Review Article

Regenerative Endodontic Therapy in the Management of Immature Necrotic Permanent Dentition: A Systematic Review

Table 1

Summary of the included human studies in this systematic review according to PRISMA guidelines.

Authors (year)No. of subjects (teeth)Age of patient-years (mean ± SD)Intracanal medicationsScaffoldsPulpal space/barrier usedFollow-up durationRoot maturation stage (Cvek’s classification)Main outcomes

Alasqah et al. [26] (2020)(n = 1)8 years oldCa(OH)2 + TAPBlood clotMTA plug2 yearsStage V (closed apical foramen and completed root development)Significant periapical healing and complete roots formation
Rizk et al. [27] (2019)(n = 30)(9.1 ± 1.02)TAPBlood clot + PRPMTA1 yearStage V (closed apical foramen and completed root development)Complete maturation of the root apex
Ajram et al. [28] (2019)(n = 1)7 years oldCa(OH)2Blood clotMicromega-MTA (MM-MTA)2 yearsStage V (closed apical foramen and completed root development)Apical closure and complete periapical healing
Ulusoy and Cehreli [29] (2017)(n = 4)(9.2 ± 1.75)TAPBlood clotMTA1.5 yearsStage I (<1/2 root length with open apex)Lack of evidence for increased root dimensions and/or apical closure, but the elimination of clinical signs/symptoms and resolution of apical periodontitis have happened.
Moodley et al. [30] (2017)(n = 1)10 years oldCa(OH)2 + TAPBlood clotMTA2–5 monthsStage V (closed apical foramen and completed root development)Apical closure and a thickening of the dentinal walls
Timmerman and Parashos [31] (2017)(n = 1)16 years oldCa(OH)2Blood clotMTA3 yearsStage V (closed apical foramen and completed root development)Root development/Apical closure
Nosrat et al. [35] (2015)(n = 2)(9.5 ± 0.74)TAPBlood clotMTA4 monthsStage V (closed apical foramen and completed root development)Root development/Apical closure
Bezgin et al. [39] (2015)(n = 20)(9.9 ± 1.9)TAPBlood clot + PRPMTA1.5 yearsStage V (closed apical foramen and completed root development)Complete apical closure, periapical tissue pathology resolution
Narang et al. [40] (2015)(n = 20)(11.2 ± 3.51)TAPBlood clot + PRP + PRFResin-modified glass ionomer cement6 months–1.5 yearsStage V (closed apical foramen and completed root development)Apical closure, root lengthening, dentinal wall thickening, and periapical healing
Saoud et al. [4] (2014)(n = 20)(11.3 ± 1.92)TAPBlood clotMTA1 yearStage V (closed apical foramen and completed root development)Apical closure, root lengthening, and root wall width
Alobaid et al. [44] (2014)(n = 31)(8.8 ± 1.67)TAP + BAP + CHBlood clotMTA8.5–14.5 monthsStage V (closed apical foramen and completed root development)Apical closure and hard tissue barrier
Nagata et al. [45] (2014)(n = 23)(11.3 ± 3.12)TAP + Ca(OH)2+ CHBlood clotMTA9–19 monthsStage V (closed apical foramen and completed root development)Root thickening/Lengthening/Apical closure
Kahler et al. [46] (2014)(n = 16)(10.1 ± 1.88)TAPBlood clotMTA1–3 yearsStage II (1/2 root length with open apex)Root thickening/lengthening. Negative results for this procedure
Nagy et al. [47] (2014)(n = 36)(10.8 ± 1.54)TAPBlood clot + blood clot with (FGF)MTA plug1 yearsStage V (closed apical foramen and completed root development)Root thickening/Lengthening/Apical closure
Jadhav et al. [50] (2013)(n = 6)(15.3 ± 6.82)Ciprofloxacin + metronidazole + minocyclineBlood clot + blood clot with PRPResin-modified glass ionomer cement1 yearStage V (closed apical foramen and completed root development)Root thickening/lengthening/Apical closure
Sönmez et al. [51] (2013)(n = 3)9 years oldCiprofloxacin + metronidazole + minocyclineBlood clotMTA2 yearsStage V (closed apical foramen and completed root development)Apical closure and dentin wall thickening
Mc Tigue et al. [52] (2013)(n = 32)(10.2 ± 1.83)TAPBlood clotMTA1 yearStage V (closed apical foramen and completed root development)Apical closure and root wall thickening + periapical tissue healing
Martin et al. [53] (2013)(n = 1)9 years oldTAPPRPMTA1 yearStage III (2/3 root length with open apex)Root thickening/lengthening
Dabbagh et al. [55] (2012)(n = 18)(10.5 ± 1.58)TAPBlood clotMTA2 yearsStage IV (wide opening apical foramen and nearly completed root length)Root thickening/lengthening, hard tissue barrier, and periapical tissue healing
Chen et al. [3] (2012)(n = 20)(10.2 ± 1.49)Ca(OH)2Blood clotMTA6–26 monthsStage IV (wide opening apical foramen and nearly completed root length)Root lengthening, dentinal wall thickening, hard tissue barrier, and periapical healing
Jeeruphan et al. [6] (2012)(n = 61)(12.9 ± 5.07)Ca(OH)2Blood clotGutta-percha11.7–21.15 monthsStage III (2/3 root length with open apex)Root wall width/lengthening
Kim et al. [56] (2012)(n = 3)(10.6 ± 1.15)Ciprofloxacin + metronidazole + cefaclorBlood clotMTA2–4 yearsStage III (2/3 root length with open apex)Periapical healing and dentin wall thickening
Iwaya et al. [57] (2011)(n = 1)7 years oldCa(OH)2Empty scaffoldGutta-percha30 monthsStage IV (wide opening apical foramen and nearly completed root length)Continued root development and apical closure
Torabinejad and Turman [20] (2011)(n = 1)11 years oldTAPBlood clotMTA5.5 monthsStage V (closed apical foramen and completed root development)Hard tissue barrier
Cehreli et al. [16] (2011)(n = 6)10 years oldCHBlood clotMTA plug1.5 yearsStage V (closed apical foramen and completed root development)Apical closure, periapical tissue healing, and tissue regeneration
Nosrat et al. [59] (2011)(n = 2)(8.5 ± 0.70)TAPBlood clotCalcium enriched mixture (CEM) cement15–18 monthsStage IV (wide opining apical foramen and nearly completed root length)Root development/Periapical tissue healing
Petrino et al. [60] (2010)(n = 6)(10 ± 3.60)TAPBlood clotMTA8 monthsStage V (closed apical foramen and completed root development)Hard tissue barrier
Thomson and Kahler [63] (2010)(n = 1)12 years oldTAPBlood clotMTA1.5 yearsStage IV (wide opening apical foramen and nearly completed root length)Continued root development and some of the apical closures are evident
Reynolds et al. [22] (2009)(n = 2)11 years oldTAPBlood clotMTA1.5 yearsStage V (closed apical foramen and completed root development)Significant root development with maturation of the dentine
Ding et al. [64] (2009)(n = 12)(9.5 ± 1.16)Ciprofloxacin + metronidazole + minocyclineBlood clotMTA15 monthsStage IV (wide opening apical foramen and nearly completed root length)Continued root development
Bose et al. [65] (2009)(n = 88)Not reportedTAP + CH + formocresolBlood clotMTA6 months-3 yearsStage IV (wide opening apical foramen and nearly completed root length)Root development/thickening/lengthening

SD: standard deviation; Ca(OH)2: calcium hydroxide; TAP: triple-antibiotics paste; BAP: bi-antibiotics paste; CH: chlorhexidine; MTA: mineral trioxide aggregate; blood clot with bFGF: blood clot with basic fibroblast growth factor; PRP: platelet-rich plasma; PRF: platelet-rich fibrin; blood clot with FGF: blood clot with fibroblast growth factor; and DPCs: dental pulp cells. Gelfoam (Pfizer, New York, NY, USA).