Treatment Outcome of Repaired Root Perforation: A Systematic Review and Meta-analysis

• Systematic review of literature, from 1950 to 2014, on clinical outcome of perforation repair.
• Success rate of >70% was generally concluded for nonsurgical perforation repair.
• Two favorable factors were maxillary teeth and absence of preoperative radiolucency.

IntroductionThis study aimed to review systematically the reported treatment outcome of repaired root perforation and to identify any preoperative factors that may influence the outcome of such repair.MethodsA comprehensive search was conducted by using 4 electronic databases, as well as manual search of cited references, to identify reports related to root perforation. Clinical studies published from 1950 to mid-2014 that evaluated the outcome of repaired root perforations were identified. Studies were further screened for similar characteristics for pooling of data for meta-analysis.ResultsSeventeen studies were included for systematic review and 12 suitable for meta-analysis. An overall pooled success rate of 72.5% (confidence interval, 61.9%–81.0%) was estimated for nonsurgical repair of root perforations. The use of mineral trioxide aggregate appeared to enhance the success rate to 80.9% (confidence interval, 67.1%–89.8%), but the difference was not statistically significant. The presence of pre-existing radiolucency adjacent to the perforation site fared a lower chance of success after repair (P < .05). Maxillary teeth demonstrated a significantly higher success rate compared with their mandibular counterpart (P < .05).ConclusionsWithin the limitations of this study, it may be concluded that nonsurgical repair of root perforation results in a success rate of more than 70%. Teeth in the maxillary arch and absence of preoperative radiolucency adjacent to the perforation are favorable preoperative factors for healing after perforation repair. In view of the relatively high rate of clinical success, nonsurgical repair may be considered as the preferred treatment to handle this complication that arises during root canal therapy.