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. 2025 Aug;51(2):495-509.
doi: 10.1111/aej.12928. Epub 2025 Feb 28.

Efficacy of Pulp Revascularization in the Treatment of Apical Periodontitis in Mature Necrotic Teeth: An Umbrella Review

Wanderson Limeira de Sousa Barbosa  1 , Luiz Renato Paranhos  2 , Márcia Valente de Brito Dantas  1 , Rômulo Dias Jesuino  2 , João Marcos da Costa Ribeiro  2 , Walbert A Vieira  3 , Felipe de Souza Matos  1
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Efficacy of Pulp Revascularization in the Treatment of Apical Periodontitis in Mature Necrotic Teeth: An Umbrella Review

Wanderson Limeira de Sousa Barbosa et al. Aust Endod J. 2025 Aug.

Abstract

This umbrella review evaluated systematic reviews in clinical studies on pulp revascularisation in permanent mature necrotic teeth to determine their effectiveness in treating or preventing apical periodontitis. Seven of 294 articles retrieved from PubMed, LILACS, SciELO, Embase, Scopus, Web of Science, Cochrane and DANS Easy databases were included. The most used pulp revascularisation techniques were blood clots associated or not with platelet-poor plasma and umbilical cord mesenchymal stem cells. Meta-analysis and qualitative results from included articles indicated the efficacy of pulp revascularisation in mature necrotic teeth with similar success rates compared to non-surgical root canal treatment, pulp revascularisation in immature teeth, or apexification. Despite the low methodological quality and high risk of bias in most analysed systematic reviews, pulp revascularisation may be a successful treatment alternative for mature necrotic teeth. Well-conducted clinical trials are required to provide confirmatory evidence.

Keywords: adult dentition; dental pulp; periapical periodontitis; pulp necrosis; regenerative endodontics.

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