Effect of Intracanal Scaffolds on the Success Outcomes of Regenerative Endodontic Therapy - A Systematic Review and Network Meta-analysis

The scaffolds used in regenerative endodontic therapy (RET) provide structural support for cells so that they can adhere to the scaffolds and also are crucial for cellular proliferation and differentiation. The objective of this network meta-analysis was to compare effects of different intracanal scaffolds on success outcomes of RET.PubMed/Medline, EMBASE, Cochrane, CINAHL, Scopus, and Web of Science databases were searched. Studies evaluating and/or comparing clinical and/or radiographic success of RET using different scaffolds with a minimum of 12 months follow-up were included. The Cochrane Collaboration risk of bias (ROB) tool and appropriate tools from Joanna Brigg's Institute were used for the assessment of ROB. A network meta-analysis was performed to compare the primary outcome (clinical success) and other success outcomes (root maturation, and pulpal sensibility) using different scaffolds.Twenty-seven studies fulfilled the desired inclusion criteria of which 25 had a low ROB whereas two had a moderate ROB. Clinical success of RET using platelet-rich plasma (PRP), blood clot (BC), and platelet-rich fibrin (PRF) scaffolds ranged between 91.66%-100%, 84.61-100%, and 77-100% respectively. The different scaffolds did not show any statistically significant difference in clinical success (PRF versus BC [p=1.000], PRP versus BC [p=1.000], and PRF versus PRP [p=0.999]), apical root closure (PRF versus BC [p=1.000], PRP versus BC [p=0.835], PRF versus PRP[p=0.956]), and pulp sensibility (PRF versus BC[p=0.980], PRP versus BC [p=0.520], and PRF versus PRP, p=0.990]).The intracanal scaffolds used during RET did not result in significant differences in regard to clinical success, root maturation, and pulpal sensibility.