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Influence of intracanal medicaments on the periodontal and periapical healing in concurrent endodontic-periodontal lesions with/without communication: a systematic review and meta-analysis

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Abstract

Objectives

The purpose of this review is to determine the effectiveness of intracanal medicament (ICM) on periodontal and periapical healing (PH) of concurrent endodontic-periodontal lesions with/without communication in permanent teeth.

Materials and methods

The pre-defined protocol was registered in PROSPERO, and a literature search using keywords was conducted on PubMed, Scopus, Cochrane, Embase electronic databases, and Gray literature and was hand-searched until August 2023. Two reviewers independently screened the title and abstracts using the inclusion criteria. Randomized or non-randomized clinical trials, cohort studies, and case-control studies were included in the review. The same reviewers extracted the study-level data and assessed the risk of bias using the Cochrane Risk of Bias 2.0 and the Newcastle-Ottawa Scale (NOS) independently. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to assess the certainty of evidence. Random effects meta-analysis was performed on eligible studies using Revman software.

Results

A total of 598 records were identified from the database search; seven studies met the inclusion criteria and were included in the review. Four randomized clinical trials, two prospective cohorts, and one retrospective case-control study with 362 patients were included. Calcium hydroxide (CH) was the most commonly used ICM, followed by using chlorhexidine gel in four studies. Periodontal therapy was performed as initial scaling and root planning (SRP) in all studies, along with open flap debridement (OFD) in three randomized clinical trials. The time lapse between two treatment protocols was variable (ranging from 1 week to 3 months). All studies exhibited a decrease in probing depth (PD) and an increase in clinical attachment level (CAL) after the treatment. Meta-analysis showed insignificant differences between different ICM materials, and the certainty of evidence was low.

Conclusion

In patients with/without concurrent endodontic-periodontal lesions, intracanal medication improved clinical periodontal parameters following endodontic therapy. In terms of influence on periapical healing, the results were inconclusive.

Clinical relevance

Two-visit RCT may be considered since it allows for the placement of an ICM in endodontic-periodontal lesions with/without communication. Sufficient time should be allowed after endodontic therapy for any potential periodontal regeneration to occur.

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Authors and Affiliations

  1. Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, 110029, India

    Sarita Gill, Krunal Tabiyar, Sidhartha Sharma, Vijay Kumar, Amrita Chawla & Ajay Logani

  2. Division of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, 110029, India

    Rajiv Balachandran

  3. Division of Public Health Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, 110029, India

    Harsh Priya & Deepali Agarwal

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Contributions

All the authors have made substantial contributions to the manuscript. Authors have read and approved the final version of the manuscript.

S.G.: data curation, formal analysis, writing – original draft preparation, writing – reviewing and editing

K.T.: data curation, formal analysis, writing – original draft preparation, writing – reviewing and editing

R.B.: methodology, data curation, writing – original draft preparation, visualization, writing – reviewing and editing

H.P.: conceptualization, methodology, data curation, writing – original draft preparation, visualization, writing – reviewing and editing

D.A.: data curation, writing – original draft preparation, writing – reviewing and editing

A.C.: conceptualization, methodology, data curation, writing – original draft preparation, visualization, writing – reviewing and editing

S.S.: writing – review and editing, contributed to the article’s drafting and critical analysis

V.K.: writing – review and editing, contributed to the article’s drafting and critical analysis

A.L.: conceptualization, methodology, writing – review and editing, contributed to the article’s drafting and critical analysis

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Correspondence to Amrita Chawla.

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Gill, S., Tabiyar, K., Balachandran, R. et al. Influence of intracanal medicaments on the periodontal and periapical healing in concurrent endodontic-periodontal lesions with/without communication: a systematic review and meta-analysis. Clin Oral Invest 27, 6371–6382 (2023). https://doi.org/10.1007/s00784-023-05286-7

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