Are platelet concentrate scaffolds superior to traditional blood clot scaffolds in regeneration therapy? A systematic review and meta-analysis

Abstract

Abstract Background The effectiveness of platelet concentrates in promoting root development of necrotic immature permanent teeth is unclear. The present study evaluated whether the platelet concentrate protocol was superior to the traditional blood clot protocol in regeneration therapy. Methods Electronic databases, such as PubMed, Cochrane Library, ClinicalTrials and EMBASE, were searched for studies comparing these protocols, with identified studies manually searched for relevant references. Clinical case-control studies were included, in which platelet-rich concentrates were tested for pulp regeneration and radicular development, with the blood clot treatment protocol as the control group. Clinical and radiographic outcomes were considered.Selected articles were assessed for risk of bias. Pooled Risk ratios were calculated for clinical success, responses to cold and electric pulp tests, periapical lesions, apex closure, root lengthening, and thickening of the dentin walls. Heterogeneity was assessed using I2 statistics and Cochrane’s Q test. Results Of the 1272 screened studies, 16 were selected, 14 case-control and two split-mouth studies, in which 465 immature necrotic permanent teeth, particularly incisors and premolars, were treated. Of these 465 teeth, 457 (98.2%) in both the control and experimental groups remained clinically asymptomatic for the entire study duration, whereas eight (1.8%) showed signs and symptoms of failure, including spontaneous pain, sensitivity to percussion or reinfection. Compared with control teeth, teeth treated with platelet-rich plasma or platelet-rich fibrin showed improved periapical healing (RR 1.09, 95% CI 1.00–1.20, P = 0.05), apical closure (RR 1.04, 95% CI 0.86–1.25, P = 0.69), root lengthening (RR 1.01, 95% CI 0.74–1.39, P = 0.93), and thickening of the dentin walls (RR 1.32, 95% CI 0.96–1.81, P = 0.08), although these differences were not statistically significant. Conclusions Platelet concentrates can act as successful scaffolds for regenerative endodontic treatment, although they did not differ significantly from conventional blood clot scaffolds.