Non-Cochrane · intervention · PM42288014
Association of Apical Maturity With Clinical and Biological Outcomes After Regenerative Endodontic Procedures: A Systematic Review and Meta-Analysis.
Zhan Shengnan, Yan Qiaoyi, Zhang Yunxia · International dental journal · 2026 · PubMed · doi:10.1016/j.identj.2026.109660
Findings
Population Permanent teeth (immature or mature) with necrotic pulps
8 findings
| Regenerative endodontic procedures (blood clot, PRF, CaOH, TAP, MTA, FGF and others) | None (single-arm proportions pooled across study arms) | Complete apical closure rate Follow-up 12 to 52 months · Clinical studies in Asia, North America, Europe and Africa · Random-effects model (DerSimonian-Laird; primary) | Proportion 0.53 [0.36, 0.70] GRADE not reported 4 studies · 196 participants |
| Regenerative endodontic procedures (blood clot, PRF, CaOH, TAP, MTA, FGF and others) | None (single-arm proportions pooled across study arms) | Pulp vitality recovery rate Follow-up 12 to 52 months · Clinical studies in Asia, North America, Europe and Africa · Random-effects model (DerSimonian-Laird; primary) | Proportion 0.21 [0.07, 0.49] GRADE not reported 4 studies · 224 participants |
| Regenerative endodontic procedures (blood clot, PRF, CaOH, TAP, MTA, FGF and others) | None (single-arm proportions pooled across study arms) | Pulp vitality recovery rate Follow-up 12 to 52 months · Clinical studies in Asia, North America, Europe and Africa · Common-effect model | Proportion 0.32 [0.26, 0.39] GRADE not reported 4 studies · 224 participants |
| Regenerative endodontic procedures (blood clot, PRF, CaOH, TAP, MTA, FGF and others) | None (single-arm proportions pooled across study arms) | Tooth survival rate Follow-up 12 to 52 months · Clinical studies in Asia, North America, Europe and Africa · Common-effect model Unresolved: the two extractors disagree on this row. | Proportion 0.98 [0.96, 0.99] GRADE not reported 9 studies · 453 participants |
| Regenerative endodontic procedures (blood clot, PRF, CaOH, TAP, MTA, FGF and others) | None (single-arm proportions pooled across study arms) | Tooth survival rate Follow-up 12 to 52 months · Clinical studies in Asia, North America, Europe and Africa · Random-effects model (DerSimonian-Laird; primary) | Proportion 0.98 [0.95, 0.99] GRADE not reported 9 studies · 453 participants |
| Regenerative endodontic procedures (blood clot, PRF, CaOH, TAP, MTA, FGF and others) | None (single-arm proportions pooled across study arms) | Complete apical closure rate Follow-up 12 to 52 months · Clinical studies in Asia, North America, Europe and Africa · Common-effect model | Proportion 0.57 [0.50, 0.64] GRADE not reported 4 studies · 196 participants |
| Regenerative endodontic procedures (blood clot, PRF, CaOH, TAP, MTA, FGF and others) | None (single-arm proportions pooled across study arms) | Clinical success rate Follow-up 12 to 52 months · Clinical studies in Asia, North America, Europe and Africa · Random-effects model (DerSimonian-Laird; primary) | Proportion 0.90 [0.83, 0.95] GRADE not reported 10 studies · 496 participants |
| Regenerative endodontic procedures (blood clot, PRF, CaOH, TAP, MTA, FGF and others) | None (single-arm proportions pooled across study arms) | Clinical success rate Follow-up 12 to 52 months · Clinical studies in Asia, North America, Europe and Africa · Common-effect model | Proportion 0.89 [0.86, 0.91] GRADE not reported 10 studies · 496 participants |
Included primary studies 10
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Lin 2017 Regenerative Endodontics Versus Apexification in Immature Permanent Teeth with Apical Periodontitis: A Prospective Randomized Controlled… PMID:28864219 | 2017 | 1 other review | Clinical success rate; Tooth survival rate; Complete apical closure rate | not extracted yet |
| Al-Qudah 2023 Outcome of Regenerative Endodontic Procedures in Nonvital Immature Permanent Teeth Using 2 Intracanal Medications: A Prospective… PMID:37225036 | 2023 | this review only | Clinical success rate; Tooth survival rate; Complete apical closure rate; Pulp vitality recovery rate | not extracted yet |
| Arslan 2019 Regenerative Endodontic Procedures in Necrotic Mature Teeth with Periapical Radiolucencies: A Preliminary Randomized Clinical Study. PMID:31155298 | 2019 | this review only | Clinical success rate; Tooth survival rate; Pulp vitality recovery rate | not extracted yet |
| Chan 2016 Longitudinal Cohort Study of Regenerative Endodontic Treatment for Immature Necrotic Permanent Teeth. PMID:28110920 | 2017 | this review only | Clinical success rate; Tooth survival rate; Complete apical closure rate | not extracted yet |
| Estefan 2016 Influence of Age and Apical Diameter on the Success of Endodontic Regeneration Procedures. PMID:27623497 | 2016 | this review only | Clinical success rate; Tooth survival rate | not extracted yet |
| Lu 2023 Treatment outcomes of regenerative endodontic procedures in nonvital mature permanent teeth: a retrospective study. PMID:37875745 | 2023 | this review only | Clinical success rate; Tooth survival rate; Pulp vitality recovery rate | not extracted yet |
| Nagy 2014 Regenerative potential of immature permanent teeth with necrotic pulps after different regenerative protocols. PMID:24461403 | 2014 | this review only | Clinical success rate; Tooth survival rate | not extracted yet |
| Sheng 2025 Outcome of regenerative endodontic procedures in delayed replanted immature permanent teeth with apical periodontitis: A retrospective… PMID:39245892 | 2025 | this review only | Clinical success rate; Tooth survival rate; Complete apical closure rate | not extracted yet |
| Silujjai 2017 Treatment Outcomes of Apexification or Revascularization in Nonvital Immature Permanent Teeth: A Retrospective Study. PMID:28132710 | 2017 | this review only | Clinical success rate | not extracted yet |
| Theekakul 2024 Mahidol Study 2: Treatment Outcomes and Prognostic Factors of Regenerative Endodontic Procedures in Immature Permanent Teeth. PMID:39216625 | 2024 | this review only | Clinical success rate; Tooth survival rate; Pulp vitality recovery rate | 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 |
|---|---|---|
| Effect of root canal filling techniques and materials on endodontic treatment outcomes: a systematic review and meta-analysis. (2026) | 1 | 0.01 |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Immature and mature permanent teeth with necrotic pulps undergoing REPs | 508 teeth in 10 studies; 8 studies immature teeth, 2 studies mature teeth; mean age 9.1 to 25.6 years |
| Intervention | REPs: blood clot, PRF, TAP, CaOH, MTA, FGF and other regenerative materials; initial apical diameter as exposure for dose-response | REP (blood clot), REP mixed, CaOH, TAP, FGF, MTA, replantation (n=10 studies) |
| Comparison | Conventional apexification (e.g., MTA) or comparisons among regenerative techniques; single-arm studies eligible | MTA apexification (2 studies), CaOH or TAP (2 studies), none in single-arm studies |
| Outcomes | Clinical success (primary); tooth survival, complete apical closure, pulp vitality recovery (secondary) | Clinical success (496 teeth), survival (453), apical closure (196), pulp vitality recovery (224) |
| Study designs | RCTs, prospective and retrospective cohort studies, case series of >=5 teeth | 4 RCTs, 3 retrospective cohorts, 1 prospective cohort, 1 longitudinal cohort, 1 case series |
| Timing | Not specified | Follow-up 12 to 52 months |
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 | No | No | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Partial Yes | NRSI: Partial Yes · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: No · NRSI: Partial Yes | NRSI: No · RCT: No | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | No | No | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |