Aim To assess the outcomes of platelet‐rich plasma as a scaffold in regenerative/revitalization endodontics (RET) using cone beam computed tomography (CBCT) and 2‐dimensional radiographs. Methodology Twenty‐six healthy patients with mean age of 12.66 ± 4.47, and immature permanent anterior teeth with necrotic pulps, were randomly allocated to two groups, whereby RET was performed using platelet‐rich plasma (PRP, test group) and blood clot (BLC, control group). Changes in root length (RL), root dentinal thickness (RDT), apical foramen width (AFW) and radiographic root area (RRA), were assessed using both radiographic methods, whilst changes in periapical area diameter (PAD) were assessed using CBCT, over a period of 12 months. T‐test and chi‐square/Fisher’s exact tests were used to compare continuous and categorical data between BLC and PRP groups, respectively. Changes in RL, RDT, AFW, RRA and PAD were examined by comparing the two groups (PRP versus BLC) using multilevel modelling, considering the clustering effect of repeated measures of several teeth originating from the same participant. Results Changes in RL, RDT, AFW, RRA and PAD, over time, were found to be significant for both groups. There was, however, no difference between the RET techniques (PRP versus BLC), using both radiographic and CBCT methods. The results of both assessment techniques (CBCT and 2‐dimensional radiographic methods) were highly consistent (overall ICC ranged between 0.80 and 0.94). In addition, a significant effect of baseline PAD was found on RL, RRA and AD at 12 months (RL effect = −0.68, P < 0.001; RRA effect = −1.91, P = 0.025; AD effect = 0.08, P = 0.024). Conclusion The current study highlights successful and comparable clinical and radiographic outcomes of RET techniques using PRP and BLC. Standardized and calibrated 2‐dimensional radiographic assessment was as effective as CBCT in assessing RET outcomes; therefore, the routine use of CBCT in RET is not recommended. Although an effect of baseline periapical lesion diameter on root development outcomes, at 12 months, were observed, more studies are recommended in order to assess such an effect.

Background Traumatic dental injuries involving the pulp are quite common and there is a need to evaluate the quality of evidence on the success of vital pulp treatment (VPT) interventions in traumatised permanent teeth. Objectives The aim of this systematic review was to assess the success of VPT in the management of traumatised human vital permanent teeth diagnosed with complicated crown or crown‐root fractures. Methods An electronic search of the following databases: Web of Science, Scopus, PubMed, MEDLINE, EMBASE, LILACS, Clinical Trial Registries and the grey literature was performed until 25th/8/2021. Controlled clinical trials, cohort studies, case‐control studies, case series with at least five cases and a minimum of 12‐months follow‐up were included. Non‐English language literature was excluded. Two independent assessors performed study selection, data extraction and quality assessment using the National Institutes of Health’s quality assessment tool. Disagreements were resolved through consensus/with a third assessor. Results A total of 14‐studies (2‐controlled clinical trials, 1‐case‐control, and 11‐case series) published between 1978–2020, with a total of 1081 permanent teeth and an age range between 6–42 years‐old were included. Bias analysis ranged considerably from ‘good’ to ‘poor’. Meta‐analysis was not performed due to data heterogeneity, unclear reporting, and limited number of controlled clinical studies. Partial pulpotomy was the main reported clinical procedure with an overall success rate between 82.9–100%. Complete pulpotomy and direct pulp capping were associated with lower success rates of 79.4–85.7% and 19.5%, respectively. Calcium hydroxide was the main pulp capping material with favourable clinical and radiographic success (79.4–100%). Biodentine®, mineral trioxide aggregate and IRoot® BP were also associated with a high clinical and radiographic success, 80–91%, 80–100%, and 90–100%, respectively, albeit in fewer studies. Discussion Although a high success rate has been reported when using VPT in managing pulpally involved traumatised teeth, the results of this systematic review clearly highlighted a paucity and low quality of the available evidence. Conclusions Overall high success of VPT in the management of traumatised vital permanent teeth were reported, although based on limited evidence of well‐conducted clinical studies. Registration PROSPERO database (CRD42020205213).

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