Effectiveness of Autologous Platelet Concentrates in Management of Young Immature Necrotic Permanent Teeth-A Systematic Review and Meta-Analysis.

Saurav Panda,Barbara Lapinska,Shahnawaz Khijmatgar,Monika Lukomska-Szymanska,Massimo Del Fabbro,Abhishek Parolia,Cristina Bucchi,Lora Mishra,Heber Isac Arbildo-Vega

doi:10.3390/cells9102241

Abstract

The use of autologous platelet concentrates (APCs) in regenerative endodontic procedures is inconsistent and unclear. The aim of this meta-analysis was to evaluate the effectiveness of autologous platelet concentrates compared to traditional blood-clot regeneration for the management of young, immature, necrotic, permanent teeth. The digital databases MEDLINE, SCOPUS, CENTRAL, Web of Science, and EMBASE were searched to identify ten randomized clinical trials. The outcomes at postoperative follow-up, such as dentinal wall thickness (DWT), increase in root length (RL), calcific barrier formation (CB), apical closure (AC), vitality response (VR), and success rate (SR), were subjected to both qualitative synthesis and quantitative meta-analysis. The meta-analysis showed that APCs significantly improved apical closure (risk ratio (RR) = 1.17; 95% CI: 1.01, 1.37; p = 0.04) and response to vitality pulp tests (RR = 1.61; 95% CI: 1.03, 2.52; p = 0.04), whereas no significant effect was observed on root lengthening, dentin wall thickness, or success rate of immature, necrotic teeth treated with regenerative endodontics. APCs could be beneficial when treating young, immature, necrotic, permanent teeth regarding better apical closure and improved response to vitality tests.

Highlights

Until recently, the most common treatment option for immature, permanent teeth diagnosed with necrotic pulp was apexification using calcium hydroxide (CH) or mineral trioxide aggregate (MTA).CH used as a root-canal dressing, aside from involving time-absorbing treatment, was found to increase the risk of root fracture [1], whereas apical MTA plugs seem to be more effective, expensive and difficult to handle [2]
This review included a total of 10 randomized clinical trials assessing the effectiveness of autologous platelet concentrates (APCs) in the management of young, immature, necrotic, permanent teeth [29,30,31,32,33,34,35,36,37,38]
The overall risk ratio (RR = 0.97, 95% CI: 0.82, 1.15) of achieving excellent/good root length (RL) was found to be not significant (p = 0.73) between the use of APCs and blood-clot regeneration (BC) in the management of young, immature, necrotic, permanent teeth (Figure 3)

Summary

Introduction

The most common treatment option for immature, permanent teeth diagnosed with necrotic pulp was apexification using calcium hydroxide (CH) or mineral trioxide aggregate (MTA).CH used as a root-canal dressing, aside from involving time-absorbing treatment, was found to increase the risk of root fracture [1], whereas apical MTA plugs seem to be more effective, expensive and difficult to handle [2]. The most common treatment option for immature, permanent teeth diagnosed with necrotic pulp was apexification using calcium hydroxide (CH) or mineral trioxide aggregate (MTA). Apexification independent of the material used to produce the apical barrier does not allow for the revitalization and further root development of the immature, necrotic tooth [4], thereby compromising its prognosis [5,6]. Current REPs remain unable to reinstate physiological structure and function, but they can induce the development of new vascularized tissue in the root-canal space. This guided endodontic repair process allows for continuing root development, thickening of root canal walls, apical closure, and complete resolution of apical periodontitis [9]

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Discussion

Conclusion