(PO115) Outcomes of Cell-Free Regenerative Endodontic Therapy: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Abstract: Cell-free regenerative therapy relies on endogenous stem cells for tissue regeneration, while cell-based therapy involves transplanting stem cells. Clinical regenerative endodontic therapy (RET) is a cell-free approach that harnesses the regenerative potential of stem cells in periapical tissues. Various cell-free techniques involving biological molecules and natural or synthetic scaffold materials have been explored for RET in immature and mature teeth. This systematic review aimed to investigate the outcomes of cell-free techniques for RET for immature and mature permanent necrotic teeth. The literature search was conducted on four electronic databases up to November 2023 to identify randomized controlled trials (RCTs) of RET. A meta-analysis using a random-effects model was conducted to determine the weighted pooled estimates of treatment outcomes, including periapical healing (primary outcome), increase in root dimension (secondary outcome), and return of pulp vitality (tertiary outcome). The quality of the evidence was graded using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Of 690 articles identified, 37 RCTs were eligible for meta-analysis. The pooled success rates for periapical healing were 94.5% in immature teeth and 89.1% in mature teeth, with no significant difference between immature and mature teeth (p > .05). The meta-analysis for the secondary and tertiary outcomes showed 85.0% of immature teeth had increased root dimension, and 35.8% responded to pulp sensibility testing, with no significant difference between immature and mature teeth (p > .05). The quality of the evidence was graded as moderate. Cell-free RET appears to be an effective treatment option for mature and immature necrotic teeth.