Effect of guided tissue regeneration on the outcome of surgical endodontic treatment: An umbrella review

Aims: This umbrella review and network meta-analysis (NMA) evaluated the comparative effectiveness of guided tissue regeneration (GTR) techniques and biomaterials in improving clinical and radiographic outcomes following surgical endodontic treatment. Methods: A systematic search of PubMed, Scopus, Embase, and Web of Science up to July 2025 identified systematic reviews and meta-analyses assessing GTR interventions. Eligible reviews included primary studies comparing resorbable and nonresorbable membranes, bone grafts, and autologous platelet concentrates. Data were extracted at the primary study level and synthesized using a frequentist random-effects NMA model. Comparative rankings were assessed using Surface Under the Cumulative Ranking (SUCRA) curves. Risk of bias was evaluated with risk of bias in systematic reviews, and credibility of evidence was assessed using a seven-domain framework. Results: Fourteen systematic reviews encompassing 48 unique primary studies were included. The combination of expanded polytetrafluoroethylene (e-PTFE) membranes with hydroxyapatite ranked highest (SUCRA = 84.4%) and showed significantly greater clinical success compared with control (odds ratio = 0.13; 95% confidence interval: 0.02–0.98). Other high-ranking strategies included concentrated growth factor plus xenogenic Bio-Oss collagen (SUCRA = 73.2%) and collagen membranes combined with bovine-derived hydroxyapatite (SUCRA = 70.8%). Overall, combination therapies consistently outperformed single-component interventions. The network demonstrated low inconsistency and minimal publication bias. However, the credibility of effect estimates was limited, with most comparisons graded as weak evidence (Class IV). Conclusion: Combination strategies incorporating barrier membranes and bone grafts, particularly e-PTFE with hydroxyapatite, appear most effective in enhancing endodontic surgical outcomes.