ | There may be little to no effect of MTA compared to Super‐EBA on success rate at 1 year but the evidence is very uncertain |
| Adverse events | Outcome was not assessed by the included studies | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) CI: confidence interval; MTA: mineral trioxide aggregate; RR: risk ratio; Super‐EBA: super ethoxybenzoic acid | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect | ||||||
| aDowngraded by 3 levels due to high risk of bias (downgraded by 1 level; the included study (Kim 2016) had high risk of bias regarding incomplete data reporting and personnel blinding) and imprecision (downgraded by 2 levels; small population might cause serious imprecision). | ||||||
| Super‐EBA versus IRM for retrograde filling in root canal therapy | ||||||
|---|---|---|---|---|---|---|
| Patient or population: patients needing retrograde filling in root canal therapy | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | Number of teeth | Certainty of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| IRM | Super‐EBA | |||||
| Success rate ‐ 1‐year outcome (tooth as unit of analysis) | 906 per 1000 | 815 per 1000 | RR 0.90 | 194 | ⊕⊝⊝⊝ | The evidence is very uncertain about the effect of Super‐EBA compared with IRM on success rate at 1 year, with results indicating Super‐EBA may reduce or have no effect on success rate |
| Adverse events | Outcome was not assessed by the included studies | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) CI: confidence interval; IRM: intermediate restorative material; RR: risk ratio; Super‐EBA: super ethoxybenzoic acid | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect | ||||||
| aDowngraded by 3 levels due to high risk of bias (downgraded by 1 level; high risk of bias existed in the only included study (Wälivaara 2011) on allocation concealment and personnel blinding) and imprecision (downgraded by 2 levels; small number of participants and wide confidence intervals including both benefit and no benefit). | ||||||
| Dentine‐bonded resin composite versus glass ionomer cement for retrograde filling in root canal therapy | ||||||
|---|---|---|---|---|---|---|
| Patient or population: patients needing retrograde filling in root canal therapy | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | Number of teeth/roots | Certainty of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Glass ionomer cement | Dentine‐bonded resin composite | |||||
| Success rate ‐ 1‐year outcome PP analysis (tooth as unit of analysis) | 306 per 1000 | 731 per 1000 | RR 2.39 | 122 teeth | ⊕⊝⊝⊝ | Compared to glass ionomer cement, dentine‐bonded resin composite may increase the success rate of the treatment at 1 year but the evidence is very uncertain |
| Success rate ‐ 1‐year outcome PP analysis (root as unit of analysis) | 519 per 1000 | 825 per 1000 | RR 1.59 | 127 roots | ⊕⊝⊝⊝ | Compared to glass ionomer cement, dentine‐bonded resin composite may increase the success rate of the treatment at 1 year but the evidence is very uncertain |
| Adverse events | Outcome was not assessed by the included studies | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; PP: per‐protocol; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect | ||||||
| aDowngraded by 3 levels due to high risk of bias (downgraded by 1 level; the included study (Jensen 2002) did not have participants, personnel, or outcome assessors blinded) and imprecision (downgraded by 2 levels; small population might cause serious imprecision). | ||||||
| Glass ionomer cement versus amalgam for retrograde filling in root canal therapy | ||||||
|---|---|---|---|---|---|---|
| Patient or population: patients needing retrograde filling in root canal therapy | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | Number of teeth | Certainty of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Amalgam | Glass ionomer cement | |||||
| Success rate ‐ 1‐year outcome (tooth as unit of analysis) | 904 per 1000 | 886 per 1000 | RR 0.98 | 105 | ⊕⊝⊝⊝ | The evidence is very uncertain about the effect of glass ionomer cement compared with amalgam on success rate at 1 year, with results indicating glass ionomer cement may reduce or have no effect on success rate |
| Adverse events | Outcome was not assessed by the included studies | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) CI: confidence interval; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect | ||||||
| aDowngraded by 3 levels due to high risk of bias (downgraded by 1 level; the included study (Jesslen 1995) had the personnel unblinded due to the nature of the study design) and imprecision (downgraded by 2 levels; small number of participants and wide confidence intervals including both benefit and no benefit). | ||||||
| MTA versus RRM for retrograde filling in root canal therapy | ||||||
|---|---|---|---|---|---|---|
| Patient or population: patients needing retrograde filling in root canal therapy Settings: China Intervention: MTA versus RRM | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | Number of teeth | Certainty of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| RRM | MTA | |||||
| Success rate ‐ 1‐year outcome (tooth as unit of analysis) Assessed by combination of clinical and radiological methods Follow‐up: 1 year | 933 per 1000 | 896 per 1000 | RR 1.00 | 278 | ⊕⊝⊝⊝ | There may be little to no effect of MTA compared to RRM on success rate at 1 year but the evidence is very uncertain |
| Adverse events | Outcome was not assessed by the included studies | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) CI: confidence interval; MTA: mineral trioxide aggregate; RR: risk ratio; RRM: root repair material | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect | ||||||
| aDowngraded by 3 levels due to high risk of bias (downgraded by 1 level; the included studies (Safi 2019; Zhou 2017) had high risk of bias regarding personnel blinding) and imprecision (downgraded by 2 levels; small number of participants and wide confidence intervals including both benefit and no benefit). | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Success rate ‐ 1‐year outcome (tooth as unit of analysis) Show forest plot | 2 | 222 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.09 [0.97, 1.22] |
| 1.2 Success rate ‐ 2‐year outcome (tooth as unit of analysis) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2.1 Success rate ‐ 1‐year outcome (tooth as unit of analysis) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 2.2 Success rate ‐ 4‐year outcome (tooth as unit of analysis) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3.1 Success rate ‐ 1‐year outcome (tooth as unit of analysis) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 4.1 Success rate ‐ 1‐year outcome PP analysis (tooth as unit of analysis) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 4.2 Success rate ‐ 1‐year outcome ITT analysis (tooth as unit of analysis) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 4.3 Success rate ‐ 1‐year outcome PP analysis (root as unit of analysis) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 4.4 Success rate ‐ 1‐year outcome ITT analysis (root as unit of analysis) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 5.1 Success rate ‐ 1‐year outcome (tooth as unit of analysis) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 5.2 Success rate ‐ 5‐year outcome (tooth as unit of analysis) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 6.1 Success rate ‐ 1‐year outcome (tooth as unit of analysis) Show forest plot | 2 | 278 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.00 [0.94, 1.07] |
