Root Resection Outcomes in Permanent Molars by Endodontic Versus Periodontal Indication: A Systematic Review and Meta-Analysis.

Authors

Mohammad A Sabeti, Ashley Wang

Published in

Journal of endodontics. Nov 02, 2026. Epub Nov 02, 2026.

Abstract

Root resection is a tooth-preserving option for selected molars when endodontic retreatment or apical surgery is infeasible or when periodontal furcation involvement compromises maintainability. This systematic review and meta-analysis compared outcomes after root resection performed for predominantly endodontic versus predominantly periodontal indications.
PubMed/MEDLINE, Embase, Web of Science, and Google Scholar were searched through May 7, 2026 for clinical studies of permanent molars treated with root resection, with at least 10 cases and at least 1 year of follow-up (PROSPERO CRD420251060463). Five comparative studies reporting both indications were meta-analyzed using crude within-study failure risk ratios (RRs; periodontal/endodontic) and a DerSimonian-Laird random-effects model. Because indication-specific time-to-event data and hazard ratios were inconsistently available, the pooled RR was considered an exploratory, non-time-standardized summary. A sensitivity analysis excluded the claims-based study that lacked individual follow-up. Risk of bias was assessed using the Newcastle-Ottawa Scale, and certainty of evidence was assessed using GRADE.
Twelve studies met the inclusion criteria, including 5 comparative studies and 7 periodontal-only studies. Comparative studies included 307 endodontically and 520 periodontally indicated resections. The pooled failure RR was 0.82 (95% confidence interval, 0.56-1.21; P = .320; I² = 24.3%), with a wide 95% prediction interval (0.33-2.07). Because only 5 studies were available and follow-up was highly nonuniform, the I² estimate was not interpreted as evidence of low heterogeneity. Restriction to 4 clinical cohorts with documented individual follow-up yielded a similar non-significant estimate (RR, 0.74; 95% CI, 0.50-1.08; I² = 10.3%). Periodontal disease progression was the most frequently reported extraction cause in periodontal-indication studies. Endodontic-indication extraction causes were available from only one comparative study (29 teeth) and were reported narratively only.
Available evidence does not demonstrate a statistically significant difference in failure risk between periodontally and endodontically indicated root resections. The meta-analytic estimate is methodologically fragile because it combines crude failure risks observed over substantially different follow-up periods and should not be interpreted as a time-standardized survival comparison. Overall certainty of evidence was very low.

PMID:
42971465
Bibliographic data and abstract were imported from PubMed on 03 Nov 2026.

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