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THE EFFECT OF LESION SIZE, GUIDED TISSUE REGENERATION AND CONE-BEAM COMPUTED TOMOGRAHPY ON THE OUTCOME OF ENDODONTIC
Ann-Sophie Schotte1, Joey d'hoop1, Alice d'hoore1
1Department of Oral Health Sciences, Endodontology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
Objectives:
To systematically review the influence of preoperative lesion size (>5 mm), guided tissue regeneration (GTR), and cone-beam computed tomography (CBCT) during follow-up on the outcome of endodontic microsurgery (EMS).
Data/Sources:
Original clinical studies (RCTs, prospective and retrospective cohorts) on adults undergoing EMS for apical lesions >5 mm were eligible. PubMed, EMBASE, and Web of Science were searched from inception to February 2026, supplemented by manual searching.
Study Selection:
Two reviewers independently screened, extracted, and appraised studies using the Cochrane RoB 2.0 and ROBINS-I tools. The review followed PRISMA 2020 and was registered in PROSPERO (CRD1178494).
Results:
Nineteen studies (4 RCTs, 15 non-randomised; 10-721 teeth; follow-up 6 months-5 years) were included from 2589 records. Larger lesions showed a trend toward lower success, though size definitions varied considerably (linear vs. volumetric; periapical radiographs vs. CBCT). GTR generally improved healing, with critical size thresholds rising from 3 mm without GTR to 6-9 mm with GTR in one study, though no volumetric benefit was observed. CBCT-based follow-up consistently yielded lower success rates than periapical radiography, reflecting detection of residual radiolucency and incomplete cortical healing.
Conclusions:
Larger lesions heal less predictably, but heterogeneous size definitions prevent firm conclusions. GTR appears beneficial for larger defects, yet protocols remain non-standardised. Standardised dimensional criteria, harmonised GTR protocols, and consistent CBCT-based outcome definitions are needed. Radiographic findings should be interpreted alongside clinical symptoms to avoid overdiagnosis and overtreatment after EMS.
Clinical Significance:
Standardised dimensional criteria, harmonised GTR protocols, and consistent CBCT-based outcome definitions are needed for meaningful cross study comparison. Radiographic findings should always be interpreted alongside clinical symptoms to avoid overdiagnosis and overtreatment after EMS.