Treatment outcome of regenerative endodontic procedures in mature permanent teeth compared to nonsurgical endodontic treatment: A systematic review and meta-analysis.

Abstract

<h4>Background</h4>Regenerative endodontic procedures (REP) have the advantage of restoring root canal's native defense ability by re-establishing vital pulp-like tissue. This review aims to determine the overall clinical and/or radiographic success rate (O) of REP (I) in mature permanent teeth (P) and to compare it (C) with nonsurgical endodontic treatment (NSET).<h4>Materials and methods</h4>Sources: PubMed, Web of Science, Embase, EBSCO, Cochrane Central Register of Controlled trials, ClinicalTrials.gov, Clinical Trials Registry-India and OpenGrey. Inclusion: Randomized clinical trials and single-arm prospective studies evaluating the treatment outcomes of REP in mature permanent teeth. Exclusion: Incomplete trials/studies, <i>in vitro</i> studies, animal studies, case reports/series, conference proceedings. Cochrane ROB2.0 and ROBINS-I tools were used to assess the risk of bias. Risk difference (R.D.) between NSET and REP was determined by meta-analysis of the randomized clinical trials. The overall success rate of REP was calculated using data from both randomized clinical trials and single-arm prospective studies. Sensitivity analysis and subgroup analysis were performed.<h4>Results</h4>Ten studies (<i>n</i> = 552) were included. R.D between REP and NSET was 0.032 (95% C.I: 0.023-0.087; <i>P</i> = 0.258). Overall success rate of REP was 96.0% (95% confidence interval: 94%-98%). No significant difference was found in sensitivity analysis (<i>P</i> = 0.551), or any of the subgroup analysis (<i>P</i> > 0.05).<h4>Discussion</h4>A limited number of randomized clinical trials were available, and only two of them had a low risk of bias. Consistent results were obtained in both types of included studies.<h4>Conclusion</h4>Based on a limited number of comparative studies, REP has a similar success rate to NSET in mature permanent teeth.<h4>Other</h4>Funding: Nil. Registration: PROSPERO (CRD42020204882).