Skip to main content

Advertisement

Log in

Influence of incision on periodontal parameters after apical surgery: a meta-analysis

  • Original Article
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Introduction

The aim of the present meta-analysis was to determine the effect of the different incision designs used in apical surgery on periodontal parameters.

Methods

An electronic search in Cochrane Library, Pubmed (MEDLINE), and Scopus was conducted on April 2020. Two independent investigators included clinical trials and prospective cohort studies comparing the influence of different incision designs used in apical surgery on gingival recession, periodontal probing depth, and clinical attachment level. A pairwise and network meta-analysis was performed in order to meta-analyze the direct and the indirect comparisons among the incision designs.

Results

Six articles were included for the qualitative and the quantitative syntheses, involving a total of 401 teeth (372 patients). The pairwise meta-analysis did not reveal statistically significant differences between the incision designs in any of the outcomes evaluated. However, to reduce the amount of buccal gingival recession, the papilla base incision presented the highest probabilities of being ranked the most effective incision (85.7%), followed by submarginal incision (50.0%) and intrasulcular incision (14.3%).

Conclusion

Regardless of the incision design used, the periodontal parameters did not statistically differ after apical surgery.

Clinical relevance

Periodontal parameters did not significantly change despite the incision used in apical surgery. However, based on the results of the present review, the papilla base incision seems to be the best option to reduce the amount of buccal gingival recession.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Setzer FC, Boyer KR, Jeppson JR, Karabucak B, Kim S (2011) Long-term prognosis of endodontically treated teeth: a retrospective analysis of preoperative factors in molars. J Endod 37:21–25. https://doi.org/10.1016/j.joen.2010.10.005

    Article  PubMed  Google Scholar 

  2. Ng YL, Mann V, Rahbaran S, Lewsey J, Gulabivala K (2008) Outcome of primary root canal treatment: systematic review of the literature - part 2. Influence of clinical factors. Int Endod J 41:6–31. https://doi.org/10.1111/j.1365-2591.2007.01323.x

    Article  PubMed  Google Scholar 

  3. Song M, Kim HC, Lee W, Kim E (2011) Analysis of the cause of failure in nonsurgical endodontic treatment by microscopic inspection during endodontic microsurgery. J Endod 11:1516–1519. https://doi.org/10.1016/j.joen.2011.06.032

    Article  Google Scholar 

  4. Chércoles-Ruiz A, Sánchez-Torres A, Gay-Escoda C (2017) Endodontics, endodontic retreatment, and apical surgery versus tooth extraction and implant placement: a systematic review. J Endod 43:679–686. https://doi.org/10.1016/j.joen.2017.01.004

    Article  PubMed  Google Scholar 

  5. Tsesis I, Faivishevsky V, Kfir A, Rosen E (2009) Outcome of surgical endodontic treatment performed by a modern technique: a meta-analysis of literature. J Endod 35:1505–1511. https://doi.org/10.1016/j.joen.2009.07.025

    Article  PubMed  Google Scholar 

  6. Setzer FC, Kohli MR, Shah SB, Karabucak B, Kim S (2012) Outcome of endodontic surgery: a meta-analysis of the literature—part 2: comparison of endodontic microsurgical techniques with and without the use of higher magnification. J Endod 38:1–10. https://doi.org/10.1016/j.joen.2011.09.021

    Article  PubMed  Google Scholar 

  7. Takei HH, Han TJ, Carranza FA, Kenney EB, Lekovic V (1985) Flap technique for periodontal bone implants: Papilla preservation technique. J Periodontol 56:204–210. https://doi.org/10.1902/jop.1985.56.4.204

    Article  PubMed  Google Scholar 

  8. Mörmann W, Ciancio SG (1977) Blood supply of human gingiva following periodontal surgery. A fluorescein angiographic study. J Periodontol 48:681–692. https://doi.org/10.1902/jop.1977.48.11.681

    Article  PubMed  Google Scholar 

  9. von Arx T, Salvi GE (2008) Incision techniques and flap designs for apical surgery in the anterior maxilla. Eur J Esthet Dent 3:110–126

    Google Scholar 

  10. Cortellini P, Pini Prato G, Tonetti MS (1996) The modified papilla preservation technique with bioresorbable barrier membranes in the treatment of intrabony defects. Case reports. Int J Periodontics Restorative Dent 16:546–559

    PubMed  Google Scholar 

  11. Hutton B, Salanti G, Caldwell DM, Chaimani A, Schmid CH, Cameron C, Ioannidis JPA, Straus S, Thorlund K, Jansen JP, Mulrow C, Catalá-López F, Gøtzsche PC, Dickersin K, Boutron I, Altman DG, Moher D (2015) The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med 162:777–784. https://doi.org/10.7326/M14-2385

    Article  PubMed  Google Scholar 

  12. Higgins JPT, Green S (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0. [update March 2011]. The Cochrane Collaboration. Available from www.cochrane-handbook.org. Accessed 1 June 2020

  13. Sterne JA, Hernán MA, Reeves BC et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919. https://doi.org/10.1136/bmj.i4919

    Article  PubMed  PubMed Central  Google Scholar 

  14. Wells G, Shea B, O’Connell D, Peterson J. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses Available at: www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 1 June 2020

  15. Caldwell DM, Ades AE, Higgins JPT (2005) Simultaneous comparison of multiple treatments: combining direct and indirect evidence. BMJ 331:897–900. https://doi.org/10.1136/bmj.331.7521.897

    Article  PubMed  PubMed Central  Google Scholar 

  16. Salanti G, Ades AE, Ioannidis JPA (2011) Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol 64:163–171. https://doi.org/10.1016/j.jclinepi.2010.03.016

    Article  PubMed  Google Scholar 

  17. Higgins JPT, Jackson D, Barrett JK, Lu G, Ades AE, White IR (2012) Consistency and inconsistency in network meta-analysis: concepts and models for multi-arm studies. Res Synth Methods 3:98–110. https://doi.org/10.1002/jrsm.1044

    Article  PubMed  PubMed Central  Google Scholar 

  18. Verardi S (2012) Apical surgery may cause gingival recession. J Evid Based Dent Pract 12:143–144. https://doi.org/10.1016/S1532-3382(12)70026-X

    Article  PubMed  Google Scholar 

  19. von Arx T (2011) Apical surgery: a review of current techniques and outcome. Saudi Dent J 23:9–15. https://doi.org/10.1016/j.sdentj.2010.10.004

    Article  Google Scholar 

  20. Velvart P, Ebner-Zimmermann U, Ebner JP (2003) Comparison of papilla healing following sulcular full-thickness flap and papilla base flap in endodontic surgery. Int Endod J 36:653–659. https://doi.org/10.1111/j.1365-2591.2004.00852.x

    Article  PubMed  Google Scholar 

  21. von Arx T, Salvi GE, Janner S, Jensen SS (2009) Gingival recession following apical surgery in the esthetic zone: a clinical study with 70 cases. Eur J Esthet Dent 4:28–45

    Google Scholar 

  22. von Arx T, Alsaeed M, Salvi GE (2011) Five-year changes in periodontal parameters after apical surgery. J Endod 37:910–918. https://doi.org/10.1016/j.joen.2011.03.024

    Article  Google Scholar 

  23. Kreisler M, Gockel R, Schmidt I, Kühl S, d’Hoedt B (2009) Clinical evaluation of a modified marginal sulcular incision technique in endodontic surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 108:22–28. https://doi.org/10.1016/j.tripleo.2009.08.005

  24. Taschieri S, Corbella S, Del Fabbro M (2014) Do gingival soft tissues benefit from the application of a papilla preservation flap technique in endodontic surgery? J Oral Maxillofac Surg 72:1898–1908. https://doi.org/10.1016/j.joms.2014.05.011

  25. Taschieri S, Del Fabbro M, Francetti L et al (2016) Does the papilla preservation flap technique induce soft tissue modifications over time in endodontic surgery procedures? J Endod 42:1191–1195. https://doi.org/10.1016/j.joen.2016.05.003

  26. Velvart P, Ebner-Zimmermann U, Ebner JP (2004) Comparison of long-term papilla healing following sulcular full thickness flap and papilla base flap in endodontic surgery. Int Endod J 37:687–693. https://doi.org/10.1111/j.1365-2591.2004.00852.x

  27. von Arx T, Vinzens-Majaniemi T, Burgin W et al (2007) Changes of periodontal parameters following apical surgery: a prospective clinical study of three incision techniques. Int Endod J 40:959–969. https://doi.org/10.1111/j.1365-2591.2007.01306.x

  28. von Arx T, Antonini L, Salvi GE, Bornstein MM (2017) Changes of periodontal parameters after apical surgery: correlation of clinical and cone-beam computed tomographic data. J Endod 43:876–884. https://doi.org/10.1016/j.joen.2017.01.016

  29. Deschner J, Wolff S, Hedderich J, Kreusch T, Jepsen S (2009) Dimensional changes of periodontal soft tissues after intrasulcular incision. Clin Oral Investig 13:401–408. https://doi.org/10.1007/s00784-009-0251-y

    Article  PubMed  Google Scholar 

  30. Cortellini P, Bissada NF (2018) Mucogingival conditions in the natural dentition: narrative review, case definitions, and diagnostic considerations. J Periodontol 89:204–213. https://doi.org/10.1002/JPER.16-0671

    Article  Google Scholar 

  31. Velvart P, Peters CI (2005) Soft tissue management in endodontic surgery. J Endod 31:4–16. https://doi.org/10.1097/01.don.000014532.08454.5c

    Article  PubMed  Google Scholar 

  32. Peters LB, Wesselink PR (1997) Soft tissue management in endodontic surgery. Dent Clin N Am 41:513–528

    PubMed  Google Scholar 

  33. Fickl S, Kebschull M, Schupbach P, Zuhr O, Schlagenhauf U, Hürzeler MB (2011) Bone loss after full-thickness and partial-thickness flap elevation. J Clin Periodontol 38:157–162. https://doi.org/10.1111/j.1600-051X.2010.01658.x

    Article  PubMed  Google Scholar 

  34. Fickl S, Fischer KR, Negri B, Ruíz RD, Calvo-Guirado JL, Kebschull M, Schlagenhauf U (2014) Tissue response following papilla-sparing and sulcular incisions in oral surgery-an experimental study. Clin Oral Investig 18:1313–1317. https://doi.org/10.1007/s00784-013-1069-1

    Article  PubMed  Google Scholar 

  35. Cortellini P, Prato GP, Tonetti MS (1995) The modified papilla preservation technique. A new surgical approach for interproximal regenerative procedures. J Periodontol 66:261–266. https://doi.org/10.1902/jop.1995.66.4.261

    Article  PubMed  Google Scholar 

  36. Velvart P (2002) Papilla base incision: a new approach to recession-free healing of the interdental papilla after endodontic surgery. Int Endod J 35:453–460. https://doi.org/10.1046/j.1365-2591.2002.00498.x

    Article  PubMed  Google Scholar 

  37. Velvart P, Ebner-Zimmermann U, Pierre Ebner J (2004) Papilla healing following sulcular full thickness flap in endodontic surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 98:365–369. https://doi.org/10.1016/S1079210404002598

    Article  PubMed  Google Scholar 

  38. Setzer FC, Shah SB, Kohli MR et al (2010) Outcome of endodontic surgery: a meta-analysis of the literature--part 1: comparison of traditional root-end surgery and endodontic microsurgery. J Endod 36:1757–1765. https://doi.org/10.1016/j.joen.2011.01.020

    Article  PubMed  Google Scholar 

  39. Girbés-Ballester P, Viña-Almunia J, Peñarrocha-Oltra D et al (2016) Soft tissue response in posterior teeth adjacent to interdental single implants: A controlled randomized clinical trial comparing intrasulcular vs trapezoidal incision. Int J Oral Maxillofac Implants 31:631–641. https://doi.org/10.11607/jomi.4178

    Article  PubMed  Google Scholar 

  40. Girbés-Ballester P, Viña-Almunia J, Balaguer-Martí JC, Peñarrocha-Diago M, Peñarrocha-Oltra D (2018) Effect of incision design on interproximal bone loss of teeth adjacent to single implants. A randomized controlled clinical trial comparing intrasulcular vs paramarginal incision. Clin Oral Implants Res 29:367–374. https://doi.org/10.1111/clr.13131

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jorge Toledano-Serrabona.

Ethics declarations

Conflict of interest

Adriana Castro-Calderón declares that she has no conflict of interest. Jorge Toledano-Serrabona declares that he has no conflict of interest. Alba Sánchez-Torres reports grants, personal fees and non-financial support from MozoGrau (Valladolid, Spain) and Mundipharma (Cambridge, UK). Octavi Camps-Font reports grants, personal fees, and non-financial support from Mundipharma (Cambridge, UK) and Menarini Richerche (Florence, Italy). Prof. Dra. Mª Ángeles Sánchez-Garcés declares that she has no conflict of interest. Prof. Dr. Cosme Gay-Escoda reports grants, personal fees, and non-financial support from Mundipharma (Cambridge, UK) and Menarini Richerche (Florence, Italy).

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Supplementary Figure 1

Forest plot for buccal gingival recession changes (A), mesial gingival recession changes (B), distal gingival recession changes (C). (JPG 539 kb)

(JPG 376 kb)

(JPG 370 kb)

Supplementary Figure 2

Forest plot for buccal periodontal probing depth changes (A), mesial periodontal probing depth changes, distal periodontal probing depth changes (C). (JPG 535 kb)

(JPG 359 kb)

(JPG 353 kb)

Supplementary Figure 3

Forest plot for buccal clinical attachment level changes (A), mesial clinical attachment level changes (B), distal clinical attachment level changes (C). (JPG 496 kb)

(JPG 224 kb)

(JPG 231 kb)

ESM 4

(PDF 125 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Castro-Calderón, A., Toledano-Serrabona, J., Sánchez-Torres, A. et al. Influence of incision on periodontal parameters after apical surgery: a meta-analysis. Clin Oral Invest 25, 4495–4506 (2021). https://doi.org/10.1007/s00784-020-03761-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-020-03761-z

Keywords

Navigation