Comparative Effectiveness of Regenerative Endodontic Treatment Versus Apexification for Necrotic Immature Permanent Teeth With or Without Apical Periodontitis: An Umbrella Review

Background/aim: The evidence related to the superiority of the recommended treatment protocols for necrotic immature permanent teeth is unclear. We aimed to compare the clinical, radiographic, and overall success rates of apexification and regenerative endodontic treatment (RET), assess the methodological quality, and assess the strength of evidence for outcomes.

Methods: A search was performed in PubMed, Scopus, LILACS, EMBASE, Web of Science, and the Cochrane Library. The titles, abstracts and full texts of systematic reviews (SRs) comparing RET and apexification were screened. The quality and strength of evidence were analyzed via AMSTAR-2, ROBIS, and modified Kohler's criteria.

Results: Twelve SRs were included, with nine having meta-analytic outcomes. The quality of only one study was high, and the risk of bias was low in two studies. Comparable success and survival rates for RET and apexification, with no superiority of any treatment, were reported. RET was superior in stimulating root thickness and lengthening. Weak evidence was noted for a higher clinical and radiographic success rate of the apical plug technique and for root lengthening and an increase in root thickness in RET.

Conclusion: RET and apexification exhibited comparable success rates of > 85% across all domains. Most comparisons did not reveal significant differences in clinical, radiographic, or overall success. However, the quality of evidence was weak (class IV) for both outcomes, and the majority of systematic reviews exhibited low or critically low quality and high risk of bias.