What factors contribute to inconsistent results in the literature on bone grafting techniques?
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The wide range of available biomaterials, variation in treatment protocols, and lack of standardization in assessment criteria.
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What factors contribute to inconsistent results in the literature on bone grafting techniques?
The wide range of available biomaterials, variation in treatment protocols, and lack of standardization in assessment criteria.
What types of membranes were used in the studies compared to control groups?
Two studies used non-resorbable e-PTFE membranes, two used collagen membranes, and one used a bioresorbable polylactic acid membrane.
What were the findings regarding the outcomes of surgery involving bone regeneration techniques?
The analysis revealed significantly better outcomes when surgery involved bone regeneration techniques than conventional surgery (OR = 2.18, p = .004).
What types of grafts were investigated solely in the studies?
One study used a bovine-derived hydroxyapatite xenograft, and another used a calcium sulphate alloplast.
What databases were searched for the literature review?
EMBASE, Web of Science, PubMed, and the Cochrane Central Register of Controlled Trials.
In the study by Parmar et al. (2019), what was the success rate for the intervention group using collagen membrane?
15 successes out of 15 cases
What is the significance of integrating contemporary clinical research into bone grafting surgery?
It is essential for implementing new techniques into the clinical environment and ensuring evidence-based practice.
What did Dominiak et al. (2009) conclude about the efficacy of regenerative techniques?
Dominiak et al. (2009) reported that the efficacy of treatment with regenerative techniques was superior to the controls, leading to an acceleration of healing and bone density closer to natural bone.
What was the success rate for the control group in the study by Taschieri et al. (2008)?
8 successes out of 14 cases
What was the conclusion about the combination of grafting and membrane placement?
The combination did not demonstrate a significant influence on the outcome in the meta-analysis.
What did the funnel plot indicate about publication bias?
The funnel plot showed a good level of symmetry, indicating no significant publication bias.
What materials were specifically mentioned as used in the studies?
Bovine-derived hydroxyapatite xenograft and calcium sulphate alloplast were used.
What was the objective of the systematic review conducted by Flynn et al.?
The objective was to evaluate the impact of bone grafting with/without barrier membrane materials on the outcome of apical surgery in patients with apical periodontitis.
What was the mean age of participants in the study by Dominiak et al. (2009)?
37.5 years
What is one of the exclusion criteria for the studies?
The study was single-arm and not comparative.
What was the primary finding of the meta-analysis regarding bone grafting in apical surgery?
The meta-analysis found significantly better success for apical surgery performed with bone grafting with or without membrane placement compared to conventional surgery.
What did the analysis find regarding the types of membranes used?
The analysis demonstrated no significant statistical difference between resorbable and non-resorbable membranes, although the non-resorbable e-PTFE membrane reduced the probability of success compared to the collagen membrane.
How were clinical symptoms recorded in the studies?
Clinically, the presence or absence of symptoms such as pain, infection, swelling, tenderness to percussion or palpation, presence of sinus tracts, or root fracture was recorded.
What is guided tissue regeneration (GTR) used for in periodontal therapy?
To enhance new bone formation before implant placement.
How many articles were included in the final meta-analysis?
Eight studies that met the inclusion criteria were included in the meta-analysis.
What was concluded about the use of resorbable versus non-resorbable membranes?
Resorbable materials demonstrated superior outcomes compared to non-resorbable alternatives.
What do some authors report about the healing outcomes of bone grafting techniques?
Some report improved healing outcomes, while others provide contrary findings.
What was the outcome of the meta-analysis regarding the use of regenerative materials in apical surgery?
The meta-analysis showed that the use of regenerative materials (bone grafting with/without barrier membranes) significantly improved the success of the outcome compared with controls, with a two-fold greater probability of success (OR = 2.18, 95% CI: 1.32–4.31, p = .004).
How were the polylactic acid membrane and collagen membrane grouped in the meta-analysis?
They were grouped together as both are resorbable membranes.
What did Tobón et al. (2002) find about the use of non-resorbable membranes?
Tobón et al. (2002) concluded that the use of non-resorbable (e-PTFE) membranes alone produced a good healing response, and the combination with hydroxyapatite graft gave complete regeneration to apical lesions.
What did previous studies conclude about resorbable membranes?
Some studies reported favorable outcomes and potential acceleration of healing, while others found no significant effect on healing rates.
What was the failure rate for the control group in the study by Garrett et al. (2002)?
1 failure out of 5 cases
What are the concerns regarding the randomization process in the studies included in the meta-analysis?
Four out of the eight studies failed to describe the randomization process, raising concerns about overall methodological rigor.
What limitation was noted regarding the sample size of the included studies?
The small sample size may limit the power of the meta-analysis results.
What types of subgroup analyses were conducted in the meta-analysis?
Subgroup analyses looked at the effect of grafting material, placement of membrane, combination of graft and membrane, type of membrane, and combination of graft and membrane type.
How many studies were initially identified for the meta-analysis?
A total of 2582 studies were identified using the defined search.
What have previous systematic reviews examined regarding bone grafting in apical surgery?
They have examined the effect of bone grafting with or without regenerative materials on the outcomes of apical surgery.
What has been reported to improve the likelihood of a successful outcome in apical surgery?
The use of membranes and grafts, as opposed to the use of either in isolation.
Did the type of membrane used significantly impact the outcome of apical surgery?
No, the type of membrane used did not significantly impact the outcome (OR = -1.09, p = .247).
What was the overall p-value for the combination of graft and membrane in the meta-regression results?
The overall p-value for the combination of graft and membrane was .94.
What was the conclusion of Parmar et al. (2019) regarding resorbable membranes?
Parmar et al. (2019) concluded that the use of a resorbable membrane (collagen) had no benefit on 'through and through' lesions compared with controls.
What was the finding regarding non-resorbable membranes compared to controls?
Non-resorbable membranes were associated with lower success rates compared to controls.
What was the age range of participants in the studies included in the meta-analysis?
The age range was 9 to 74 years.
What was a strength of the systematic review conducted in the meta-analysis?
The literature review utilized multiple scientific databases and included a wide range of articles with strict inclusion and exclusion criteria.
What did the meta-analysis conclude about the use of microscopy in studies?
The meta-analysis did not use microscopy as a randomized factor due to insufficient evidence supporting significant differences in outcomes.
What tool was used for the risk of bias assessment in the included studies?
A RoB assessment was carried out using the revised Cochrane RoB tool for randomized trials (RoB2).
What are the two classifications of barrier membranes used in apical surgery?
Non-resorbable and resorbable.
How many studies were included in the meta-analysis?
Eight randomized clinical trials were included in the meta-analysis.
What was the aim of the systematic review mentioned in the text?
To systematically examine the current evidence regarding bone grafting techniques in apical surgery.
What combination of materials was used in the studies investigating grafting and membrane placement?
Two studies used bovine-derived hydroxyapatite xenograft with collagen membrane, and one used e-PTFE membrane with bovine-derived hydroxyapatite xenograft.
What was concluded about the use of calcium sulphate alloplastic grafts in apical surgery?
Its use may improve the outcome and healing of lesions post-apical surgery, but the benefit of a grafting material without a membrane is unknown.
What did the meta-analysis reveal about the effect of barrier membrane placement alone?
The effect was not shown to be significant, with an odds ratio of -0.09 and a p-value of .885.
What did the subgroup analysis reveal about the use of grafting material alone?
The subgroup analysis indicated that using grafting material alone appeared to increase the likelihood of success, but the finding was not statistically significant.
What future research directions are suggested for regenerative techniques in apical surgery?
High-quality, institutionally led longitudinal studies with large participant numbers are recommended to enhance evidence-based knowledge.
What was the finding of Pecora et al. (2001) regarding grafting material for 'through and through' lesions?
Pecora et al. (2001) concluded that the use of calcium sulphate alloplast for 'through and through' lesions may contribute to an improved outcome.
What concerns were raised in the risk of bias analysis of the included studies?
The risk of bias analysis showed that 75% of studies had some concerns regarding overall bias, particularly in the randomization process.
What were the results of the subgroup analysis comparing membrane placement with control?
The subgroup analysis showed no significant differences between membrane placement and control.
What types of membranes were used in the included studies?
Both non-resorbable and resorbable membranes, including collagen and polylactic acid, were used.
What did previous reviews reveal about the impact of regenerative materials on apical surgery outcomes?
Findings varied, with some studies showing significant improvement while others found no benefit, especially in small apical lesions.
What were the two types of lesions assessed in the study by Taschieri et al. (2007)?
One intervention group had through and through lesions, while the other had four-walled defects.
What are the inclusion criteria for the studies in the systematic review?
Prospective randomized trials with patients presenting non-healing apical periodontitis, using bone grafting, barrier membrane placement, or a combination in the intervention group.
What regenerative material was used in the intervention group of the study by Pecora et al. (2001)?
Calcium sulphate graft
What did Liu et al. (2020) demonstrate regarding regenerative techniques in apical surgery?
Liu et al. (2020) demonstrated that regenerative techniques showed improved outcomes in apical surgery.
What type of membrane was used in the study by Tobón et al. (2002)?
e-PTFE membrane
What was the lesion type in the study by Taschieri et al. (2007)?
Through and through
What was the overall finding regarding heterogeneity among the included studies?
Overall, heterogeneity was not found between the studies, with an I2 of 0% and a p-value for the QH statistic of .972.
What criteria were used to categorize radiographic healing?
Radiographically, healing was categorized as complete, incomplete (scar tissue), uncertain, or unsatisfactory.
What are xenografts?
Grafts from different species, such as bovine or porcine, processed to remove organic constituents.
What is the purpose of the systematic review and meta-analysis mentioned in the text?
To provide an evidence-based examination of the effect of bone grafting, barrier membrane placement, or a combination of both on the outcome of apical surgery.
How many trials indicated positive outcomes for regeneration techniques used in the study?
Five trials indicated positive outcomes for the regeneration techniques used.
What limitation was noted regarding the evidence on bone grafting materials without barrier membranes in apical surgery?
There is limited evidence on the use of a bone grafting material alone, without barrier membrane application in apical surgery, which limited the number of randomized trials included in the meta-analysis.
What methodology was followed for conducting the meta-analysis?
The PRISMA guidelines were followed, using a PICOTS format.
What was the follow-up time required for the studies included in the review?
At least 1-year follow-up.
What details were included in the data collection form created for the studies?
The data collection form included details such as Author, year of publication, description of the trial, mean age, age range, lesion size and type, grafting material or membrane material used, number of cases in the intervention group, results of the intervention group, number of cases in the control group, results of the control group, and conclusion of the trial.
How does the size of the apical lesion influence the outcome of apical surgery according to the findings?
Small lesions do not benefit significantly from grafting, while complicated lesions have shown to benefit from grafting with or without membrane placement.
What was the primary analysis focus in the meta-analysis?
The primary analysis examined the effect of intervention on the success rate.
What is considered the gold standard for bone grafting materials in apical surgery?
Autografts.
What did the subgroup analysis reveal about the combination of graft and membrane type?
There were no significant differences between the groups regarding success rates.
How many studies described the blinding of patients in the meta-analysis?
Only one study described the blinding of patients, highlighting the challenges of achieving complete blinding in surgical procedures.
What is the standard of care for treating persistent endodontic lesions?
Apical surgery (AS) is the standard of care for treating persistent endodontic lesions following failed non-surgical root canal treatment or in cases where traditional orthograde treatment is not feasible.
What was the significance of the funnel plot in the meta-analysis?
It was used to assess the risk of bias and heterogeneity in the included studies.
What are the two possible outcomes of wound healing following apical surgery?
Repair and regeneration.
What are allografts?
Grafts between genetically dissimilar members of the same species, usually obtained from tissue banks.
What are alloplasts?
Synthetic alternatives to graft types that are osteoconductive but have no regenerative potential.
What is the principal objective of apical surgery (AS)?
To eliminate the intra-radicular source of infection and create an optimal environment for healing.
What statistical software was used for the meta-analysis?
A meta-analysis was conducted using R 3.5.1.
What is the impact of bone grafting with/without barrier membrane placement on the outcome of apical surgery?
Bone grafting with/without barrier membrane placement significantly improves healing after apical surgery compared to surgery without grafting materials.
