Non-Cochrane · intervention · PM42662661
Context-dependent effectiveness of autologous platelet concentrates in regenerative endodontic procedures and periapical surgery: A systematic review and meta-analysis.
Mantri Shivkumar P, Gupta Niharika A, Mantri Sneha S · Journal of conservative dentistry and endodontics · 2026 · PubMed · doi:10.4103/jcde.jcde_444_26
Findings
5 findings
| Population | ||||
|---|---|---|---|---|
| Necrotic immature permanent teeth undergoing regenerative endodontic procedures | Autologous platelet concentrates (PRP, PRF, platelet pellet) as REP scaffold | Blood clot scaffold (induced bleeding) | Periapical healing (radiographic success) 12 to 28 months follow-up · Regenerative endodontic procedure; immature permanent teeth | RD 0.04 [-0.08, 0.16] Very low Downgraded: risk of bias, imprecision, inconsistency 3 studies · 236 participants |
| Necrotic mature permanent teeth with periapical lesions | APC-based regenerative endodontic procedure (PRP, S-PRF, A-PRF, PRF) | Control: conventional endodontic treatment or retreatment, or blood clot scaffold | Pulp sensibility (positive response) 12 to 18 months follow-up · Regenerative endodontic procedure; mature permanent teeth | RR 5.31 [0.00, 1421155.98] 16 vs 51 Very low 3 studies · 183 participants |
| Necrotic mature permanent teeth with periapical lesions | APC-based regenerative endodontic procedure (PRP, S-PRF, A-PRF, PRF) | Control: conventional endodontic treatment or retreatment, or blood clot scaffold | Radiographic healing (clinical and/or radiographic success) 12 to 18 months follow-up · Regenerative endodontic procedure; mature permanent teeth | RR 0.99 [0.70, 1.40] 85 vs 91 Moderate Downgraded: inconsistency 3 studies · 142 participants |
| Adults with periapical lesions undergoing periapical (endodontic) surgery | Adjunctive autologous platelet concentrate (PRP, PRF, A-PRF+) in the surgical defect | Conventional periapical surgery without platelet concentrate | Postoperative pain (VAS) First postoperative week (7 days) · Periapical surgery / endodontic microsurgery | MD -3.96 [-9.36, 1.44] Moderate Downgraded: imprecision, indirectness 2 studies · 70 participants |
| Adults with periapical lesions undergoing periapical (endodontic) surgery | Adjunctive autologous platelet concentrate (PRP, PRF, A-PRF+) in the surgical defect | Conventional periapical surgery without platelet concentrate | Radiographic success (healing) 12 months · Periapical surgery / endodontic microsurgery | RR 1.95 [1.27, 2.98] Moderate Downgraded: risk of bias, imprecision 2 studies · 60 participants |
Included primary studies 39
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Ahmed 2023 Evaluation of postoperative pain and healing following regenerative endodontics using platelet-rich plasma versus conventional endodontic… PMID:36565044 | 2023 | 1 other review | Radiographic healing (clinical and/or radiographic success) | not extracted yet |
| Gulsever 2025 Apicoectomy versus apical curettage in combination with or without L-PRF application: a randomized clinical trial. PMID:40057596 | 2025 | 1 other review | not stated | not extracted yet |
| Karan 2020 Assessment of bone healing after mineral trioxide aggregate and platelet-rich fibrin application in periapical lesions using cone-beam… PMID:31321573 | 2020 | 1 other review | not stated | not extracted yet |
| Karkle 2025 Impact of Advanced Platelet-Rich Fibrin on Early Bone Healing After Endodontic Microsurgery: A Randomized Controlled Trial. PMID:40075764 | 2025 | 1 other review | not stated | not extracted yet |
| Soto-Peñaloza 2020 Pain and quality of life after endodontic surgery with or without advanced platelet-rich fibrin membrane application: a randomized… PMID:31612327 | 2020 | 1 other review | Postoperative pain (VAS) | not extracted yet |
| Tiwari 2020 Comparative analysis of platelet-rich fibrin, platelet-rich fibrin with hydroxyapatite and platelet-rich fibrin with alendronate in bone… PMID:33623234 | 2020 | 1 other review | not stated | not extracted yet |
| 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 | Periapical healing (radiographic success) | not extracted yet |
| You 2023 Volumetric evaluation of effects of platelet-rich fibrin and concentrated growth factor on early bone healing after endodontic… PMID:37899448 | 2023 | 1 other review | not stated | not extracted yet |
| Alshahhoud 2024 Application of Three Types of Scaffolds in Pulp Regeneration for Permanent Mature Teeth with Periapical Lesions: A Randomized Controlled… PMID:39704629 | 2024 | this review only | not stated | not extracted yet |
| Angerame 2015 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Asal 2024 Comparative Evaluation of Platelet-rich Fibrin and Treated Dentin Matrix in Regenerative Endodontic Treatment of Nonvital Immature… PMID:39364823 | 2024 | this review only | not stated | not extracted yet |
| Bezgin 2015 Efficacy of platelet-rich plasma as a scaffold in regenerative endodontic treatment. PMID:25459571 | 2015 | this review only | Periapical healing (radiographic success) | not extracted yet |
| Darwish 2025 Healing potentiality of blood clot, S-PRF and A-PRF as scaffold in treatment of non-vital mature single rooted teeth with chronic… PMID:39789544 | 2025 | this review only | Radiographic healing (clinical and/or radiographic success); Pulp sensibility (positive response) | not extracted yet |
| Del Fabbro 2012 Effect of platelet concentrate on quality of life after periradicular surgery: a randomized clinical study. PMID:22595104 | 2012 | this review only | not stated | not extracted yet |
| Dhamija 2020 Impact of Platelet-rich Plasma in the Healing of Through-and-through Periapical Lesions Using 2-dimensional and 3-dimensional Evaluation:… PMID:32553878 | 2020 | this review only | Radiographic success (healing) | not extracted yet |
| El-Kabbaney 2021 matched by author and year (probable) | NR | this review only | Radiographic success (healing) | not extracted yet |
| Elheeny 2024 A 12-month randomized controlled trial to assess the efficacy of revitalization of retreated mature incisors with periapical radiolucency… PMID:39013938 | 2024 | this review only | Radiographic healing (clinical and/or radiographic success); Pulp sensibility (positive response) | not extracted yet |
| ElSheshtawy 2020 The effect of platelet-rich plasma as a scaffold in regeneration/revitalization endodontics of immature permanent teeth assessed using… PMID:32249441 | 2020 | this review only | not stated | not extracted yet |
| Garg 2023 Application of platelet-rich fibrin and freeze-dried bone allograft following apicoectomy: A comparative assessment of radiographic healing. PMID:37417055 | 2023 | this review only | not stated | not extracted yet |
| Gupta 2022 Comparative evaluation of bioglass nanofiber, dexamethasone-coated bioglass nanofiber, and platelet-rich fibrin, as scaffolds in… PMID:36506625 | 2022 | this review only | not stated | not extracted yet |
| Jadhav 2012 Revascularization with and without platelet-rich plasma in nonvital, immature, anterior teeth: a pilot clinical study. PMID:23146641 | 2012 | this review only | not stated | not extracted yet |
| Kavitha 2022 Comparative Evaluation of Platelet-rich Fibrin and Concentrated Growth Factor as Scaffolds in Regenerative Endodontic Procedure: A… PMID:37125518 | 2022 | this review only | not stated | not extracted yet |
| Lin 2025 The use of concentrated growth factors in guiding bone regeneration after microsurgical endodontic surgery for periapical lesions. PMID:41018924 | 2025 | this review only | not stated | not extracted yet |
| Major 2025 matched by author and year (probable) | NR | this review only | Postoperative pain (VAS) | not extracted yet |
| Major 2025 Fenestrated endovascular aneurysm repair with concomitant horseshoe kidney. PMID:32025598 | 2020 | this review only | Postoperative pain (VAS) | not extracted yet |
| Markandey 2022 Evaluation of blood clot, platelet-rich plasma, and platelet-rich fibrin-mediated regenerative endodontic procedures in teeth with… PMID:36518608 | 2022 | this review only | not stated | not extracted yet |
| Meschi 2021 Regenerative Endodontic Procedure of Immature Permanent Teeth with Leukocyte and Platelet-rich Fibrin: A Multicenter Controlled Clinical… PMID:34400199 | 2021 | this review only | not stated | not extracted yet |
| Mittal 2021 Assessment of pulp sensibility in the mature necrotic teeth using regenerative endodontic therapy with various scaffolds - Randomised… PMID:34810392 | 2021 | this review only | Pulp sensibility (positive response) | not extracted yet |
| Mittal 2024 Comparison of double antibiotic chitosan hydrogel scaffold with platelet-rich fibrin in regeneration in immature necrotic permanent teeth… PMID:39959016 | 2024 | this review only | not stated | not extracted yet |
| Mohamed 2024 Evaluation of the efficacy of injectable platelet-rich fibrin versus platelet-rich plasma in the regeneration of traumatized necrotic… PMID:37612879 | 2024 | this review only | not stated | not extracted yet |
| Qamar 2025 Comparative Evaluation of Advanced Platelet-Rich Fibrin and Blood Clot as Scaffolds in Regenerative Endodontics for Immature Necrotic… PMID:40655730 | 2025 | this review only | not stated | not extracted yet |
| Ragab 2019 Comparative Study between Revitalization of Necrotic Immature Permanent Anterior Teeth with and without Platelet Rich Fibrin: A Randomized… PMID:30730794 | 2019 | this review only | not stated | not extracted yet |
| Rizk 2019 Regenerative Endodontic Treatment of Bilateral Necrotic Immature Permanent Maxillary Central Incisors with Platelet-rich Plasma versus… PMID:31866720 | 2019 | this review only | not stated | not extracted yet |
| Rizk 2020 Comparative evaluation of Platelet Rich Plasma (PRP) versus Platelet Rich Fibrin (PRF) scaffolds in regenerative endodontic treatment of… PMID:32647469 | 2020 | this review only | not stated | not extracted yet |
| Rizk 2020 Pulp Revascularization/Revitalization of Bilateral Upper Necrotic Immature Permanent Central Incisors with Blood Clot vs Platelet-rich… PMID:33149405 | 2020 | this review only | not stated | not extracted yet |
| Salah 2025 Regenerative potential of concentrated growth factor compared to platelet-rich fibrin in treatment of necrotic mature teeth: a randomized… PMID:39900647 | 2025 | this review only | not stated | not extracted yet |
| Shivashankar 2017 Comparison of the Effect of PRP, PRF and Induced Bleeding in the Revascularization of Teeth with Necrotic Pulp and Open Apex: A Triple… PMID:28765825 | 2017 | this review only | Periapical healing (radiographic success) | not extracted yet |
| Wahba 2025 Change in the size of apical radiolucencies in adolescent's mature maxillary incisors following retreatment with two regenerative… PMID:40319119 | 2025 | this review only | not stated | not extracted yet |
| Zhang 2024 Clinical and radiographic evaluation of regenerative endodontic procedures (REPs) with or without concentrated growth factor (CGF) as… PMID:39087227 | 2024 | 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 question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients with necrotic immature teeth or mature permanent teeth with necrotic pulp and/or periapical lesions | Necrotic immature teeth (n=18 studies); necrotic mature teeth with periapical pathology (n=8 studies); periapical surgery (n=13 studies) |
| Intervention | Autologous platelet concentrates (PRP, PRF, A-PRF, i-PRF, CGF) | PRP, PRF, A-PRF, i-PRF, CGF, PRGF as scaffold in REPs or adjunct in periapical surgery |
| Comparison | Blood clot scaffold, conventional root canal treatment, no scaffold, or alternative biomaterials | Blood clot; conventional endodontic treatment; other scaffolds or biomaterials; conventional surgery without platelet concentrates |
| Outcomes | Clinical success, periapical healing, root development, pulp sensibility, postoperative pain, quality of life | Periapical healing; radiographic healing; pulp sensibility; postoperative pain (pooled); root development, apical closure, clinical success, quality of life (narrative) |
| Study designs | RCTs, controlled clinical trials, prospective clinical studies with comparator | 39 studies, 36 RCTs and 3 nonrandomized prospective studies (n=39) |
| Timing | Not specified | Follow-up 1 week to 36 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 | Partial Yes | Partial Yes | 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: Yes | NRSI: Yes · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: No | NRSI: No · RCT: No | no |
| 12Impact of risk of bias on the pooled results | Yes | Yes | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |