Outcome of Crown and Root Resection: A Systematic Review and Meta-analysis of the Literature

Frank C Setzer; Haochang Shou; Pacharee Kulwattanaporn; Meetu R Kohli; Bekir Karabucak

doi:10.1016/j.joen.2018.10.003

Outcome of Crown and Root Resection: A Systematic Review and Meta-analysis of the Literature

J Endod. 2019 Jan;45(1):6-19. doi: 10.1016/j.joen.2018.10.003. Epub 2018 Dec 6.

Authors

Frank C Setzer¹, Haochang Shou², Pacharee Kulwattanaporn³, Meetu R Kohli⁴, Bekir Karabucak⁴

Affiliations

¹ Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: fsetzer@upenn.edu.
² Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania.
³ Department of Operative Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
⁴ Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

PMID: 30527594
DOI: 10.1016/j.joen.2018.10.003

Abstract

Introduction: A systematic review and meta-analysis were conducted to report combined and individual weighted pooled outcome rates for crown resection (CR) and root resection (RR) procedures.

Methods: Three electronic databases (PubMed [MEDLINE], Scopus, and the Cochrane Library) were searched to identify human studies in 12 languages on CR (hemisection, trisection, and premolarization) and RR (amputations and RRs without removal of crown portions). Five peer-reviewed journals, references of relevant publications, and reviews were hand searched. Assessment by 3 independent reviewers was based on the following predefined Population, Intervention, Comparison, Outcome, Study Design question: "For teeth in patients undergoing surgical therapy by CR versus RR, what is the expected probability of survival according to longitudinal studies with strictly defined outcome measurements and inclusion/exclusion criteria?" Clinical investigations with at least 12 months of follow-up were included. Studies and level of evidence were appraised using the Newcastle-Ottawa Scale and Grading of Recommendations, Assessment, Development and Evaluations.

Results: Thirty-four articles were obtained for final analysis. Data could be extracted from 19 studies (CR and RR OVERALL: N = 2667 [19 studies], CR: n = 111 [3 studies], and RR: n = 1127 [9 studies]). A random effects model showed weighted mean survival rates of 85.6% (95% confidence interval [CI], 76.7-91.5) for CR and RR procedures OVERALL. Individual data showed weighted mean survival rates of 81.9% (95% CI, 72.0-88.8) for CR and 87.2% (95% CI, 71.7-94.8) for RR. There was no statistically significant difference between CR and RR (P = .89, odds ratio calculation) or between maxillary and mandibular molars (P = .81, Fisher exact test).

Conclusions: Overall, CR and RR procedures showed good outcome rates. Large-scale randomized controlled trials should be conducted to strengthen the evidence.

Keywords: Crown resection; meta-analysis; outcome; root resection; success; survival; systematic review.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Apicoectomy*
Databases, Bibliographic
Follow-Up Studies
Humans
Outcome Assessment, Health Care*
Tooth Crown / surgery*
Tooth Root / surgery*