Evaluation of the Clinical Outcomes of Regenerative Endodontic Procedures Using Autologous Platelet Concentrate: A Systematic Review and Meta-Analysis

ABSTRACT

Objective:  To assess the clinical outcomes of regenerative endodontic procedures using autologous platelet concentrate. Both regeneration and apexification procedures were examined and compared with each other.

Material and Methods:  The PRISMA 2020 Checklist has been utilized to carry out the systematic review and meta-analysis for the present study. PubMed, Scopus, Web of Science, EBSCO, Embase, and ISI Web of Knowledge have been reviewed for systematic literature until May 2023. A fixed-effect model and a Mantel-Haenszel methodology have been used to measure the risk ratio’s 95% confidence interval. Then, Metaanalyses were carried out utilizing Stata/MP version 17.

Results:  Duplicate studies were eliminated from the first review, 849 studies’ abstracts were reviewed, two authors reviewed 103 papers’ full texts, and finally, 20 articles were selected. The survival rate in regenerative endodontic procedures between apexification and regenerative endodontic procedures was −0.01 (RR: −0.01, 95% CI: −0.05, 0.02; p=0.35).

Conclusion:  Throughout the present meta-analysis, regenerative endodontic therapy is an effective intervention with a high survival and success rate in managing immature necrotic permanent teeth.

Keywords:
Autografts; Regenerative Endodontics; Root Canal Obturation; Thrombosis

Introduction

In endodontics, root canal treatment is used to treat inflamed pulp tissue or irreversible necrosis, usually damaged by infectious diseases or trauma [¹]. However, there is a possibility of re-infection due to microleakage and increased susceptibility to root fracture. Therefore, the goal of regenerative pulp treatment is to maintain the vitality of dental pulp [²].

Traumatic dental injuries are among the most common reasons for pulp necrosis in permanent teeth; Statistics show that its prevalence is 85% [¹]. Reports indicate that over one billion people suffer from trauma worldwide, one-third of which suffer from dental injuries that may cause pulp necrosis [²]. In growing children and adolescents, pulp necrosis caused by caries or trauma can cause permanent tooth roots not to grow [³]. Studies show that immature permanent teeth with necrotic pulp have lower survival. After conventional root canal filling treatment, they are also more susceptible to root fracture [⁴, ⁵].

Early interventions are essential; however, choosing the right interventions is challenging and time-consuming. Apexification and regeneration are the interventions used to treat these patients [⁶]. Regeneration has been suggested in short roots with thin canal walls and teeth with no root formation potential or open apex. Apexification is performed for teeth that have almost done root formation with an open apex [³]. Biologically based methods known as regenerative endodontic procedures are generally used to restore damaged components like roots and dentin. The purpose of this method is to restore the pulp tissue and grow the root of the tooth. The basic principles of Apexification and regeneration are canal debridement, necrotic pulp removal, and infection control [⁷]. The current research’s objective is to assess the clinical outcomes of regenerative endodontic procedures using autologous platelet concentrate, and both regeneration and apexification procedures were examined and compared with each other.

Material and Methods

Search Strategy

PRISMA 2020 Checklist was used throughout the systematic review and meta-analysis presented in this study [⁸]. PubMed, Science Direct, Scopus, ISI, Embase, and Web of Knowledge have been reviewed till May 2023 using keywords regarding the purpose of the study. The Google Scholar search engine has been utilized to locate additional relevant publications. MeSH keywords:

(((((("Dental Implantation, Endosseous, Endodontic"[Mesh]) AND ("Dental Pulp"[Mesh] OR "Dental Pulp Necrosis"[Mesh])) AND "Survival Rate"[Mesh]) AND "Contraceptive Effectiveness"[Mesh]) AND "Periapical Periodontitis"[Mesh]) AND "Apexification"[Mesh]) AND "Regeneration"[Mesh].

Selection Process, Data Items, and Data Collection

A checklist that contained the name of the authors, publication year, study design, size of the sample, follow-up period, pulp necrosis, intracanal medication, recall time, and intervention type were extracted from the studies. Each article was subjected to the inclusion criteria, and each record underwent independent evaluation by two reviewers.

Eligibility Criteria

Inclusion criteria: as seen in Table 1, inclusion criteria have responded to PICO. English-language articles, observational studies, randomized controlled trials, cohort studies, and research evaluating either or both apexification and regeneration. The following exclusion criteria were established: in-vitro, case studies, review articles, and case reports, as well as animal studies; and articles that do not have full-text access.

Table 1
PICO strategy

PICO	Description
P	Patients with immature necrotic permanent teeth
I	Platelet concentrate /regenerative endodontic procedures
C	Blood clot/apexification procedure
O	Dentinal wall thickness, Root length, Apical foramen width, Vitality response, Success rate, Survival rate

Study Risk of Bias Assessment

The Cochrane Collaboration’s instrument has been utilized to assess the quality of the research in the present analysis, which only comprised randomized control clinical trial works [⁹]. Each item in this tool is scored between 0 and 6, with the 1 score demonstrating low risk and the 0 score demonstrating high and unclear risk. The higher score indicates a higher quality study.

ROBINS-I tool [¹⁰] has been used to assess quality in the Non-randomized control clinical trial works; this scale measures seven domains. Studies with ROBINS-I tool scores of 1-3, 4-6, and 7-9 have been categorized as having high, medium, and low risk of bias in the analysis.

Data Analysis

Data analysis has been carried out utilizing STATA/MP Vl7 software. The confidence interval of 95% for mean differences has been determined using inverse-variance and the fixed effect model methodology. The risk ratio has been calculated using the fixed effect model and the Mantel-Haenszel methodology. Random effects have been utilized to address potential heterogeneity, and P revealed heterogeneity. P levels over 50% suggest moderate to high heterogeneity, whereas P values under 50% indicate low heterogeneity.

Results

Study Selection

The first search found 849 research studies regarding the mentioned keywords. There were 15 duplicate studies, 12 articles were eliminated because of ineligibility by the automation instruments, and 18 research were eliminated for other acceptable reasons. Accordingly, we reviewed abstracts of 804 papers, and ultimately, using the exclusion criteria, 701 articles were excluded from the study. After reviewing 85 papers, 20 articles were chosen after 65 articles were eliminated based on inclusion criteria (Figure 1).

Figure 1
PRISMA 2020 flow diagram.

Study Characteristics

Table 2 presents the study data that were extracted. The sample size was 855, the range of recall time was 2 to 4 weeks, and the range of follow-up period was 12 to 36 months.

Table 2
Data extraction from included articles.

No	Study	Study Design	Sample Size	Intervention Type	Presence of Periapical Lesion	Recall Time (Weeks)	Cause of Pulp Necrosis	Follow-up (Months)
1	Li et al. [11]	Non-RCT	112	REP vs. APP	Yes	2	Trauma	12
2	Casey et al. [12]	Non-RCT	211	REP vs. APP	Yes	2	Trauma	32
3	Caleza-Jiménez et al. [13]	Non-RCT	18	REP vs. APP	Yes	2	Trauma, Caries	25
4	Cheng et al. [14]	Non-RCT	62	REP	No	2	Trauma	16
5	Meschi et al. [15]	RCT	19	REP	Yes	2	Trauma	36
6	Jayadevan et al. [16]	RCT	21	REP	No	4	Trauma	12
7	Pereira et al. [17]	Non-RCT	44	REP vs. APP	No	4	Trauma	16
8	Mittal et al. [18]	RCT	8	REP	Yes	4	Trauma, Caries	12
9	Ulusoy et al. [19]	RCT	73	REP	Yes	4	Trauma	NR
10	Ragab et al. [20]	RCT	22	REP	Yes	3	Trauma	12
11	Xuan et al. [21]	RCT	30	REP vs. APP	Yes	4	Trauma	12
12	Shivashankar et al. [22]	RCT	39	REP	No	3	Trauma, Caries	12
13	Lin et al. [23]	RCT	103	REP vs. APP	Yes	3	Trauma, Caries	12
14	Alagl et al. [24]	RCT	30	REP	Yes	3	Trauma, Caries	12
15	Silujjai et al. [25]	Non-RCT	43	REP vs. APP	Yes	-	Trauma, Caries	30
16	Bezgin et al. [26]	RCT	20	REP	Yes	3	Trauma, Caries	18
17	Narang et al. [27]	RCT	20	REP	Yes	4	Trauma, Caries	18
18	Alobaid et al. [28]	Non-RCT	31	REP vs. APP	Yes	3	Trauma	20
19	Jadhav et al. [29]	RCT	20	REP	No	-	Trauma, Caries	12
20	Jeeruphan et al. [30]	Non-RCT	41	REP vs. APP	No	3	Trauma, Caries	24

• RCT: Randomized Controlled Trial; Non-RCT: Non-Randomized Controlled Trial; REP: Regenerative Endodontic Procedure; APP: Apexification Procedure.

Risk of Bias in Studies

Based on the bias assessment tool, it was determined that all studies had a minimal risk of bias.

Dentinal Wall Thickness

Subgroup meta-analysis showed that the overall risk ratio of dentinal wall thickness in regenerative endodontic procedure between the two groups was −0.16 (RR: 0.16, 95% CI: −0.36, 0.04; p=0.56), having minimal heterogeneity (I²=0%; p =0.74). These findings show that among the two groups, there has been no statistically substantial difference (Figure 2).

Figure 2
The dentinal wall thickness in the regenerative endodontic procedure. Platelet concentrate.

Root Length

Subgroup meta-analysis showed that the overall risk ratio of raised root length throughout regenerative endodontic procedure among the two groups had been −0.02 (RR: −0.02, 95% CI: −0.25, 0.21; p=0.58), having minimal heterogeneity (I²=38.14%; p=0.15). These results show that between the two groups, there has been no statistically substantial difference (Figure 3).

Figure 3
The increased root length.

Apical Foramen Width

Subgroup meta-analysis showed that the overall risk ratio of apical foramen width in regenerative endodontic procedure between the two groups was 0.08 (RR: 0.08, 95% CI: −0.06, 0.21; p=0.95), having minimal heterogeneity (I²=26.75%; p=0.19). These results show that among the two groups, there has been no statistically substantial difference (Figure 4).

Figure 4
The apical foramen width in the regenerative endodontic procedure.

Vitality Response

Subgroup meta-analysis showed vitality response’s overall risk ratio in regenerative endodontic procedure between the two groups was 0.70 (RR: 0.70, 95% CI: 0.13, 1.27; p=0.02) having minimal heterogeneity (I²=0%; p=0.77). These results show that among the two groups, there has been no statistically substantial difference (Figure 5).

Figure 5
The vitality response in the regenerative endodontic procedure.

Success Rate

The regenerative endodontic procedure’s success rate between the two groups has been 0.03 (RR: 0.03, 95% CI: −0.06, 0.12; p=0.57), having minimal heterogeneity (I²=0%; p=0.75). These results show that between the two groups, there has been no statistically substantial difference (Figure 6).

Figure 6
The success rate.

Survival Rate

The survival rate in regenerative endodontic procedure between the two groups was −0.01 (RR: −0.01, 95% CI: −0.05, 0.02; p=0.35) with minimal heterogeneity (I²=0%; p=0.62). These results show that between the two groups, there has been no statistically substantial difference (Figure 7).

Figure 7
The survival rate.

The Success Rate of Regenerative Endodontic Procedure vs. Apexification Procedure

The success rate in the regenerative endodontic procedure vs. apexification procedure was 0.07 (RR: 0.07, 95% CI: 0.00, 0.14; p=0.05) with minimal heterogeneity (I²= 14.53%; p=0.32). These data show no difference between the apexification and regenerative endodontic procedures (Figure 8).

Figure 8
The forest plot showed the success rate of the regenerative endodontic procedure vs. the apexification procedure.

Discussion

The present study investigated clinical parameters and immature necrotic teeth’ success and survival rate in the oral cavity after regeneration and apexification. The studies’ low heterogeneity resulted from the selection of 19 publications that matched the study’s inclusion requirements, so the current study’s findings provide strong evidence. Also, the studies’ quality was high.

Platelet-rich plasma is a method based on tissue engineering that supports the differentiation and proliferation of stem cells. As platelet-rich plasma scaffolds, autologous platelet concentrates, as well as blood clots, have been used [³¹]. Blood clots are a natural clotting process with many advantages, including low cost, no allergic reaction, and patient comfort. Autologous platelet concentrates are products derived from blood with a concentration higher than the basic level of platelets, which act as a stable scaffold due to the high concentration of growth factors and dense fibrin matrix [³², ³³]. After the patient’s blood is centrifuged, a small amount of platelet-rich plasma is suspended in plasma and plays an essential role in treating damaged tissue [³⁴]. Plateletrich fibrin is obtained without anticoagulant drugs and biochemical blood manipulation [³⁵].

Based on the selected studies, the teeth selected for intervention were due to trauma and secondary caries. A meta-analysis showed that autologous platelet concentrates significantly improve the response to vital pulp tests. However, no difference was observed between autologous platelet concentrates and blood clots in other clinical parameters. The findings informed the results of Panda et al. 2020 of the current investigation [³⁶]. According to studies, regenerative endodontic therapy thickens canal walls to support fragile, immature, permanent teeth. It can restore the pulp-dentin complex to repair the damaged tissue in the canal area [³⁷, ³⁸]. The current meta-analysis revealed that Platelet-rich plasma, compared to Platelet-rich fibrin, has better results throughout endo repair methods. These results require confirmation by additional research using a bigger sample size and an extended follow-up time. According to the outcomes of the meta-analysis, which examined the survival rate between the two regeneration and apexification groups in the Ca(OH)₂ and MTA subgroups, it was observed that there had been no significant difference regarding survival.

Moreover, the survival rates in Ca(OH)₂ and MTA are similar. Ca(OH)₂ is cheap and generally used in clinical procedures [³⁹]. A systematic review study observed that MTA is better than the Ca(OH)₂ apposition [⁴⁰]. According to a systematic review study, whereas pulpal revascularization methods may lengthen and widen roots, there should be an effort to assess the "true benefit" of root growth using standardized methodologies [⁴¹].

Conclusion

Regenerative endodontic therapy is an effective intervention with a survival and success rate in managing immature necrotic permanent teeth. In general, autologous platelet concentrates and Blood clots showed similar successful results in the regeneration process. As it is noticeable in the findings of this work and other investigations, it is necessary to conduct more studies to provide stronger evidence and confirm the results; a longer follow-up period is also needed.

• Financial Support
  None.
• Data Availability
  The data used to support the findings of this study can be made available upon request to the corresponding author.

References

• ¹ Locker D. Self-reported dental and oral injuries in a population of adults aged 18–50 years. Dent Traumatol 2007; 23(5):291-296. https://doi.org/10.1111/j.1600-9657.2006.00457.x
  » https://doi.org/10.1111/j.1600-9657.2006.00457.x
• ² Ashraf A, Pérez Alfayate R. Regenerative endodontic treatment in teeth with internal root resorption: An insight over the available literature. Int J Sci Res Dent Med Sci 2020; 2(4):131-134. https://doi.org/10.30485/IJSRDMS.2020.245647.1082
  » https://doi.org/10.30485/IJSRDMS.2020.245647.1082
• ³ Jabbari G, Jamali S, Nasrabadi N, Keikha F. Success rate of contemporary regenerative endodontic therapy and the expected outcomes of the endodontic microsurgery: A systematic review and meta-analysis. Pesqui Bras Odontopediatria Clin Integr 2021; 21:e5471. https://doi.org/10.1590/pboci.2021.163
  » https://doi.org/10.1590/pboci.2021.163
• ⁴ Fernandes FD, Silva Júnior JP, Cavalcante BM, Almeida LF, Cordeiro NA, Silva AL. Endodontic intervention for the control of periapical injury associated with traumatized teeth: A case report. Int J Sci Res Dent Med Sci 2023; 5(2):102-106. https://doi.org/10.30485/ijsrdms.2023.393390.1479
  » https://doi.org/10.30485/ijsrdms.2023.393390.1479
• ⁵ Duggal M, Tong HJ, Al-Ansary M, Twati W, Day PF, Nazzal H. Interventions for the endodontic management of non-vital traumatised immature permanent anterior teeth in children and adolescents: A systematic review of the evidence and guidelines of the European Academy of Paediatric Dentistry. Eur Arch Paediatr Dent 2017; 18(3):139-151. https://doi.org/10.1007/s40368-017-0289-5
  » https://doi.org/10.1007/s40368-017-0289-5
• ⁶ Lee BN, Moon JW, Chang HS, Hwang IN, Oh WM, Hwang YC. A review of the regenerative endodontic treatment procedure. Restor Dent Endod 2015; 40(3):179-187. https://doi.org/10.5395/rde.2015.40.3.179
  » https://doi.org/10.5395/rde.2015.40.3.179
• ⁷ Singh R, Goel K, Sharma S, Shrestha S, Koirala P, Khanal S. Comparative clinical evaluation of modified coronally advanced flap with and without platelet rich fibrin in the treatment of multiple adjacent Miller’s Class I and Class II gingival recession defects: A randomized clinical trial. Int J Sci Res Dent Med Sci 2022; 4(3):110-118. https://doi.org/10.30485/ijsrdms.2022.354418.1348
  » https://doi.org/10.30485/ijsrdms.2022.354418.1348
• ⁸ Tugwell P, Tovey D. PRISMA 2020. J Clin Epidemiol 2021; 134:A5-6. https://doi.org/10.1016/j.jclinepi.2021.04.008
  » https://doi.org/10.1016/j.jclinepi.2021.04.008
• ⁹ Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011; 343:d5928. https://doi.org/10.1136/bmj.d5928
  » https://doi.org/10.1136/bmj.d5928
• ¹⁰ Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016; 355:i4919. https://doi.org/10.1136/bmj.i4919
  » https://doi.org/10.1136/bmj.i4919
• ¹¹ Li J, Cheng J, Yang F, Yu J, Song G. Treatment outcomes of immature permanent necrotic evaginated teeth: A retrospective study comparing regenerative endodontic procedures with apexification. Int J Paediatr Dent Int J Paediatr Dent 2023; 33(6):595-606. https://doi.org/10.1111/ipd.13079
  » https://doi.org/10.1111/ipd.13079
• ¹² Casey SM, Fox D, Duong W, Bui N, Latifi N, Ramesh V, et al. Patient centered outcomes among a cohort receiving regenerative endodontic procedures or apexification treatments. J Endod 2022; 48(3):345-354. https://doi.org/10.1016/j.joen.2021.11.013
  » https://doi.org/10.1016/j.joen.2021.11.013
• ¹³ Caleza-Jiménez C, Ribas-Pérez D, Biedma-Perea M, Solano-Mendoza B, Mendoza-Mendoza A. Radiographic differences observed following apexification vs revascularization in necrotic immature molars and incisors: A follow-up study of 18 teeth. Eur Arch Paediatr Dent 2022; 23(3):381-389. https://doi.org/10.1007/s40368-022-00692-z
  » https://doi.org/10.1007/s40368-022-00692-z
• ¹⁴ Cheng J, Yang F, Li J, Hua F, He M, Song G. Treatment outcomes of regenerative endodontic procedures in traumatized immature permanent necrotic teeth: A retrospective study. J Endod 2022; 48(9):1129-1136. https://doi.org/10.1016/j.joen.2022.03.015
  » https://doi.org/10.1016/j.joen.2022.03.015
• ¹⁵ Meschi N, EzEldeen M, Garcia AE, Lahoud P, Van Gorp G, Coucke W, et al. Regenerative endodontic procedure of immature permanent teeth with leukocyte and platelet-rich fibrin: A multicenter controlled clinical trial. J Endod 2021; 47(11):1729-1750. https://doi.org/10.1016/j.joen.2021.08.003
  » https://doi.org/10.1016/j.joen.2021.08.003
• ¹⁶ Jayadevan V, Gehlot PM, Manjunath V, Madhunapantula SV, Lakshmikanth JS. A comparative evaluation of advanced platelet-rich fibrin (a-prf) and platelet-rich fibrin (prf) as a scaffold in regenerative endodontic treatment of traumatized immature non-vital permanent anterior teeth: A prospective clinical study. J Clin Exp Dent 2021; 13(5):e463. https://doi.org/10.4317/jced.57902
  » https://doi.org/10.4317/jced.57902
• ¹⁷ Pereira AC, Oliveira ML, Cerqueira-Neto AC, Vargas-Neto J, Nagata JY, Gomes BP, et al. Outcomes of traumatised immature teeth treated with apexification or regenerative endodontic procedure: A retrospective study. Aust Endod J 2021; 47(2):178-187. https://doi.org/10.1111/aej.12447
  » https://doi.org/10.1111/aej.12447
• ¹⁸ Mittal N, Parashar V. Regenerative evaluation of immature roots using PRF and artificial scaffolds in necrotic permanent teeth: a clinical study. J Contemp Dent Pract 2019; 20(06):720-726.
• ¹⁹ Ulusoy AT, Turedi I, Cimen M, Cehreli ZC. Evaluation of blood clot, platelet-rich plasma, platelet-rich fibrin, and platelet pellet as scaffolds in regenerative endodontic treatment: A prospective randomized trial. J Endod 2019; 45(5):560-566. https://doi.org/10.1016/j.joen.2019.02.002
  » https://doi.org/10.1016/j.joen.2019.02.002
• ²⁰ Ragab RA, Lattif AE, Dokky NA. Comparative study between revitalization of necrotic immature permanent anterior teeth with and without platelet rich fibrin: A randomized controlled trial. J Clin Pediatr Dent 2019; 43(2):78-85. https://doi.org/10.17796/1053-4625-43.2.2
  » https://doi.org/10.17796/1053-4625-43.2.2
• ²¹ Xuan K, Li B, Guo H, Sun W, Kou X, He X, et al. Deciduous autologous tooth stem cells regenerate dental pulp after implantation into injured teeth. Sci Transl Med 2018; 10(455):eaaf3227. https://doi.org/10.1126/scitranslmed.aaf3227
  » https://doi.org/10.1126/scitranslmed.aaf3227
• ²² Shivashankar VY, Johns DA, Maroli RK, Sekar M, Chandrasekaran R, Karthikeyan S, et al. Comparison of the effect of PRP, PRF and induced bleeding in the revascularization of teeth with necrotic pulp and open apex: A triple blind randomized clinical trial. J Clin Diagn Res 2017; 11(6):ZC34. https://doi.org/10.7860/JCDR/2017%2F22352.10056
  » https://doi.org/10.7860/JCDR/2017%2F22352.10056
• ²³ Lin J, Zeng Q, Wei X, Zhao W, Cui M, Gu J, et al. Regenerative endodontics versus apexification in immature permanent teeth with apical periodontitis: A prospective randomized controlled study. J Endod 2017; 43(11):1821-1827. https://doi.org/10.1016/j.joen.2017.06.023
  » https://doi.org/10.1016/j.joen.2017.06.023
• ²⁴ Alagl A, Bedi S, Hassan K, AlHumaid J. Use of platelet-rich plasma for regeneration in non-vital immature permanent teeth: Clinical and cone-beam computed tomography evaluation. J Int Med Res 2017; 45(2):583-593. https://doi.org/10.1177/0300060517692935
  » https://doi.org/10.1177/0300060517692935
• ²⁵ Silujjai J, Linsuwanont P. Treatment outcomes of apexification or revascularization in nonvital immature permanent teeth: A retrospective study. J Endod 2017; 43(2):238-245. https://doi.org/10.1016/j.joen.2016.10.030
  » https://doi.org/10.1016/j.joen.2016.10.030
• ²⁶ Bezgin T, Yilmaz AD, Celik BN, Kolsuz ME, Sonmez H. Efficacy of platelet-rich plasma as a scaffold in regenerative endodontic treatment. J Endod 2015; 41(1):36-44. https://doi.org/10.1016/j.joen.2014.10.004
  » https://doi.org/10.1016/j.joen.2014.10.004
• ²⁷ Narang I, Mittal N, Mishra N. A comparative evaluation of the blood clot, platelet-rich plasma, and platelet-rich fibrin in regeneration of necrotic immature permanent teeth: a clinical study. Contemp Clin Dent 2015; 6(1):63-68. https://doi.org/10.4103/0976-237X.149294
  » https://doi.org/10.4103/0976-237X.149294
• ²⁸ Alobaid AS, Cortes LM, Lo J, Nguyen TT, Albert J, Abu-Melha AS, et al. Radiographic and clinical outcomes of the treatment of immature permanent teeth by revascularization or apexification: A pilot retrospective cohort study. J Endod 2014; 40(8):1063-1070. https://doi.org/10.1016/j.joen.2014.02.016
  » https://doi.org/10.1016/j.joen.2014.02.016
• ²⁹ Jadhav G, Shah N, Logani A. Revascularization with and without platelet-rich plasma in nonvital, immature, anterior teeth: a pilot clinical study. J Endod 2012; 38(12):1581-1587. https://doi.org/10.1016/j.joen.2012.09.010
  » https://doi.org/10.1016/j.joen.2012.09.010
• ³⁰ Jeeruphan T, Jantarat J, Yanpiset K, Suwannapan L, Khewsawai P, Hargreaves KM. Mahidol study 1: Comparison of radiographic and survival outcomes of immature teeth treated with either regenerative endodontic or apexification methods: a retrospective study. J Endod 2012; 38(10):1330-1336. https://doi.org/10.1016/j.joen.2012.06.028
  » https://doi.org/10.1016/j.joen.2012.06.028
• ³¹ Saber SE. Tissue engineering in endodontics. J Oral Sci 2009; 51(4):495-507. https://doi.org/10.2334/josnusd.51.495
  » https://doi.org/10.2334/josnusd.51.495
• ³² Metlerska J, Fagogeni I, Nowicka A. Efficacy of autologous platelet concentrates in regenerative endodontic treatment: A systematic review of human studies. J Endod 2019; 45(1):20-30. https://doi.org/10.1016/j.joen.2018.09.003
  » https://doi.org/10.1016/j.joen.2018.09.003
• ³³ Ezzat OM. Autologous platelet concentrate preparations in dentistry. Biomed J Sci Tech Res 2018; 8(1706):10-26717. https://doi.org/10.26717/BJSTR.2018.08.001706
  » https://doi.org/10.26717/BJSTR.2018.08.001706
• ³⁴ Giannini S, Cielo A, Bonanome L, Rastelli C, Derla C, Corpaci F, et al. Comparison between PRP, PRGF and PRF: Lights and shadows in three similar but different protocols. Eur Rev Med Pharmacol Sci 2015; 19(6):927-930.
• ³⁵ 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(13):3909. https://doi.org/10.3390/jcm11133909
  » https://doi.org/10.3390/jcm11133909
• ³⁶ Panda S, Mishra L, Arbildo-Vega HI, Lapinska B, Lukomska-Szymanska M, Khijmatgar S, et al. Effectiveness of autologous platelet concentrates in management of young immature necrotic permanent teeth — A systematic review and meta-analysis. Cells 2020; 9(10):2241. https://doi.org/10.3390/cells9102241
  » https://doi.org/10.3390/cells9102241
• ³⁷ Alghamdi FT, Alqurashi AE. Regenerative endodontic therapy in the management of immature necrotic permanent dentition: A systematic review. Sci World J 2020; 2020. https://doi.org/10.1155/2020/7954357
  » https://doi.org/10.1155/2020/7954357
• ³⁸ Iwaya SI, Ikawa M, Kubota M. Revascularization of an immature permanent tooth with periradicular abscess after luxation. Dent Traumatol 2011; 27(1):55-58. https://doi.org/10.1111/j.1600-9657.2010.00963.x
  » https://doi.org/10.1111/j.1600-9657.2010.00963.x
• ³⁹ Shabahang S. Treatment options: Apexogenesis and apexification. J Endod 2013; 39(3 Suppl):S26-29. https://doi.org/10.1016/j.joen.2012.11.046
  » https://doi.org/10.1016/j.joen.2012.11.046
• ⁴⁰ Guerrero F, Mendoza A, Ribas D, Aspiazu K. Apexification: A systematic review. J Conserv Dent 2018; 21(5):462-465. https://doi.org/10.4103/JCD.JCD_96_18
  » https://doi.org/10.4103/JCD.JCD_96_18
• ⁴¹ Nicoloso GF, Goldenfum GM, Pizzol TD, Scarparo RK, Montagner F, de Almeida Rodrigues J, et al. Pulp revascularization or apexification for the treatment of immature necrotic permanent teeth: Systematic review and meta-analysis. J Clin Pediatr Dent 2019; 43(5):305-313. https://doi.org/10.17796/1053-4625-43.5.1
  » https://doi.org/10.17796/1053-4625-43.5.1

Edited by

• Academic Editor:
  Myroslav Goncharuk-Khomyn

Data availability

The data used to support the findings of this study can be made available upon request to the corresponding author.

Publication Dates

• Publication in this collection
  31 Jan 2025
• Date of issue
  2025

History

• Received
  22 July 2023
• Reviewed
  10 Jan 2024
• Accepted
  13 May 2024