Non-Cochrane · intervention · PM42160814
Efficacy of White Mineral Trioxide Aggregate in Regenerative Endodontic Procedures and Apexification for Immature Permanent Teeth: A Systematic Review and Meta-Analysis.
Li Zizhan, Xu Yue, An Songlin, et al. · International dental journal · 2026 · PubMed · doi:10.1016/j.identj.2026.109611
Findings
Population Children and adolescents with non-vital immature permanent teeth
8 findings
| WMTA as apical plug (apexification) or coronal barrier in regenerative endodontic procedures, single-arm | None (single-arm pooled proportion) | Radiographic success PRF + WMTA (REP) | Proportion 0.98 [0.88, 1.00] GRADE not reported 2 studies · 32 participants |
| WMTA as apical plug (apexification) or coronal barrier in regenerative endodontic procedures | None (single-arm proportion) | Radiographic success Generalized linear mixed model, random effects | Proportion 0.96 [0.90, 0.99] Very low Downgraded: risk of bias, imprecision 6 studies · 112 participants |
| WMTA as apical plug (apexification) or coronal barrier in regenerative endodontic procedures, single-arm | None (single-arm pooled proportion) | Radiographic success Overall (random effects, Freeman-Tukey double arcsine) | Proportion 0.99 [0.96, 1.00] Very low Downgraded: risk of bias, imprecision 6 studies · 112 participants |
| Platelet concentrate scaffold (PRP, PRF or PP) with WMTA in regenerative endodontic procedures | Blood clot scaffold with WMTA | Radiographic success PRP + WMTA versus BC + WMTA | OR 7.49 [1.16, 48.22] GRADE not reported 2 studies · 69 participants |
| Platelet concentrate scaffold (PRP, PRF or PP) with WMTA in regenerative endodontic procedures | Blood clot scaffold with WMTA | Radiographic success Overall platelet concentrates (PRP, PRF, PP) | OR 3.56 [0.87, 14.52] Very low Downgraded: imprecision, indirectness 4 studies · 145 participants |
| WMTA coronal barrier with platelet-rich plasma (PRP) scaffold in REP | None (single-arm proportion) | Radiographic success Subgroup PRP+MTA, random effects | Proportion 0.98 [0.87, 1.00] GRADE not reported 2 studies · 33 participants |
| WMTA coronal barrier in regenerative endodontic procedures | Alternative bioceramic cements (Totalfill putty, Biodentine) | Clinical success Overall (random effects) | OR 0.18 [0.02, 1.68] Moderate Downgraded: imprecision 2 studies · 67 participants |
| WMTA as coronal barrier in REP | Alternative bioceramic cements (Totalfill putty, Biodentine) as coronal barrier in REP | Clinical success Common effect model | OR 0.18 [0.02, 1.68] Moderate Downgraded: imprecision 2 studies · 67 participants |
Included primary studies 15
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Ulusoy 2019 Evaluation of Blood Clot, Platelet-rich Plasma, Platelet-rich Fibrin, and Platelet Pellet as Scaffolds in Regenerative Endodontic… PMID:30935618 | 2019 | 1 other review | Radiographic success; Clinical success; PM42160814-P4-O1; PM42160814-P5-O1 | not extracted yet |
| Alagl 2017 Use of platelet-rich plasma for regeneration in non-vital immature permanent teeth: Clinical and cone-beam computed tomography evaluation. PMID:28415948 | 2017 | this review only | Radiographic success; PM42160814-P4-O1; PM42160814-P5-O1 | not extracted yet |
| Alsofi 2019 Regenerative Endodontics for Upper Permanent Central Incisors after Traumatic Injury: Case Report with a 3-year Follow-up. PMID:31797857 | 2019 | this review only | not stated | not extracted yet |
| Aly 2019 Clinical and radiographic evaluation of Biodentine and Mineral Trioxide Aggregate in revascularization of non-vital immature permanent… PMID:30702789 | 2019 | this review only | Clinical success | not extracted yet |
| Annamalai 2010 Efficacy of mineral trioxide aggregate as an apical plug in non-vital young permanent teeth: preliminary results. PMID:21417116 | 2010 | this review only | Radiographic success | not extracted yet |
| Bartaw 2024 Discoloration after revascularization using calcium phosphosilicate-based bioceramic versus mineral trioxide aggregate in necrotic… PMID:38634024 | 2024 | this review only | Clinical success | not extracted yet |
| D'Mello 2017 Management of coronal discolouration following a regenerative endodontic procedure in a maxillary incisor. PMID:27554379 | 2017 | this review only | not stated | not extracted yet |
| Ghorbanzadeh 2015 Maturogenesis of Two Maxillary Central Incisors: A Case Report with 10 Years of Follow Up. PMID:26622286 | 2015 | this review only | not stated | not extracted yet |
| Kahler 2014 Revascularization outcomes: a prospective analysis of 16 consecutive cases. PMID:24565648 | 2014 | this review only | not stated | not extracted yet |
| Kandemir Demirci 2020 Regenerative Endodontic Therapy with Platelet Rich Fibrin: Case Series. PMID:31995420 | 2020 | this review only | not stated | not extracted yet |
| Loroño 2022 Regenerative Endodontic Procedure in an Immature Permanent Incisor with Internal Root Resorption: a Case Report. PMID:35783498 | 2022 | this review only | not stated | not extracted yet |
| Maniglia-Ferreira 2020 12-Year Follow-Up of Regenerative Endodontic Treatment of Immature Permanent Upper Incisors with Acute Abscess. PMID:33237241 | 2020 | this review only | not stated | not extracted yet |
| Nageh 2018 Assessment of Regaining Pulp Sensibility in Mature Necrotic Teeth Using a Modified Revascularization Technique with Platelet-rich Fibrin:… PMID:30174103 | 2018 | this review only | Radiographic success; Clinical success | not extracted yet |
| Sachdeva 2015 Regenerative endodontic treatment of an immature tooth with a necrotic pulp and apical periodontitis using platelet-rich plasma (PRP) and… PMID:25369448 | 2015 | this review only | not stated | not extracted yet |
| Timmerman 2018 Bleaching of a Discolored Tooth with Retrieval of Remnants after Successful Regenerative Endodontics. PMID:29079055 | 2018 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
| Review | Shared studies | Jaccard |
|---|---|---|
| Context-dependent effectiveness of autologous platelet concentrates in regenerative endodontic procedures and periapical surgery: A… (2026) | 1 | 0.02 |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Children and adolescents with non-vital immature permanent teeth (open apex, pulp necrosis with or without apical periodontitis) | Children and adolescents with non-vital immature permanent teeth (15 studies) |
| Intervention | WMTA as apical plug in conventional apexification or as coronal barrier in regenerative endodontic procedures (REP) | WMTA as coronal barrier in REP with PRP, PRF, PP or blood clot scaffolds (n=6 studies meta-analyzed); WMTA apical plug in apexification (n=1) |
| Comparison | Blood clot scaffold; platelet concentrates (PRP, PRF, PP); alternative bioceramics (Biodentine, Totalfill) when directly compared with WMTA; no comparator in single-arm studies | Blood clot scaffold (4 studies, 145 observations); alternative bioceramics Totalfill and Biodentine (2 studies, 67 observations); none in single-arm analysis |
| Outcomes | Clinical success; radiographic success; continued root development; restoration of pulp sensibility; tooth discolouration | Radiographic success (6 studies, 112 observations); clinical success vs alternative bioceramics (2 studies); root development, pulp sensibility, discolouration narrative |
| Study designs | RCTs, non-RCTs, prospective/retrospective cohorts, case series (3 or more cases) and case reports | 4 RCTs, 2 cohort studies, 9 case reports/series |
| Timing | Not specified | Follow-up 3 to 49 months in comparative studies; up to 12 years in case reports |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | Yes | Yes | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | No | No | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | Yes | Yes | yes |
| 8Included studies described in detail | Yes | Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Partial Yes | Partial Yes · Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: No | No | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Low | Low | yes |