Comparative Evaluation of Autologous Platelet Aggregates Versus Blood Clot On The Outcome Of Regenerative Endodontic Therapy: A Systematic Review and Meta-Analysis

Abstract

Background: Regenerative endodontics represents a transformative approach to dental care, revitalizing necrotic teeth. This systematic review and meta-analysis evaluated the role of autologous platelet aggregates compared to the traditional blood clot method in regenerative endodontics. Material and Methods: A systematic search was conducted in PubMed, Scopus, EBSCO, Open Grey, and Google Scholar between 1st–12th August 2024. Case series, RCTs, retrospective studies, and case reports were included. Meta-analysis on RCTs and case series utilized RevMan 5.4 software, with p=0.05 as the significance level. The JBI risk of bias tool and GRADE system assessed study quality. Results: Nineteen studies met inclusion criteria, of which 13 were evaluated for risk of bias—11 showed low risk, and 2 were moderate. Rates of complete apical closure using PRF, BC, PRP, and CGF scaffolds ranged from 61.76% to 100%. Statistical analysis revealed no significant differences between autologous platelet aggregates and BC for outcomes such as complete apical closure (BC vs. PRP: p=0.28; BC vs. PRF: p=0.36), positive vitality (BC vs. PRP: p=0.70; BC vs. PRF: p=0.36), healing response (BC vs. PRF: p=0.23), and overall success score (BC vs. PRP: p=0.62). Conclusions: BC remains an effective primary scaffold for non-vital teeth with open apexes. PRP and PRF are viable alternatives when intracanal blood induction is challenging. Overall, platelet aggregates and BC showed comparable clinical and radiographic outcomes.