Clinical Outcome and Comparison of Regenerative and Apexification Intervention in Young Immature Necrotic Teeth—A Systematic Review and Meta-Analysis

Abstract

This systematic review aimed to evaluate interventions individually and compare the clinical outcome of young, immature teeth treated with regenerative endodontic therapy (RET) and apexification procedure. The protocol was registered with PROSPERO (International Prospective Register of Systematic Reviews), bearing the registration number CRD42021230284. A bibliographic search in the biomedical databases was conducted in four databases—PubMed, CENTRAL, EMBASE and ProQuest—using searching keywords and was limited to studies published between January 2000 and April 2022 in English. The search was supplemented by manual searching, citation screening and scanning of all reference lists of selected paper. The study selection criteria were randomized clinical trial, prospective clinical studies and observational studies. The search found 32 eligible articles, which were included in the study. The quality assessment of the studies was performed using the Cochrane risk of bias tool for randomized control trials and non-randomized clinical studies. The meta-analysis was performed using Review Manager software (REVMAN, version 5). The results indicated that a clinicians’ MTA apexification procedure was more successful compared to calcium hydroxide. In RET, apical closure and overall success rate is statistically same for both apical platelet concentrates (APCs) and blood clots (BC). Both interventions have similar survival rates; however, RET should be preferred in cases where the root development is severely deficient, there is insufficient dentine and the tooth’s prognosis is hopeless even with an apexification procedure.

External Inflammatory Root Resorption in Traumatized Immature Incisors: MTA Plug or Revitalization? A Case Series

“…Due to the abovementioned drawbacks, it seems appropriate to prefer the use of MTA to induce an apical barrier. Furthermore, a recent systematic review and meta-analysis stated lower success rates for CH apexification compared to the MTA plug [28]. In the cases described here, CH was used for canal disinfection for at least 3 weeks to optimize intracanal disinfection.…”

Clinical applications of calcium silicate‐based materials: a narrative review

“…81,82 The basic principles of GER include removal of necrotic tissues, minimal or no root canal instrumentation, copious irrigation with NaOCl and control of infection with or without intracanal medication similar to apexification treatment. 83 GER is generally performed by inducing apical bleeding to form a blood clot in the root canal and placing a CSC on the clot as a coronal barrier. 84 CSCs are preferred in this treatment as they provide a good coronal seal, have antibacterial effects due to high pH and Ca(OH) 2 release, and allow hydroxyapatite formation in contact with tissue fluids.…”

“…Response to pulp sensibility tests after this treatment has also been reported in some cases 81,82 . The basic principles of GER include removal of necrotic tissues, minimal or no root canal instrumentation, copious irrigation with NaOCl and control of infection with or without intracanal medication similar to apexification treatment 83 . GER is generally performed by inducing apical bleeding to form a blood clot in the root canal and placing a CSC on the clot as a coronal barrier 84 .…”

Management of contralateral molar teeth with necrotic pulp and open apexes using platelet‐rich plasma and vital pulp therapy

“…MTA apexification as a one-step technique gradually replaces CH-based procedures since it needs fewer appointments for treatment and shorter time for apical barrier formation. 6 Although MTA application improves the clinical outcome and patient satisfaction and reduces the duration of treatment, the completion of root development and increase in root dentin thickness, is not achieved. 7 In contrast, RET induces the release of growth factors from platelets and stem cells located in the pericardial tissue and can lead to the formation of a natural scaffold (fibrin clot) within the root canal.…”

“…Apexification with MTA is more successful than CH. MTA apexification as a one‐step technique gradually replaces CH‐based procedures since it needs fewer appointments for treatment and shorter time for apical barrier formation 6 . Although MTA application improves the clinical outcome and patient satisfaction and reduces the duration of treatment, the completion of root development and increase in root dentin thickness, is not achieved 7 .…”