Efficacy of White Mineral Trioxide Aggregate in Regenerative Endodontic Procedures and Apexification for Immature...

This study systematically reviews the efficacy of bioceramic-based treatments for non-vital immature permanent teeth in children. A systematic search retrieved 229 records, ultimately including 15 studies, focused on White Mineral Trioxide Aggregate (WMTA) or other bioceramics used in apexification or Regenerative Endodontic Procedures (REP). A meta-analysis was conducted on WMTA's radiographic success and the comparative efficacy of platelet concentrates (PC) versus blood clot (BC) scaffolds. Data regarding clinical success, pulp sensibility, root development, and discolouration, were extracted. Risk of Bias (RoB) was evaluated using the RoB2 tool for RCTs. Evidence certainty was assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. The meta-analysis of radiographic success included 6 studies, revealing a pooled proportion of 0.99 (95% CI: 0.96-1.00), though GRADE rated evidence certainty as very low due to serious risk of bias and imprecision. Comparative analysis of PC versus BC scaffolds (4 studies, 145 observations) showed a non-significant trend favouring PC (OR = 3.56, 95% CI: 0.87-14.52), but very low certainty due to indirectness and sparse data. Comparison of WMTA versus alternative bioceramics revealed 100% clinical success, though non-significant (OR = 0.18, 95% CI: 0.02-1.68), with moderate certainty downgraded only for imprecision. All analyses demonstrated no heterogeneity (I² = 0.0%). PC favoured root lengthening compared to BC scaffolds that promoted dentinal wall thickening, alternative bioceramics exhibited a significantly lower discolouration risk than WMTA (7.69% vs 58.33%, P = .01), and pulp sensibility restoration was achieved in 60% to 86% of cases across regenerative treatments. Bioceramic-based treatments achieve high success for non-vital immature permanent teeth in children, though evidence certainty ranges from very low to moderate. While therapeutic efficacy is comparable, alternative bioceramics reduce discolouration risk compared to WMTA, and scaffold selection influences root maturation patterns.