Adam S Kharchi1, Nara Tagiyeva-Milne2, Shalini Kanagasingam3. 1. Clinical teaching fellow, University of Leeds; Associate General Dental Practitioner with a Special Interest in Endodontology. 2. Co-Director, MIPH, Lecturer (Epidemiology), Liverpool School of Tropical Medicine, University of Liverpool. 3. Senior Clinical Lecturer, Specialist Endodontist, Course Lead MSc & MClinDent Endodontology; School of Dentistry, Faculty of Clinical and Biomedical Sciences, University of Central Lancashire, Preston, UK.
Abstract
AIMS: This systematic review aims to identify and synthesise available evidence to determine the clinical and radiographic outcomes of REP involving any disinfection irrigant together with a non-antibiotic intracanal medicament. METHODS: Experimental and observational studies evaluating the outcomes of REP in immature non-vital permanent teeth in 6-16 year olds, where the protocol used any type of disinfectant irrigant together with a non-antibiotic intracanal medicament (non-setting calcium hydroxide) were included. Data was narratively synthesised and presented in respect to the primary outcome (elimination of symptoms and infection) and secondary outcomes (increase in root length/width; positive response to vitality testing; patient-reported outcomes; adverse effects). MAIN FINDINGS: 1628 studies were identified, of which five met the eligibility criteria for inclusion in the review. Studies included one randomised control trial and four observational studies. All five studies showed an absence of clinical signs and symptoms for all teeth postoperatively with radiographic resolution or absence of pathology following the disinfection stages of the REP used. Choice of secondary outcomes were inconsistent but included further root development, coronal discolouration and root canal calcifications postoperatively. There was a high risk of bias in all five studies and subsequently the quality of the evidence base was judged to be low. PRINCIPLE CONCLUSIONS: REP using a non-antibiotic disinfectant approach appears capable of providing satisfactory outcomes for a non-vital immature permanent tooth. Further high-quality research is required before solid recommendations towards clinical practice guidelines for the disinfection portion of REP can be implemented.
AIMS: This systematic review aims to identify and synthesise available evidence to determine the clinical and radiographic outcomes of REP involving any disinfection irrigant together with a non-antibiotic intracanal medicament. METHODS: Experimental and observational studies evaluating the outcomes of REP in immature non-vital permanent teeth in 6-16 year olds, where the protocol used any type of disinfectant irrigant together with a non-antibiotic intracanal medicament (non-setting calcium hydroxide) were included. Data was narratively synthesised and presented in respect to the primary outcome (elimination of symptoms and infection) and secondary outcomes (increase in root length/width; positive response to vitality testing; patient-reported outcomes; adverse effects). MAIN FINDINGS: 1628 studies were identified, of which five met the eligibility criteria for inclusion in the review. Studies included one randomised control trial and four observational studies. All five studies showed an absence of clinical signs and symptoms for all teeth postoperatively with radiographic resolution or absence of pathology following the disinfection stages of the REP used. Choice of secondary outcomes were inconsistent but included further root development, coronal discolouration and root canal calcifications postoperatively. There was a high risk of bias in all five studies and subsequently the quality of the evidence base was judged to be low. PRINCIPLE CONCLUSIONS: REP using a non-antibiotic disinfectant approach appears capable of providing satisfactory outcomes for a non-vital immature permanent tooth. Further high-quality research is required before solid recommendations towards clinical practice guidelines for the disinfection portion of REP can be implemented.
Authors: Luísa Bandeira Lopes; João Albernaz Neves; João Botelho; Vanessa Machado; José João Mendes Journal: Int J Environ Res Public Health Date: 2021-01-17 Impact factor: 3.390