Effect of Foraminal Enlargement on Periapical Healing in Necrotic Teeth: A Systematic Review.

Abstract

<h4>Introduction</h4>Foraminal Enlargement (FE) is a cleaning performed in the apical-most region of the tooth, in order to optimize root disinfection. This systematic review evaluated the influence of FE during root canal treatment on bacterial reduction and repair of the periapical lesion.<h4>Materials and methods</h4>Searches in PubMed/MEDLINE, Scopus, Cochrane Library, Web of Science, Embase, Scielo, Lilacs and OpenGrey were performed until January-2024. <i>Ex vivo</i> and <i>in vivo</i> studies evaluating the effects of FE in the bacterial reduction and repair of the periapical lesion were included, respectively, followed by risk of bias assessment (modified version of Joanna Briggs Institute's for <i>ex vivo</i> studies and Systematic Review Centre for Laboratory animal Experimentation's risk of bias tools for <i>in vivo</i> studies). The meta-analysis was not feasible and a qualitative summary for each outcome was provided.<h4>Results</h4>Of 950 studies, 2 <i>in vivo</i> studies were eligible, using animal models with infected teeth. Of these two, periapical repair was evaluated with hematoxylin-eosin stain, and FE improved periapical healing. Regarding <i>ex vivo</i> studies, 3 were eligible, using extracted human teeth. The inoculations in <i>ex vivo</i> models were performed with <i>Enterococcus</i> <i>(E.) faecalis,</i> and FE reduced <i>E. faecalis</i> in the <i>ex vivo</i> models.<h4>Conclusions</h4>Foraminal enlargement seems to increase bacterial reduction within the root canal, and provide major periapical tissue repair on the histological analysis in animal studies. However, caution is necessary when translating these results to the clinical environment.