(PO89) Treatment Outcomes of Regenerative Endodontic Therapy in Immature Permanent Teeth with Pulpal Necrosis: A Systematic Review and Network Meta-Analysis

Abstract: To assess which modality regarding scaffold selection for immature permanent teeth with pulpal necrosis will be the most successful for regenerative endodontic treatment, records until August 2022 were searched, providing a total of 3,021 articles. Nine of these articles were included for analysis. A network meta-analysis was conducted to estimate effects for primary outcomes (clinical and radiographic healing) and secondary outcomes (apical closure, root length, and root wall thickness increase) [mean difference (MD); 95% credible interval (CrI), and surface under the cumulative ranking curve (SUCRA)]. Six interventions were identified: blood clot scaffold (BC), blood clot scaffold with basic fibroblast growth factor, blood clot scaffold with collagen, platelet pellet, platelet-rich plasma (PRP), and platelet-rich fibrin (PRF). The PRP scaffold showed the greatest increase in root lengthening at 6-12 months (MD=4.2; 95% CrI, 1.2 to 6.8; SUCRA=89.0%, very low confidence). PRP or PRF achieved the highest level of success for primary and secondary outcomes at 1-6 and 6-12 months. The blood clot scaffold (with collagen or combined with basic fibroblast growth factor (bFGF)) achieved the highest level of success for secondary outcomes beyond 12 months. Very low to low quality of evidence suggests that both PRP or PRF exhibit the greatest success evaluating primary and secondary outcomes within 12 months postoperatively compared to the traditional blood clot scaffold protocol.Limited evidence suggests both PRP and PRF exhibit success in the short term, not long term. This information advises prioritizing both materials in the protocols for upcoming trials.