Comparison between Calcium Hydroxide with Mineral Trioxide Aggregate and Regenerative Endodontics in Inducing Root Apex Closure during Apexification – A Systematic Review and Meta-analysis

Abstract

This study aimed to assess better effectiveness between regenerative endodontic procedures (REP) and apexification procedures (AP) with mineral trioxide aggregate (MTA) and calcium hydroxide for inducing root end apex closure. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed and registered in PROSPERO-CRD42023398997. Electronic databases were searched for studies evaluating effectiveness of REP and AP in terms of survival rate, success rate, increase in root length, root width and decrease in apical diameter. Cochrane risk of bias (RoB) -2 tool was used for quality assesssment using RevMan 5.3. The risk ratio (RR) and standardized mean difference (SMD) was used as summary statistic measure with random effect model (P < 0.05). Nine studies were included in qualitative synthesis and eight studies for meta-analysis. Quality assessment revealed moderate to low risk of bias. The pooled estimate through RR and SMD favoured REP being superior to AP for better survival rate (RR = 1.01 (0.96 – 1.06)), success rate (RR = 1.09 (0.96 – 1.24)), increase in root length (SMD = 0.25 (-0.14 – 0.63)), root width (0.66 (0.22 – 1.10)) and decrease in apical diameter (SMD =0.66 (-0.51 – 1.83)). Funnel plot did not show any heterogeneity indicating absence of publication bias. REP significantly improved apical root end closure. AP are equally effective in forming calcific barrier, however it was concluded that regeneration procedures are comparably superior to apexification procedures with greater outcomes. Clinicians should consider employing the REP in cases when root development is severely deficient and where tooth’s prognosis is hopeless even with an apexification procedure.

Keywords

• apexification
• necrotic pulp
• regenerative endodontics
• revascularization
• root canals