THE EFFECT OF LESION SIZE, GUIDED TISSUE REGENERATION AND CONE-BEAM COMPUTED TOMOGRAHPY ON THE OUTCOME OF ENDODONTIC MICROSURGERY: A SYSTEMATIC REVIEW.

Authors

Ann-Sophie Schotte, Joey d'hoop, Alice d'hoore, Paul Lambrechts, Mariano S Pedano, Andres Torres

Published in

Journal of dentistry. Pages 106982. Aug 18, 2026. Epub Aug 18, 2026.

Abstract

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).
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.
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).
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.
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.
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.

PMID:
42612960
Bibliographic data and abstract were imported from PubMed on 19 Aug 2026.

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