Nonsurgical Root Perforation Repair Showed 89.7% Favorable Outcomes in Meta-Analysis

Edited by Dentaltown staff

Nonsurgical repair of root perforations in permanent teeth produced favorable outcomes in an estimated 89.7% of cases, with smaller defects and maxillary teeth faring best, according to a systematic review and meta-analysis published Aug. 8 in the Journal of Endodontics.

Investigators searched six databases for studies published between January 2000 and February 2026 that reported outcomes of repaired root perforations with at least 12 months of follow-up. Of 393 records screened and 60 full-text articles assessed, nine observational studies qualified for the review and seven contributed to the meta-analysis. All nine evaluated nonsurgical repair.

The pooled favorable outcome was 89.7%, with a 95% confidence interval of 83.0% to 94.9%.

Two factors predicted better results. Perforations measuring 3 mm or less carried higher odds of a favorable outcome than larger defects, at an odds ratio of 2.69 and P = .008. Maxillary teeth showed higher odds than mandibular teeth, at 2.31 and P = .023.

Several factors clinicians might expect to matter did not. Tooth type, perforation location, patient sex, preoperative radiolucency, and preoperative signs and symptoms were not significantly associated with favorable outcomes.

The estimate sits well above an earlier synthesis. A 2015 review reported a pooled success rate of 72.5% drawing on studies published from 1950 onward, while the present review was limited to work from 2000 forward and captures newer calcium silicate-based repair materials.

Two investigators independently handled study selection, data extraction, and risk of bias assessment using the Joanna Briggs Institute critical appraisal checklist, and graded evidence using Oxford Centre for Evidence-Based Medicine levels and the GRADE approach.

Yee Ang, Lay Ann Teh, Jonathan Jun Xian Yuen, and Galvin Sim Siang Lin conducted the review, which received no specific funding.

Every included study was observational, and the authors rated overall certainty as low with substantial clinical heterogeneity across studies. They cautioned that the pooled figure and the prognostic associations should be interpreted with that in mind.

Sources:
Journal of Endodontics, “Treatment Outcomes Following Root Perforation Repair in Permanent Teeth: A Systematic Review and Meta-Analysis,” published online Aug. 8, 2026: sciencedirect.com/science/article/abs/pii/S0099239926004231
DOI: doi.org/10.1016/j.joen.2026.08.003