Comparative Analysis of Autologous Scaffold Formation Protocols in Regenerative Endodontic Therapy: A Systematic Review and Meta-analysis
Júlia Magalhães-Saldanha
*
Department of Endodontics, Faculty of Dentistry, University of Fortaleza, Edson Queiroz, Fortaleza, Ceará, Brazil.
José Evando da Silva-Filho
Department of Endodontics, Faculty of Dentistry, University of Fortaleza, Edson Queiroz, Fortaleza, Ceará, Brazil.
Samuel Chillavert Dias Pascoal
Department of Restorative Dentistry, Faculty of Dentistry, Federal University of Ceará, Rodolfo Teófilo, Fortaleza, Ceará, Brazil.
Francisco Samuel Rodrigues Carvalho
Division of Oral and Maxillofacial Surgery, Federal University of Ceará, Campus Sobral, Sobral, Ceará, Brazil.
Anil Kishen
Faculty of Dentistry, University of Toronto, 124 Edward Street, Toronto, Ontario, Canada.
Fábio de Almeida Gomes
Department of Endodontics, Faculty of Dentistry, University of Fortaleza, Edson Queiroz, Fortaleza, Ceará, Brazil.
Eduardo Diogo Gurgel-Filho
Department of Endodontics, Faculty of Dentistry, University of Fortaleza, Edson Queiroz, Fortaleza, Ceará, Brazil.
*Author to whom correspondence should be addressed.
Abstract
Aims: To evaluate the protocols of autogenous scaffold formation in regenerative endodontic therapy, with a focus on their efficacy in functional recovery, continued root development, and periapical healing in necrotic permanent teeth with incomplete root formation, while also assessing the increase in root length, root thickness, and reduction of the apical foramen.
Study Design: This is a systematic review and meta-analysis assessing the performance of various protocols for autogenous scaffold formation.
Place and Duration of Study: The review was conducted using the Embase, PubMed, Web of Science, Scopus, Cochrane, and LILACS databases, covering articles published until June 2024.
Methodology: The research question was developed using the PICOT framework. Inclusion criteria focused on randomized clinical trials with a minimum six-month follow-up, protocols employing autogenous scaffolds, and control groups with at least ten participants. Paired and independent searches with no filters applied were performed using the registered Medical Subject Headings "(Regenerative Endodontics) AND (Endodontics) AND (Calcium Hydroxide) AND (Platelet-Rich Fibrin) AND (Blood Coagulation) AND (Tooth Injuries) AND (Dental Pulp) AND (Dental Pulp Diseases)” and its related entry terms, covering articles relevant to the study's theme with no language or time restrictions. From an initial pool of 3.321 articles, 11 studies met the inclusion criteria, and five were included in the meta-analysis.
Results: Experimental scaffolds (e.g., Platelet-Rich Plasma and Platelet Rich Fibrin) showed statistically significant improvements in Root Length Increase compared to blood clots (P = 0.0006). Blood clots outperformed in Apical Foramen Reduction (P < 0.00001), while Root Thickness Increase results were equivalent across groups. High heterogeneity among studies was observed.
Conclusion: Both traditional blood clots and experimental autogenous scaffolds showed efficacy in regenerative endodontics. While Platelet-Rich Plasma and Platelet Rich Fibrin demonstrated better outcomes in root lengthening, blood clots provided superior apical healing.
Keywords: Blood coagulation, calcium hydroxide, dental pulp, dental pulp diseases, endodontics, platelet-rich fibrin, regenerative endodontics, tooth injuries