revista de revistas 3
TRANSCRIPT
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UNIVERSIDAD PERUANA
CAYETANO HEREDIA
Facultad de Estomatologa
von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. Journal of endodontics36.6(2010): 957-973.
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Tasa de xito 80% - 90%
Ciruga apical
Uso de instrumentos / equipos adecuados Tcnica qx adecuada
Adecuada seleccin de caso
Estrategias
Existen pocos estudios acerca de factores queafectan el pronstico
von Arx T. Failed root canals: The case for apicoectomy (periradicular surgery). JOral Maxillofac Surg 2005;63:8327.
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Lustmann J, Friedman S, Shaharabany V. Relation of pre- and intraoperative factors to prognosis of posteriorapical surgery. J Endod 1991;17:23941.Rahbaran S, Gilthorpe MS, Harrison SD, et al. Comparison of clinical outcome of periapical surgery in endodonticand oral surgery units of a teaching dental hospital: a retrospective study. Oral Surg Oral Med Oral Pathol OralRadiol Endod 2001;91:7009.Jensen SS, Nattestad A, Egdo P, et al. A prospective, randomized, comparative clinical study of resin compositeand glass ionomer cement for retrograde root filling. Clin Oral Investig 2002;6:23643.
Wang N, Knight K, Dao T, et al. Treatment outcome in endodonticsThe Toronto study. Phases I and II: apicalsurgery. J Endod 2004;30:75161.
Edad
Sexo
Pzadentaria
Posteradicular
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Peterson yGutman (2001)
Pronstico dereintervenciones
Seguimiento: 1ao
xito 35.7%
Niederman etal. (2003) Mat de
obturacinretrgrada
Sesgo sig. 2 ECA
Mead et al.(2005)
Niveles deevidencia
Series de casos
Del Fabbro etal. (2001)
Rtx qx vs. no qx Corto plazo: rtx
qx
Peterson J, Gutmann JL. The outcome of endodontic resurgery: a systematic review. Int Endod J 2001;34:16975.Niederman R, Theodosopoulou JN. A systematic review of in vivo retrograde obturation materials. Int Endod J2003;36:57785.Mead C, Javidan-Nejad S, Mego ME, et al. Levels of evidence for the outcome of endodontic surgery. J Endod 2005;31:19
24.del Fabbro M, Taschieri S, Testori T, et al. Surgical versus non-surgical endodontic re-treatment for periradicular lesions(Review). Cochrane Database S stematic Rev 2007;3. CD005511.
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Friedman et al.(2005)
Fac. preoperatorios
Tamao de la lesin Sobreobturacin /
subobturacin Pronstico reservado:
reintervenciones
Fac.intraoperatorios
Material deobturacin
Calidad de obturacin
Friedman S. The prognosis and expected outcome of apical surgery. EndodTopics 2005;11:21962.
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Realizar un meta-anlisis actualizadopara evaluar los potenciales factores queinfluyen en el pronstico de cirugaapical con el relleno retrgrado delconducto radicular mediante la revisinde todos los niveles de evidencia clnica.
von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. "Prognostic factors in apicalsurgery with root-end filling: a meta-analysis."Journal of endodontics36.6 (2010): 957-973.
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von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. "Prognostic factors in apicalsurgery with root-end filling: a meta-analysis."Journal of endodontics36.6 (2010): 957-973.
Criteriode
inclusin
Ensayo clnico : cirugaapical y colocacin dematerial de obturacin
Criterios
deexclusin
Estudios in vitro
o en animales
Periodo deevaluacin 1980 2007
IdiomasIngls, alemn, francs,
espaol, italiano, portugus,lenguas escandinavas
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von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. "Prognostic factors in apicalsurgery with root-end filling: a meta-analysis."Journal of endodontics36.6 (2010): 957-973.
Bases de bsqueda
PubMed Cochrane
Revistas
JOE, Int J Endod, Oral Surg Oral Med
Oral Pathol Oral Radiol Endod, DentTraumatol, J Oral Maxillofac Surg, yInt J Oral Maxillofac Surg.
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von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. "Prognostic factors in apicalsurgery with root-end filling: a meta-analysis."Journal of endodontics36.6 (2010): 957-973.
Evaluacin de resultado: parmetros
clnicos y rx Tamao de muestra mnima: 10 sujetos Periodo de seguimiento mnimo: 6 meses
xito: variable dicotmica
Caractersticas
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xito
No signos o sntomas clnicos
Reparacin rx completa o incompleta
Fracaso
Presencia de signos o sntomas clnicos
No se observa reparacin o la lesin haprogresado
Rud J, Andreasen JO, Jensen JE. Radiographic criteria for the assessment of healing afterendodontic surgery. Int J Oral Surg 1972;1:195214.Molven O, Halse A, Grung B. Observer strategy and the radiographic classification ofhealing after endodontic surgery. Int J Oral Maxillofac Surg 1987;16: 4329.
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von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. "Prognostic factors in apicalsurgery with root-end filling: a meta-analysis."Journal of endodontics36.6 (2010): 957-973.
PacientePieza
dentaria
Tratamiento
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von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. "Prognostic factors in apicalsurgery with root-end filling: a meta-analysis."Journal of endodontics36.6 (2010): 957-973.
OR
Interv. deconfianza
Forestplot
Variablesdicotmicas
Estimador
Interv. deconfianza
Prueba
exacta deFisher
Variablespolitmicas
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von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. "Prognostic factors in apicalsurgery with root-end filling: a meta-analysis."Journal of endodontics36.6 (2010): 957-973.
695 artculos
Abstracts
555excludos
Otros motivos
102excludos
Artculosconsiderados:38
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von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. "Prognostic factors in apicalsurgery with root-end filling: a meta-analysis."Journal of endodontics36.6 (2010): 957-973.
Edad
Sexo
Hbitos Fumar: no incluido
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von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. "Prognostic factors in apicalsurgery with root-end filling: a meta-analysis."Journal of endodontics36.6 (2010): 957-973.
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von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. "Prognostic factors in apicalsurgery with root-end filling: a meta-analysis."Journal of endodontics36.6 (2010): 957-973.
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von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. "Prognostic factors in apicalsurgery with root-end filling: a meta-analysis."Journal of endodontics36.6 (2010): 957-973.
Tipo de pzaDolorpreoperatorio
Sntomaspreoperatorios
Densidad de
obturacinradicular Presencia de lesin Tamao de lesin
Longitud deobturacin
Retratamiento noqx previo
Presencia de poste
No incluidos Restauracin definitiva Sellado coronal Nivel de hueso marginal Extensin de la lesin Histopatologa de la lesin
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von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. "Prognostic factors in apicalsurgery with root-end filling: a meta-analysis."Journal of endodontics36.6 (2010): 957-973.
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von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. "Prognostic factors in apicalsurgery with root-end filling: a meta-analysis."Journal of endodontics36.6 (2010): 957-973.
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von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. "Prognostic factors in apicalsurgery with root-end filling: a meta-analysis."Journal of endodontics36.6 (2010): 957-973.
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von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. "Prognostic factors in apicalsurgery with root-end filling: a meta-analysis."Journal of endodontics36.6 (2010): 957-973.
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von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. "Prognostic factors in apicalsurgery with root-end filling: a meta-analysis."Journal of endodontics36.6 (2010): 957-973.
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von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. "Prognostic factors in apicalsurgery with root-end filling: a meta-analysis."Journal of endodontics36.6 (2010): 957-973.
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von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. "Prognostic factors in apicalsurgery with root-end filling: a meta-analysis."Journal of endodontics36.6 (2010): 957-973.
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von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. "Prognostic factors in apicalsurgery with root-end filling: a meta-analysis."Journal of endodontics36.6 (2010): 957-973.
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von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. "Prognostic factors in apicalsurgery with root-end filling: a meta-analysis."Journal of endodontics36.6 (2010): 957-973.
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von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. "Prognostic factors in apicalsurgery with root-end filling: a meta-analysis."Journal of endodontics36.6 (2010): 957-973.
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Tipo de cirugaPreparacin de lacavidad
Uso de microscopa Uso de ATB
Material de obturacinretrgrada
von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. "Prognostic factors in apicalsurgery with root-end filling: a meta-analysis."Journal of endodontics36.6 (2010): 957-973.
No analizados: Experiencia del operador Tipo de operador Uso de agente hemosttico Tipo de micro-punta Complicaciones
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von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. "Prognostic factors in apicalsurgery with root-end filling: a meta-analysis."Journal of endodontics36.6 (2010): 957-973.
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von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. "Prognostic factors in apicalsur er with root-end fillin : a meta-anal sis."Journal o endodontics 6.6 2010 : - .
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von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. "Prognostic factors in apicalsurgery with root-end filling: a meta-analysis."Journal of endodontics36.6 (2010): 957-973.
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von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. "Prognostic factors in apicalsurgery with root-end filling: a meta-analysis."Journal of endodontics36.6 (2010): 957-973.
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von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. "Prognostic factors in apicalsurgery with root-end filling: a meta-analysis."Journal of endodontics36.6 (2010): 957-973.
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von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. "Prognostic factors in apicalsurgery with root-end filling: a meta-analysis."Journal of endodontics36.6 (2010): 957-973.
Importancia
Seleccin del caso Eleccin del tratamiento
Limitaciones
Pocos estudios que consideran pronstico
Potencia estadstica del estudio Diferente diseo de estudio, tcnica qx,
valoracin de xito
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von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. "Prognostic factors in apicalsurgery with root-end filling: a meta-analysis."Journal of endodontics36.6 (2010): 957-973.
Wu MK, Dummer PMH, Wesselink PR. Consequences of and strategies to deal with residualpost-treatment root canal infection. Int Endod J 2006;39:34356.
Fac. relacionados al pacienteEdad y sexo: no sig.
Consideraciones con condiciones sistmicas
Fac. relacionados a la pza dentariaPzas anteriores: mayor tasa de xito
Molares inf: menor tasa de xito
Presencia de sntomas: relacionados a procesos agudos
Presencia de tx de conductos previo
No significativo
Tx no qx es la primera alternativa
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von Arx, Thomas, Miguel Penarrocha, and Storgrd Jensen. "Prognostic factors in apicalsurgery with root-end filling: a meta-analysis."Journal of endodontics36.6 (2010): 957-973.
Fuss Z, Lustig J, Katz A, et al. An evaluation of endodontically treated vertical root fracturedteeth: impact of operative procedures. J Endod 2001;27:468.
Longitud es demayor importancia
Fac que predisponefx radicular
Posteintraradicular
Reseccin 3 mm
Recomendacin No significativo Tiempo de
seguimiento
Tamao delesin
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Chong BS, Pitt Ford TR, Hudson MB. A prospective clinical study of MTA and IRM when used as root-endfilling materials in endodontic surgery. Int Endod J 2003; 36:5206.Lindeboom JAH, Frenken JWH, Valkenburg P, et al. The role of preoperative prophylactic antibiotic
administration in periapical endodontic surgery: a randomized, prospective double-blind placebo-controlled study. Int Endod J 2005;38: 87781.
Material de obturacinretrgrada
MTA (91.4%)
Reintervencin
Menos tasa de xito No homogeneidad
Uso de ATB
Estudio clnico aleatorizado No diferencia sig
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Uso de microcopa
No OR vlido Estudios in vitro
demuestran ventajas
Preparacin de lacavidad
Uso de fresa empeorael pronstico
von Arx T, Montagne D, Zwinggi C, et al. Diagnostic accuracy of endoscopy in periradicularsurgerya comparison with scanning electron microscopy. Int Endod J 2003;36:6919.
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von Arx, Thomas, et al. "Five-year longitudinal assessment of the prognosis of apical
microsurgery."Journal of Endodontics38.5 (2012): 570-579.
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El estudio presenta un alto nivel de evidencia cientfica, y sedebe considerar para la prctica clnica.
Se debe seleccionar adecuadamente el caso para determinar elpronstico del mismo.
Existe evidencia que indica que los factores que influyen en elpronstico de la piezas son:
Dolor preoperatorio
Densidad de obturacin
Presencia de lesin apical
Tipo de ciruga
Preparacin de la cavidad
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