Optimizing Endodontic Surgery: A Systematic Review of Guided Tissue Regeneration, Grafting, and Platelet Concentrates vs. No Intervention.

Background/Objectives: Guided tissue regeneration (GTR) and the use of various grafting materials and platelet concentrates have emerged as promising adjunctive techniques in endodontic surgery to enhance bone regeneration and improve healing outcomes, although evidence regarding their consistent effectiveness remains inconclusive. The aim of this systematic review is to evaluate existing randomized controlled trials (RCTs) and prospective clinical trials to determine the efficacy of bone grafts, membranes, or platelet concentrates on outcomes in endodontic periapical surgery, employing a robust evidence-based approach. Methods: Searches were conducted in MEDLINE (PubMed), Embase, Cochrane Library, and gray literature databases from their inception until March 2024. Study selection and data extraction were conducted independently by two reviewers. Eligible randomized controlled trials (RCTs) and prospective clinical trials underwent critical appraisal for risk of bias and quality of evidence and were subjected to meta-analysis to determine treatment effects. Results: Twelve studies were included. The pool success rate for periapical surgery using any regenerative material (bone graft, membrane, or platelet concentrate) was 2.48 (OR: 2.48, 95% CI: 1.42-4.34). Multiple subgroup analyses based on the type of regenerative material used during treatment were performed, presenting high certainty of evidence. The subgroup analysis, which examined bone graft only, bone graft with membrane, membrane only, concentrated growth factor only, and concentrated growth factor with bone graft, yielded significant results only for concentrated growth factor with bone graft (OR: 15.01, 95% CI: 1.12-271.70). While the success rate of periapical surgery with other regenerative materials did not reach statistical significance, the effect size was substantial. Conclusions: Overall, the findings indicate that utilizing a concentrated growth factor with a bone graft significantly improves the success of bone regeneration procedures over a 12-month follow-up period compared to interventions without these components. However, more research will be needed with larger sample sizes and longer follow-up times.