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Yang F, Sheng K, Yu L, Wang J. Does the use of different scaffolds have an impact on the therapeutic efficacy of regenerative endodontic procedures? A systematic evaluation and meta-analysis. BMC Oral Health 2024; 24:319. [PMID: 38461281 PMCID: PMC10924999 DOI: 10.1186/s12903-024-04064-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/22/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND In the regenerative endodontic procedures, scaffolds could influence the prognosis of affected teeth. Currently, there is controversy regarding the postoperative evaluation of various scaffolds for pulp regeneration. The objective of this study was to access whether other scaffolds, used alone or in combination with blood clot (BC), are more effective than BC in regenerative endodontic procedures. METHODS We systematically search the PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and Google Scholar databases. Randomized controlled trials examining the use of BC and other scaffold materials in the regenerative endodontic procedures were included. A random effects model was used for the meta-analysis. The GRADE method was used to determine the quality of the evidence. RESULTS We screened 168 RCTs related to young permanent tooth pulp necrosis through electronic and manual retrieval. A total of 28 RCTs were related to regenerative endodontic procedures. Ultimately, 12 articles met the inclusion criteria and were included in the relevant meta-analysis. Only 2 studies were assessed to have a low risk of bias. High quality evidence indicated that there was no statistically significant difference in the success rate between the two groups (RR=0.99, 95% CI=0.96 to 1.03; 434 participants, 12 studies); low-quality evidence indicated that there was no statistically significant difference in the increase in root length or root canal wall thickness between the two groups. Medium quality evidence indicated that there was no statistically significant difference in pulp vitality testing between the two groups. CONCLUSIONS For clinical regenerative endodontic procedures, the most commonly used scaffolds include BC, PRP, and PRF. All the different scaffolds had fairly high clinical success rates, and the difference was not significant. For regenerative endodontic procedures involving young permanent teeth with pulp necrosis, clinical practitioners could choose a reasonable scaffold considering the conditions of the equipment and patients.
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Affiliation(s)
- Feng Yang
- Department of Pediatric Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Kai Sheng
- Department of Pediatric Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Lintong Yu
- Department of Pediatric Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, 200011, China.
| | - Jun Wang
- Department of Pediatric Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, 200011, China.
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2
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Sabeti M, Ghobrial D, Zanjir M, da Costa BR, Young Y, Azarpazhooh A. Treatment outcomes of regenerative endodontic therapy in immature permanent teeth with pulpal necrosis: A systematic review and network meta-analysis. Int Endod J 2024; 57:238-255. [PMID: 37966465 DOI: 10.1111/iej.13999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 10/21/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023]
Abstract
AIM The aim of this study was to assess which treatment modality regarding scaffold selection for immature permanent teeth with pulpal necrosis will be the most successful for regenerative endodontic treatment (RET). METHODOLOGY PubMed, Cochrane, Web of Science and Embase, and additional records until August 2022 were searched providing a total of 3021 articles, and nine of these articles were included for quantitative synthesis. The reviewers selected eligible randomized controlled trials and extracted pertinent data. Network meta-analysis was conducted to estimate treatment effects for primary outcomes (clinical and radiographic healing) and secondary outcomes (apical closure, root length and root wall thickness increase) following RET [mean difference (MD); 95% credible interval (CrI) and surface under the cumulative ranking curve (SUCRA)]. The quality of the included studies was appraised by the revised Cochrane risk of bias tool, and the quality of evidence was assessed using the GRADE approach. RESULTS Six interventions from nine included studies were identified: blood clot scaffold (BC), blood clot scaffold with basic fibroblast growth factor, blood clot scaffold with collagen, platelet pellet, platelet-rich plasma (PRP) and platelet-rich fibrin (PRF). The PRP scaffold showed the greatest increase in root lengthening at 6-12 months (MD = 4.2; 95% CrI, 1.2 to 6.8; SUCRA = 89.0%, very low confidence). PRP or PRF achieved the highest level of success for primary and secondary outcomes at 1-6 and 6-12 months. Blood clot scaffold (with collagen or combined with basic fibroblast growth factor (bFGF)) achieved the highest level of success for secondary outcomes beyond 12 months follow-up. A very low to low quality of evidence suggests that both PRP and PRF exhibit the greatest success evaluating primary and secondary outcomes within 12 months postoperatively compared to the traditional blood clot scaffold protocol. CONCLUSION Limited evidence suggests both PRP and PRF exhibit success in the short-term, not long-term. The value of this information stems in its recommendation for future randomized trials prioritizing both of these materials in their protocol.
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Affiliation(s)
- Mohammad Sabeti
- Department of Preventive and Restorative Dental Science, UCSF School of Dentistry, San Francisco, California, USA
| | - Daniel Ghobrial
- PG Endodontic Resident, UCSF School of Dentistry, San Francisco, California, USA
| | - Maryam Zanjir
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Bruno R da Costa
- Clinical Epidemiology & Health Care Research, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Yating Young
- UCSF School of Dentistry, San Francisco, California, USA
| | - Amir Azarpazhooh
- Head Division of Endodontics and Research, Director, Department of Dentistry, Faculty of Advanced Training Program in Orofacial, Faculty of Dentistry, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
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Priya B L, Singh N, Mangalam KK, Sachdev R, P A, Jain HN, Nagi PK. Success and Complication Rates of Revascularization Procedures for Immature Necrotic Teeth: A Systematic Review. Cureus 2023; 15:e51364. [PMID: 38292962 PMCID: PMC10825383 DOI: 10.7759/cureus.51364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/30/2023] [Indexed: 02/01/2024] Open
Abstract
Frequently, adolescents exhibit instances of immature necrotic teeth, which are identifiable by their slender root walls and unclosed root tips. The lack of a natural narrowing near the root's end creates difficulty when using standard endodontic procedures, making the effective sealing of the immature root canal difficult or impractical. Revascularization therapy surfaces as a prospective strategy for addressing the management of undeveloped, non-vital, immature, necrotic teeth. Notwithstanding this, apexification continues to hold prominence in the preferences of clinicians owing to its perceived predictability in treatment outcomes. A systematic investigation was conducted involving various search engines and databases, covering the period from 2001 to 2023. The main aim of this investigation was to find randomized clinical trials that compared the efficacy of revascularization therapy to apexification for treating immature necrotic teeth. The evaluation included a thorough examination of both clinical and radiographic outcomes assessing the success rates and complications. Out of the 850 identified articles, 15 studies were chosen for comprehensive analysis. Notable dissimilarities were not identified between the revascularization therapy and apexification groups concerning parameters such as rates of periapical healing, overall effectiveness/invalidation, and apical closure. However, concentrating on measurable factors, it became clear that the revascularization treatment group displayed a notable rise in root length compared to the apexification group. Both revascularization endodontic therapy and apexification demonstrated effectiveness in addressing periapical periodontitis healing and open apex closure. Pulp revascularization stood out for its notable efficacy in enhancing root elongation and thickening, all while having a reduced likelihood of treatment being deemed ineffective overall.
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Affiliation(s)
- Lalitha Priya B
- Conservative Dentistry and Endodontics, Sri Ramakrishna Dental College and Hospital, Coimbatore, IND
| | - Neha Singh
- Conservative Dentistry and Endodontics, Maharana Pratap Dental College and Hospital, Kanpur, IND
| | - Keshav Kumar Mangalam
- Conservative Dentistry and Endodontics, Maharana Pratap Dental College and Hospital, Kanpur, IND
| | - Rohan Sachdev
- Public Health, The University of Western Australia Dental School, Crawley, AUS
| | - Aishwarrya P
- Orthodontics and Dentofacial Orthopaedics, Sri Ramakrishna Dental College and Hospital, Coimbatore, IND
| | | | - Puneet Kamal Nagi
- Periodontics, Punjab Government Dental College and Hospital, Amritsar, IND
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Biradar N, Ragulakollu R, Tej G, Bogishetty C, Gandham S, Vardhan P. Combination Therapy of Antibiotics and Platelet-rich Fibrin for Apical Closure: Case Series. Int J Clin Pediatr Dent 2023; 16:541-546. [PMID: 37496947 PMCID: PMC10367293 DOI: 10.5005/jp-journals-10005-2613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
The aim of endodontic treatment in immature teeth is to disinfect and regenerate tissues in the apical region for the closure of the root. Stem cells from apical papilla (SCAP) by differentiating into odontogenic and osteogenic tissues create apical closure. Triple antibiotic pastes (TAP) disinfect the root canal without adversely affecting the SCAP. Differentiation of SCAP is promoted by platelet-rich fibrin (PRF). Hence, combining TAP and PRF could have a synergistic effect. Case description An 11-year-old girl, a 9-year-old boy, and a 13-year-old boy, symptomatic patients with open apex, are treated with TAP, PRF, and mineral trioxide aggregate (MTA) as an apical barrier sequentially. There was the formation of a calcific barrier at the end of 12, 6, and 3 months, respectively. Conclusion Correct diagnosis and protocol of sequential disinfection, regeneration, and finally filling the canal with an apical barrier could yield better results. How to cite this article Biradar N, Ragulakollu R, Tej G, et al. Combination Therapy of Antibiotics and Platelet-rich Fibrin for Apical Closure: Case Series. Int J Clin Pediatr Dent 2023;16(3):541-546.
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Affiliation(s)
- Nandini Biradar
- Department of Dentistry, Bidar Institute of Medical Sciences, Bidar, Karnataka, India
| | - Rajesh Ragulakollu
- Department of Paediatric Dentistry, Malla Reddy Institute of Dental Sciences (MRIDS), Hyderabad, Telangana, India
| | - Gururam Tej
- Department of Periodontics, Malla Reddy Institute of Dental Sciences (MRIDS), Hyderabad, Telangana, India
| | - Chittaranjan Bogishetty
- Department of Prosthodontics, Malla Reddy Institute of Dental Sciences (MRIDS), Hyderabad, Telangana, India
| | - Srehitha Gandham
- Department of Paediatric Dentistry, Malla Reddy Institute of Dental Sciences (MRIDS), Hyderabad, Telangana, India
| | - Pavan Vardhan
- Department of Paediatric Dentistry, Malla Reddy Institute of Dental Sciences (MRIDS), Hyderabad, Telangana, India
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Rahul M, Lokade A, Tewari N, Mathur V, Agarwal D, Goel S, Keshari P, Sharma S, Bansal K. Effect of Intracanal Scaffolds on the Success Outcomes of Regenerative Endodontic Therapy - A Systematic Review and Network Meta-analysis. J Endod 2023; 49:110-128. [PMID: 36410623 DOI: 10.1016/j.joen.2022.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/12/2022] [Accepted: 11/12/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The scaffolds used in regenerative endodontic therapy (RET) provide structural support for cells so that they can adhere to the scaffolds and also are crucial for cellular proliferation and differentiation. The objective of this network meta-analysis was to compare effects of different intracanal scaffolds on success outcomes of RET. METHODS PubMed/Medline, EMBASE, Cochrane, CINAHL, Scopus, and Web of Science databases were searched. Studies evaluating and/or comparing clinical and/or radiographic success of RET using different scaffolds with a minimum of 12 months follow-up were included. The Cochrane Collaboration risk of bias (ROB) tool and appropriate tools from Joanna Briggs Institute were used for the assessment of ROB. A network meta-analysis was performed to compare the primary outcome (clinical success) and other success outcomes (root maturation, and pulpal sensibility) using different scaffolds. RESULTS Twenty-seven studies fulfilled the desired inclusion criteria of which 25 had a low ROB whereas 2 had a moderate ROB. Clinical success of RET using platelet-rich plasma (PRP), blood clot (BC), and platelet-rich fibrin (PRF) scaffolds ranged between 91.66%-100%, 84.61%-100%, and 77%-100% respectively. The different scaffolds did not show any statistically significant difference in clinical success (PRF vs BC [P = 1.000], PRP vs BC [P = 1.000], and PRF vs PRP [P = .999]), apical root closure (PRF vs BC [P = 1.000], PRP vs BC [P = .835], PRF vs PRP [P = .956]), and pulp sensibility (PRF vs BC [P = .980], PRP versus BC [P = .520], and PRF vs PRP [P = .990]). CONCLUSION The intracanal scaffolds used during RET did not result in significant differences in regard to clinical success, root maturation, and pulpal sensibility.
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Affiliation(s)
- Morankar Rahul
- Division of pedodontics and preventive dentistry, Centre for Dental Education and Research, AIIMS, New Delhi, India.
| | - Amolkumar Lokade
- Division of pedodontics and preventive dentistry, Centre for Dental Education and Research, AIIMS, New Delhi, India
| | - Nitesh Tewari
- Division of pedodontics and preventive dentistry, Centre for Dental Education and Research, AIIMS, New Delhi, India
| | - Vijay Mathur
- Division of pedodontics and preventive dentistry, Centre for Dental Education and Research, AIIMS, New Delhi, India
| | - Deepali Agarwal
- Division of Public Health Dentistry, Centre for Dental Education and Research, AIIMS, New Delhi, India
| | - Shubhi Goel
- Department of Public Health Dentistry, Postgraduate Institute of Dental Sciences, Rohtak, Haryana, India
| | | | - Sidhartha Sharma
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, AIIMS, New Delhi, India
| | - Kalpana Bansal
- Division of pedodontics and preventive dentistry, Centre for Dental Education and Research, AIIMS, New Delhi, India
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Tang Q, Jin H, Lin S, Ma L, Tian T, Qin X. Are platelet concentrate scaffolds superior to traditional blood clot scaffolds in regeneration therapy of necrotic immature permanent teeth? A systematic review and meta-analysis. BMC Oral Health 2022; 22:589. [PMID: 36494711 PMCID: PMC9733063 DOI: 10.1186/s12903-022-02605-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/17/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The effectiveness of platelet concentrates in promoting root development of necrotic immature permanent teeth is unclear. The present study evaluated whether the platelet concentrate protocol was superior to the traditional blood clot protocol in regeneration therapy. METHODS We searched Electronic databases, such as PubMed, Cochrane Library, ClinicalTrials and EMBASE. Randomized controlled trial studies, cohort studies, case-control studies and cross-sectional studies were included, in which platelet-rich concentrates were tested for periapical healing and root development, with the blood clot treatment protocol as the control group. Clinical and radiographic outcomes were considered. Selected articles were assessed for risk of bias. Pooled risk ratios (risk ratio, RR) were calculated for clinical success, responses to cold and electric pulp tests, periapical lesions, apex closure, root lengthening, and thickening of the dentin walls. Subgroup meta-analysis were conducted according to the type of platelet concentrate used. RESULTS Of the 1272 screened studies, 13 randomized controlled studies, 2 case-control studies and 1 cohort study were selected, in which 465 immature necrotic permanent teeth, particularly incisors and premolars, were treated. Of these 465 teeth, 457 (98.2%) in both the control and experimental groups remained clinically asymptomatic for the entire study duration, whereas eight (1.8%) showed signs and symptoms of failure, including spontaneous pain, sensitivity to percussion or reinfection. Compared with control teeth, teeth treated with PRP achieved better apical healing than BC group (RR 1.13, 95% CI 1.01-1.26, P = 0.03), and teeth treated with platelet concentrates showed improved apical closure (RR 1.04, 95% CI 0.86-1.25, P = 0.69), root lengthening (RR 1.01, 95% CI 0.74-1.39, P = 0.93), and thickening of the dentin walls (RR 1.35, 95% CI 0.95-1.93, P = 0.09), although these differences were not statistically significant. CONCLUSIONS Platelet concentrates can be used as successful scaffolds for regenerative endodontic treatment of necrotic immature permanent teeth, and PRP as a scaffold may achieve better periapical healing of teeth with periapical inflammation, although they did not differ significantly from conventional blood clot scaffolds in development of the root.
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Affiliation(s)
- Qianwei Tang
- grid.256607.00000 0004 1798 2653College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, Guagnxi China
| | - Hua Jin
- grid.19373.3f0000 0001 0193 3564Department of Stomatology, Harbin Institute of Technology Hospital, Harbin, HeiLongjiang China
| | - Song Lin
- Department of Pediatric Dentistry, Jinan Stomatology Hospital, Jinan, 250001 Shandong Province China
| | - Long Ma
- Department of Pediatric Dentistry, Jinan Stomatology Hospital, Jinan, 250001 Shandong Province China
| | - Tingyu Tian
- Department of Pediatric Dentistry, Jinan Stomatology Hospital, Jinan, 250001 Shandong Province China
| | - Xiurong Qin
- Department of Pediatric Dentistry, Jinan Stomatology Hospital, Jinan, 250001 Shandong Province China
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Minic S, Vital S, Chaussain C, Boukpessi T, Mangione F. Tissue Characteristics in Endodontic Regeneration: A Systematic Review. Int J Mol Sci 2022; 23:ijms231810534. [PMID: 36142446 PMCID: PMC9504778 DOI: 10.3390/ijms231810534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 12/01/2022] Open
Abstract
The regenerative endodontic procedure (REP) represents a treatment option for immature necrotic teeth with a periapical lesion. Currently, this therapy has a wide field of pre-clinical and clinical applications, but no standardization exists regarding successful criteria. Thus, by analysis of animal and human studies, the aim of this systematic review was to highlight the main characteristics of the tissue generated by REP. A customized search of PubMed, EMBASE, Scopus, and Web of Science databases from January 2000 to January 2022 was conducted. Seventy-five human and forty-nine animal studies were selected. In humans, the evaluation criteria were clinical 2D and 3D radiographic examinations. Most of the studies identified a successful REP with an asymptomatic tooth, apical lesion healing, and increased root thickness and length. In animals, histological and radiological criteria were considered. Newly formed tissues in the canals were fibrous, cementum, or bone-like tissues along the dentine walls depending on the area of the root. REP assured tooth development and viability. However, further studies are needed to identify procedures to successfully reproduce the physiological structure and function of the dentin–pulp complex.
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Affiliation(s)
- Sandra Minic
- URP 2496 Laboratory of Orofacial Pathologies, Imaging and Biotherapies, Life Imaging Platform (PIV), Laboratoire d’excellence INFLAMEX, UFR Odontology, Université Paris Cité, 92120 Montrouge, France
| | - Sibylle Vital
- URP 2496 Laboratory of Orofacial Pathologies, Imaging and Biotherapies, Life Imaging Platform (PIV), Laboratoire d’excellence INFLAMEX, UFR Odontology, Université Paris Cité, 92120 Montrouge, France
- Louis Mourier Hospital, AP-HP, DMU ESPRIT, 92700 Colombes, France
| | - Catherine Chaussain
- URP 2496 Laboratory of Orofacial Pathologies, Imaging and Biotherapies, Life Imaging Platform (PIV), Laboratoire d’excellence INFLAMEX, UFR Odontology, Université Paris Cité, 92120 Montrouge, France
- Bretonneau Hospital Dental Department and Reference Center for Rare Diseases of Calcium and Phosphorus Metabolism, AP-HP, 75018 Paris, France
| | - Tchilalo Boukpessi
- URP 2496 Laboratory of Orofacial Pathologies, Imaging and Biotherapies, Life Imaging Platform (PIV), Laboratoire d’excellence INFLAMEX, UFR Odontology, Université Paris Cité, 92120 Montrouge, France
- Pitié Salpétrière Hospital, DMU CHIR, AP-HP, 75013 Paris, France
| | - Francesca Mangione
- URP 2496 Laboratory of Orofacial Pathologies, Imaging and Biotherapies, Life Imaging Platform (PIV), Laboratoire d’excellence INFLAMEX, UFR Odontology, Université Paris Cité, 92120 Montrouge, France
- Henri Mondor Hospital, AP-HP, 94000 Créteil, France
- Correspondence:
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Panda P, Mishra L, Govind S, Panda S, Lapinska B. Clinical Outcome and Comparison of Regenerative and Apexification Intervention in Young Immature Necrotic Teeth-A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11133909. [PMID: 35807193 PMCID: PMC9267570 DOI: 10.3390/jcm11133909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 12/12/2022] Open
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.
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Affiliation(s)
- Pratima Panda
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, Odisha, India; (P.P.); (S.G.)
| | - Lora Mishra
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, Odisha, India; (P.P.); (S.G.)
- Correspondence: (L.M.); (B.L.); Tel.: +91-889-526-6363 (L.M.); +85-42-675-74-61 (B.L.)
| | - Shashirekha Govind
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, Odisha, India; (P.P.); (S.G.)
| | - Saurav Panda
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, Odisha, India;
| | - Barbara Lapinska
- Department of General Dentistry, Medical University of Lodz, 92-213 Lodz, Poland
- Correspondence: (L.M.); (B.L.); Tel.: +91-889-526-6363 (L.M.); +85-42-675-74-61 (B.L.)
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9
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Galler KM, Akamp T, Knüttel H, Widbiller M. A critical analysis of clinical research methods to study regenerative endodontics. Int Endod J 2022; 55 Suppl 2:456-470. [PMID: 35338660 DOI: 10.1111/iej.13734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Abstract
Regenerative endodontic treatment such as revitalization provides a treatment option for immature teeth with pulp necrosis. The main difference to the alternative procedure, the apical plug, is the induction of a blood clot inside the canal as a scaffold for healing and new tissue formation. Due to the biology-based and minimally-invasive nature of the treatment, revitalization has raised considerable interest in recent years. Whereas the procedure is fairly new and recommendations from endodontic societies have been in place only for a few years, the treatment protocol has evolved over the past two decades. Evidence has been created, not only from laboratory and animal work, but also from clinical studies including case reports, cohort studies and eventually prospective randomized controlled clinical trials, systematic reviews and meta-analyses. However, the research methods and clinical studies with subsequent reports oftentimes present with methodical limitations, which makes it difficult to objectively assess the value of this treatment modality. Several open questions remain, including the need for a more differentiated indication of revitalization after different traumatic injuries, the long-term prognosis of treated teeth and the true benefits for the patient. Therefore, this review aims to identify and reflect on such limitations, scrutinizing study design, diagnostic tools, procedural details and outcome parameters. A core outcome set is also proposed in this context, which can be considered in future clinical investigations. These considerations may lead to a more detailed and stringent planning and execution of future studies in order to create high-quality evidence for the treatment modality of revitalization and thus provide more robust data, create a larger body of knowledge for clinicians and further specify current recommendations.
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Affiliation(s)
- K M Galler
- Department of Operative Dentistry and Periodontology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen
| | - T Akamp
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
| | - H Knüttel
- University Library, University of Regensburg, Germany
| | - M Widbiller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
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Báez V, Corcos L, Morgillo F, Imperatrice L, Gualtieri AF. "Meta-analysis of regenerative endodontics outcomes with antibiotics pastes and calcium hydroxide. The apex of the iceberg". J Oral Biol Craniofac Res 2022; 12:90-98. [PMID: 34815932 PMCID: PMC8593466 DOI: 10.1016/j.jobcr.2021.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/17/2021] [Accepted: 11/04/2021] [Indexed: 12/26/2022] Open
Abstract
PORPOSE The aim of this study was to evaluate, through a meta-analysis, the predictability of Regenerative Endodontic therapies with antibiotic pastes and calcium hydroxide [Ca(OH)2], related to four variables as follows: root dentin wall thickening, apical closure, apical repair and root lengthening. METHODS Literature electronic searches were performed in Pubmed - MEDLINE, Scopus and Lilacs-BVS platforms using appropriate search terms, Mesh (Medical Subject Headings), DeCS (Health Sciences Descriptors) and Boolean operators comprising articles published between 2009 and 2020. Thirty-two original indexed papers were included making a total of 758 regenerative endodontic procedures. A descriptive meta-analysis was performed. RESULTS Dentin wall thickening was present in 66% (CI95: 58%-73%) of the cases treated with antibiotic paste, while when Ca(OH)2 was used, a percentage of 53% (CI95: 26%-78%), was obtained. When antibiotic paste was used, apical closure was found in the 66% (CI95: 58%-73%) of the regenerative endodontic procedures, while when Ca(OH)2 was used, 88% (CI95: 80%-93%) of the cases were found to reach apical closure. Root lengthening and apical repair were found satisfactory for both disinfection protocols. CONCLUSIONS There could be differences between the two treatments since a higher percentage of root dentin wall thickening was found when using antibiotic pastes, while a higher percentage of apical closure was found when calcium hydroxide was used. Development of more clinical studies would be necessary in order to confirm the observed differences. The proposed approach could provide a useful contribution for endodontists when planning regenerative endodontic procedures, so as to guide decision-making to the best elective treatment and to select the appropriate disinfection method in accordance with preoperative radiographic diagnosis of root development stage, then increasing the predictability of regenerative endodontic treatment and reducing potential risk of root fractures.
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Affiliation(s)
- Viviana Báez
- Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Endodoncia. Buenos Aires, Argentina
- Centro de Educación Médica e Investigaciones Clínicas CEMIC, Departamento de Odontología. Buenos Aires, Argentina
| | - Lorena Corcos
- Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Endodoncia. Buenos Aires, Argentina
| | - Florencia Morgillo
- Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Endodoncia. Buenos Aires, Argentina
| | - Lorena Imperatrice
- Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Endodoncia. Buenos Aires, Argentina
| | - Ariel Félix Gualtieri
- Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Biofísica y Bioestadística. Buenos Aires, Argentina
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Cell-Based Transplantation versus Cell Homing Approaches for Pulp-Dentin Complex Regeneration. Stem Cells Int 2021; 2021:8483668. [PMID: 34646323 PMCID: PMC8505125 DOI: 10.1155/2021/8483668] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/01/2021] [Accepted: 08/19/2021] [Indexed: 12/19/2022] Open
Abstract
Regenerative dentistry has paved the way for a new era for the replacement of damaged dental tissues. Whether the causative factor is dental caries, trauma, or chemical insult, the loss of the pulp vitality constitutes one of the major health problems worldwide. Two regenerative therapies were introduced for a fully functional pulp-dentin complex regeneration, namely, cell-based (cell transplantation) and cell homing (through revascularization or homing by injection of stem cells in situ or intravenously) therapies, with each demonstrating advantages as well as drawbacks, especially in clinical application. The present review is aimed at elaborating on these two techniques in the treatment of irreversibly inflamed or necrotic pulp, which is aimed at regenerating a fully functional pulp-dentin complex.
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Sponchiado-Júnior EC, de Andrade Vieira W, Frozoni M, Herkrath FJ, de-Jesus-Soares A. CONSORT Compliance in Randomized Clinical Trials of Regenerative Endodontic treatments of Necrotic Immature Teeth. A Scoping Review. J Endod 2021; 47:1751-1766. [PMID: 34352304 DOI: 10.1016/j.joen.2021.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION This study aimed to investigate methodological quality of clinical trials in regenerative endodontics and its compliance with the CONSORT statement. METHODS An electronic search was performed in eight electronic databases. Only clinical trials whose participants underwent regenerative endodontic treatment on necrotic permanent immature teeth were included. Quality assessment was performed using the Cochrane Collaboration's Risk of Bias Tool (RoB, version 2.0). Compliance of articles with the CONSORT guidelines was assessed by a tool with scales: 0 = no description, 1 = deficient, and 2 = adequate description, totaling a maximum score of 32 points. The Mann-Whitney and Kruskal-Wallis tests were used to compare the scores between journals, studies, country, income levels, and publication periods. Spearman correlation analyses were performed between CONSORT compliance scores and 2019 journal CiteScore values, publication year, and quality assessment. RESULTS Twenty studies were included. The average CONSORT compliance score was 20.95 (±6.19). The better reported items were the description of the interventions performed in the trials (100%), followed by the description of the number of patients analyzed, losses and exclusions (90%) and the hypothesis tested (85%). Within the 20 studies, 3 articles were classified as "low risk of bias," 8 studies were classified as "some concerns" and 9 studies were considered "high risk of bias". Studies carried out in countries with higher income levels presented higher CONSORT scores. Significant moderate correlations were found between the CONSORT score and the percentage of risk of bias in low-risk domains (rs = 0.63, 95%CI = 0.31 to 0.94, p = 0.003) and the overall risk of bias categories (rs = 0.76, 95%CI = 0.54 to 0.98, p = 0.001). CONCLUSIONS The adequacy of reporting based on the CONSORT checklist items of regenerative endodontic trials was low with a moderate to high risk of bias.
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Affiliation(s)
- Emílio Carlos Sponchiado-Júnior
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas, Piracicaba, SP, Brazil; Division of Endodontics, Dental School, Federal University of Amazonas, Manaus, Amazonas, Brazil.
| | - Walbert de Andrade Vieira
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas, Piracicaba, SP, Brazil
| | - Marcos Frozoni
- São Leopoldo Mandic School of Dentistry, Campinas, São Paulo, Brazil
| | | | - Adriana de-Jesus-Soares
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas, Piracicaba, SP, Brazil
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Novel Approaches for the Treatment of Necrotic Immature Teeth Using Regenerative Endodontic Procedures: A Systematic Review and Meta-Analysis. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11115199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The induction of a blood clot allowing apical revascularization with a subsequent apical closure was reported several decades ago. Recent research has been focused on examining different scaffolds for regenerative endodontic procedures (REPs). The aim of this study was to analyze the main outcomes in novel REP reported in the literature. The search was conducted using six databases. Only clinical trials aiming at the study of scaffolds for REP in the treatment of necrotic immature teeth were included. The risk of bias was assessed by the Risk of Bias 2 tool. Additionally, the quality of the included studies was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. A summary of individual studies and a meta-analysis were performed. Relative risks of data from clinical success and root length changes were used from the studies, and these were combined using a random-effects meta-analysis. The meta-analysis results reveal that the main outcomes showed no differences between the patients who received REP with scaffolds or only REP. Limitations include that the certainty of evidence was low and that there was significant heterogeneity in the scaffolds used in the included studies. The data suggest that the blood clot remains as the gold standard for REP.
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Nosrat A, Bolhari B, Saber Tahan S, Dianat O, Dummer PMH. Revitalizing previously treated teeth with open apices: A case report and a literature review. Int Endod J 2021; 54:1782-1793. [PMID: 34003516 DOI: 10.1111/iej.13570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 12/14/2022]
Abstract
Revitalizing the root canals of previously treated teeth with open apices is appealing to clinicians and patients. However, there are fundamental differences in the microbiome and the microenvironment between a canal with a primary endodontic infection and a canal with a persistent endodontic infection. The aims of this report are to report a case where a previously treated tooth with an open apex and a large apical radiolucency was treated successfully using regenerative endodontic treatment (RET) and to review and critically appraise the literature on procedures and outcomes of RET that result in revitalization of canal(s) in previously treated teeth with open apices. A maxillary central incisor with poor-quality root filling, a large apical radiolucency and an open apex was retreated using RET using platelet-rich fibrin as the scaffold. After 24 months, there was complete healing of the periapical lesion and obvious radiographic signs of apical root closure. Electronic searches were performed in MEDLINE, Scopus and Embase, and the baseline, procedural and outcome data of qualified articles were collected. An assessment tool was developed to rate the quality of evidence reported in these case report/series. Nine articles, three case series and six case reports, with a total of 17 teeth of all types, were included in the reports identified. The age of patients ranged from 7 to 48 years (mean: 19.4 years). The recall period ranged from 12 to 72 months (mean: 29 months). All 17 teeth survived and were functional with healing/healed outcomes. "Apical closure" was the most common radiographic finding regarding root development. The quality of evidence using the new assessment tool was rated "Excellent" in three case reports but only "Fair" in the other six articles. The present case report, as well as the review of the literature, suggests that revitalizing the root canal system of teeth with open apices and post-treatment disease using RET is a potentially valid treatment option. However, more clinical studies with higher levels of evidence and higher quality of evidence are required to confirm the viability of this treatment approach.
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Affiliation(s)
- Ali Nosrat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, Maryland, USA.,Private Practice, Centreville Endodontics, Centreville, Virginia, USA
| | - Behnam Bolhari
- Department of Endodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Shima Saber Tahan
- Department of Endodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Omid Dianat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, Maryland, USA
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What is the best long-term treatment modality for immature permanent teeth with pulp necrosis and apical periodontitis? Eur Arch Paediatr Dent 2021; 22:311-340. [PMID: 33420674 PMCID: PMC8213569 DOI: 10.1007/s40368-020-00575-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/17/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate and assess the current knowledge about apexification and regenerative techniques as a meaningful treatment modality and to map the scientific evidence for the efficacy of both methods for the management of traumatised immature teeth with pulp necrosis and apical periodontitis. METHODS This systematic review searched five databases: PubMed, Web of Science, Cochrane Library, Ovid (Medline), and Embase. Published articles written in English were considered for inclusion. The following keywords were used: Regenerative endodontic treatment OR regenerat* OR revital* OR endodontic regeneration OR regenerative endodontics OR pulp revascularization OR revasculari* OR 'traumatized immature teeth'. Only peer-reviewed studies with a study size of at least 20 cases followed up for 24 months were included. Eligibility assessment was performed independently in a blinded manner by three reviewers and disagreements were resolved by consensus. Subgroup analyses were performed on three clinical outcomes: survival, success, and continued root development. RESULTS Seven full texts out of 1359 citations were included and conventional content analysis was performed. Most of the identified citations were case reports and case series. CONCLUSIONS In the present systematic review, the qualitative analysis revealed that both regenerative and apexification techniques had equal rates of success and survival and proved to be effective in the treatment of immature necrotic permanent teeth. Endodontic regenerative techniques appear to be superior to apexification techniques in terms of stimulation of root maturation, i.e. root wall thickening and root lengthening. Knowledge gaps were identified regarding the treatment and follow-up protocols for both techniques.
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Surboyo MD, Anggrarista KA, Cecilia P, Nagoro AA, Saskianti T. SHED, PRF, and Chitosan as Three-Dimensional of Tissue Engineering for Dental Pulp Regeneration. DENTAL HYPOTHESES 2021. [DOI: 10.4103/denthyp.denthyp_121_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Panda S, Mishra L, Arbildo-Vega HI, Lapinska B, Lukomska-Szymanska M, Khijmatgar S, Parolia A, Bucchi C, Fabbro MD. Effectiveness of Autologous Platelet Concentrates in Management of Young Immature Necrotic Permanent Teeth-A Systematic Review and Meta-Analysis. Cells 2020; 9:cells9102241. [PMID: 33036462 PMCID: PMC7600252 DOI: 10.3390/cells9102241] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 12/24/2022] Open
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.
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Affiliation(s)
- Saurav Panda
- Department of Periodontics and Oral Implantology, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, India;
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milano, Italy;
| | - Lora Mishra
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, India;
| | - Heber Isac Arbildo-Vega
- Department of General Dentistry, Dentistry School, Universidad San Martín de Porres, Chiclayo 14012, Peru;
- Department of General Dentistry, Dentistry School, Universidad Particular de Chiclayo, Chiclayo 14012, Peru
| | - Barbara Lapinska
- Department of General Dentistry, Medical University of Lodz, 92-213 Lodz, Poland; (B.L.); (M.L.-S.)
| | | | - Shahnawaz Khijmatgar
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milano, Italy;
- Nitte (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences (ABSMIDS), Department of Oral Biology and Genomic Studies, Mangalore 575018, India
| | - Abhishek Parolia
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lampur 57000, Malaysia;
| | - Cristina Bucchi
- Faculty of Dentistry, CICO Research Centre, Universidad de La Frontera, Temuco 4811230, Chile;
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milano, Italy;
- Dental Clinic, IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy
- Correspondence: ; Tel.: +39-02-5031-9950; Fax: +39-02-5031-9960
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Koç S, Del Fabbro M. Does the Etiology of Pulp Necrosis Affect Regenerative Endodontic Treatment Outcomes? A Systematic Review and Meta-analyses. J Evid Based Dent Pract 2020; 20:101400. [PMID: 32381409 DOI: 10.1016/j.jebdp.2020.101400] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 12/01/2019] [Accepted: 01/17/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate if there is a connection between the causes of pulp necrosis (eg, caries, trauma, dental anomaly) and the success of regenerative endodontic treatment. METHODS Electronic databases (PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Embase) were searched for studies on regenerative endodontic treatment, which used both clinical and radiographic evaluation of root maturation after at least 6 months of follow-up. The search terms "necrotic pulp", "regenerative endodontic treatment", "revascularization", and "revitalization" were combined using Boolean operators. The main journals on endodontics and dental traumatology were additionally hand-searched. Studies were included if they specified the causes of pulp necrosis. The primary question under review was, "Does the cause of pulp necrosis affect the outcome of regenerative endodontic treatment?" Other factors such as tooth type, intracanal medicament, irrigation protocol, use of a collagen matrix, and the type of scaffold were evaluated for possible relation with the outcome. The risk-of-bias assessment for randomized and nonrandomized studies was performed separately, using a modified Cochrane Collaboration's tool and risk of bias in non-randomized studies of interventions-I tool, respectively. Meta-analysis was performed, when possible, between studies comparing treatment outcomes of teeth whose pulp necrosis had different etiology. The search strategy yielded 1197 items. After screening, 18 studies reporting 445 regenerative endodontic treatment cases were included. RESULTS The overall success rate for 274 teeth with trauma etiology was 94.8%, for 95 teeth with dens evaginatus etiology was 93.1%, and for 24 teeth with caries etiology was 96%. No significant difference was found between the results of regenerative endodontic treatment among teeth with trauma, dens evaginatus, and caries etiology (P = .055). Meta-analysis of studies comparing teeth with caries vs dens evaginatus and those with trauma vs caries confirmed that there was no evidence for difference in outcomes. CONCLUSION Further randomized studies specifically testing such hypothesis are needed to confirm the preliminary results of this review.
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Affiliation(s)
- Simay Koç
- Department of Endodontics, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy; IRCCS Orthopedic Institute Galeazzi, Milan, Italy.
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