Effectiveness of various scaffolds on the success of endodontic tissue regeneration: A systematic review and meta-analysis of randomized controlled trials

Abstract

Introduction: This systematic review was planned to summarize and quantitatively assess the effect of various tissue regenerative scaffolds on the success of regenerative endodontic techniques in nonvital immature permanent teeth. Materials and Methods: An organized electronic search was conducted through multiple databases. Only randomized controlled trials in patients with nonvital immature teeth were included. The main outcomes were the healing of periapical radiolucency, apical closure, and an increase in root length. The Cochrane risk of bias assessment tool was used for evaluating the risk of bias in the included studies. The quality of each outcome was assessed through the use of the Grading of Recommendations, Assessment, Development, and Evaluation approach. A random-effects model was used for meta-analysis. Results: Sixteen studies involving 153 patients were included, and the overall risk of bias in these studies was moderate. A comparison between blood clot (BC) and platelet-rich plasma (PRP) showed that BC had the greater healing of periapical radiolucency, with an odds ratio (OR) of 3.99; 95% confidence interval (CI): 1.073–14.79; P = 0.04; I2 = 0% (certainty of evidence = moderate), as well as greater root length development, with an OR of 2.94; 95% CI: 1.34–6.48; P = 0.007; I2 = 83% (certainty of evidence = moderate). However, no significant difference in apical closure had been found between the BC and PRP groups, with an OR of 1.73; 95% CI: 0.53–5.70; P = 0.36; I2 = 46% (certainty of evidence = moderate). Conclusions: Moderate quality evidence showed that BC and platelet-rich fibrin are equally effective in the healing of apical radiolucency, apical closure, and an increase in root length of nonvital immature permanent teeth during tissue regeneration. BC scaffold performs better than PRP. Additional well-designed randomized controlled trials on other scaffolds are recommended.