Regenerative Endodontic Therapy in the Management of Nonvital Immature Permanent Teeth: A Systematic Review-Outcome Evaluation and Meta-analysis

Abstract

Introduction: Although the protocols in previously published studies appeared to be largely similar, there were inadequate evidence-based guidelines to support a single protocol. Using a meta-analysis, this systematic review aimed to summarize and quantitatively evaluate the outcomes for nonvital immature permanent teeth treated using the regenerative endodontic technique (RET) as well as critically appraise the level and quality of evidence of the existing publications.

Methods: Risk of bias assessment and level of evidence grading were performed on all included studies. Meta-analyses using a random effects model were performed to combine the results of randomized controlled trials. The pooled success rate for each exposure was estimated for each outcome (event rates with 95% confidence intervals). The outcomes of all included studies were summarized.

Results: Success rates for tooth survival and resolution of periapical pathosis were excellent; however, results for apical closure and continued root development were inconsistent. There are few well-reported randomized prospective clinical studies. Reporting of long-term outcomes and late-stage effects was sparse. No study evaluated health economic outcomes and improvements to patients' quality of life.

Conclusions: Many knowledge gaps still exist within the studies published. Current published evidence is unable to provide definitive conclusions on the predictability of RET outcomes.

Keywords: Level of evidence; meta-analysis; outcomes; regenerative endodontic therapy.