Clinical efficacy of orifice barriers in endodontics: A systematic review

IF 5.8 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of dentistry Pub Date : 2026-04-01 Epub Date: 2026-02-04 DOI:10.1016/j.jdent.2026.106556

Michael E. Wylie , James R. Fernando , Peter Parashos , Alastair J. Sloan , Joseph E.A. Palamara , Nadia Kaunein

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引用次数: 0

Abstract

Objectives

Orifice barriers (OBs) are commonly placed as sub-seals following root canal treatment, to resist microbial leakage if the primary coronal seal fails. However, despite numerous in vitro studies, clinical evidence supporting their efficacy is limited. This is the first systematic review of the in vivo endodontic literature evaluating OB effectiveness in root filled teeth (RFT), addressing a critical research gap.

Data sources

MEDLINE, Embase, CENTRAL, Web of Science and Scopus were systematically searched from inception through 16^th May 2025. Articles were screened using Covidence by two independent reviewers. Risk of bias and certainty of evidence assessments were undertaken to assess methodological rigour of included studies.

Study selection and results

Seven studies met the inclusion criteria. OBs improved outcomes for teeth with radicular cracks in two small single-arm cohort studies (90.6 % success & 96.6 % survival at 2-4years; 100 % at 1-3years). OBs were associated with lower apical periodontitis (AP) in one cross-sectional study (p < 0.005), while in a second, positioning the root filling/coronal restoration interface apical to marginal bone level was associated with lower AP (p < 0.005). Two remaining cohort studies showed no significant benefit for OBs in RFT. One randomised controlled trial showed no benefit of OBs, but follow-up was only one year. Heterogeneity among studies precluded meta-analysis.

Conclusions

Very low certainty in vivo evidence supports OBs in cracked RFT, but there is little evidence for OBs elsewhere. The limitations identified underscore the need for well-designed prospective in vivo studies to validate the evidence base for OBs.

Clinical significance

OB placement apical to radicular cracks may improve success and survival for cracked RFT, with specialist referral for treatment under microscopy recommended in such cases. OBs may play a role in creating a well-sealed coronal restoration following RCT, but further clinical research is required to determine their efficacy.

查看原文本刊更多论文

孔道屏障在牙髓学中的临床疗效：系统综述。

目的：孔道屏障（OBs）通常作为根管治疗后的亚密封，以防止初级冠状动脉密封失败时微生物泄漏。然而，尽管有大量的体外研究，临床证据支持其功效是有限的。这是第一次对体内牙髓学文献进行系统综述，评估OB在根补牙（RFT）中的有效性，解决了一个关键的研究空白。数据来源：MEDLINE， Embase， CENTRAL， Web of Science和Scopus从成立到2025年5月16日进行系统检索。文章由两名独立审稿人使用covid - ence进行筛选。对纳入研究的方法学严谨性进行偏倚风险和证据确定性评估。研究选择和结果：7项研究符合纳入标准。在两项小型单臂队列研究中，OBs改善了具有根状裂纹的牙齿的预后（2-4年的成功率为90.6%，生存率为96.6%；1-3年的生存率为100%）。在一项横断面研究中，OBs与下根尖牙周炎（AP）相关（p < 0.005），而在另一项研究中，定位根填充/冠状修复界面根尖至边缘骨水平与较低的AP相关（p < 0.005）。其余两项队列研究显示，在RFT中，OBs没有明显的益处。一项随机对照试验显示ob没有任何益处，但随访时间只有一年。研究间的异质性妨碍了meta分析。结论：非常低确定性的体内证据支持裂口RFT中的OBs，但其他地方的OBs证据很少。这些局限性强调了需要精心设计的前瞻性体内研究来验证OBs的证据基础。临床意义：OB放置根尖至根状裂缝可以提高裂化RFT的成功率和存活率，在这种情况下推荐专家在显微镜下进行治疗。随机对照试验（RCT）后，OBs可能在创建密封良好的冠状动脉修复中发挥作用，但需要进一步的临床研究来确定其疗效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of dentistry 医学-牙科与口腔外科

CiteScore

7.30

自引率

11.40%

发文量

349

审稿时长

35 days

期刊介绍： The Journal of Dentistry has an open access mirror journal The Journal of Dentistry: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The Journal of Dentistry is the leading international dental journal within the field of Restorative Dentistry. Placing an emphasis on publishing novel and high-quality research papers, the Journal aims to influence the practice of dentistry at clinician, research, industry and policy-maker level on an international basis. Topics covered include the management of dental disease, periodontology, endodontology, operative dentistry, fixed and removable prosthodontics, dental biomaterials science, long-term clinical trials including epidemiology and oral health, technology transfer of new scientific instrumentation or procedures, as well as clinically relevant oral biology and translational research. The Journal of Dentistry will publish original scientific research papers including short communications. It is also interested in publishing review articles and leaders in themed areas which will be linked to new scientific research. Conference proceedings are also welcome and expressions of interest should be communicated to the Editor.