Regenerative Endodontic Treatment or Mineral Trioxide Aggregate Apical Plug in Teeth with Necrotic Pulps and Open Apices: A Systematic Review and Meta-analysis

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A mineral trioxide aggregate (MTA) apical plug (MAP) and regenerative endodontic treatment (RET) have shown acceptable clinical outcomes. However, comparative studies are scarce. The aims of this study were to examine the level of evidence for both treatments, conduct a systematic review of the literature on MAP and RET, and run a meta-analysis on the survival and success rates of teeth treated with these procedures.


Electronic searches were performed in MEDLINE, Web of Science, and the Cochrane Library. Two authors independently screened the titles and abstracts for eligibility. Subgroup analyses were performed on the clinical outcomes (ie, survival and success) of the procedures.


In all, 750 studies were identified, and 144 studies were subjected to qualitative synthesis. Ten randomized clinical trials were included in subgroup analyses. Most of the studies in both groups were case reports and case series (72% and 86% in MAP and RET, respectively). The overall level of evidence in both groups was low. The pooled survival rates were 97.1% (95% confidence interval [CI], 93.7–100) and 97.8% (95% CI, 94.8–100) for MAP and RET, respectively. The pooled success rates were 94.6% (95% CI, 90.2–99.1) and 91.3% (95% CI, 84.5–98.2) for MAP and RET, respectively. Very little heterogeneity was observed among the studies regarding survival and success rates (I2 < 50%, P > .10). There was no significant difference between the 2 groups regarding survival (P = 1.00) or success rates (P = .58).


The existing literature lacks high-quality studies with a direct comparison of outcomes of MAP and RET. Randomized multicenter clinical trials with large sample sizes and long-term follow-ups are needed to address this gap in knowledge.

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