Hyaluronic Acid vs. PRP, PRF, and Collagen in Regenerative Endodontics: A Systematic Review

Background: Regenerative endodontic procedures (REPs) aim to restore pulp vitality and promote root development in immature necrotic permanent teeth. Scaffold materials provide a 3D framework to support cellular migration, proliferation, and differentiation and play a critical role in regenerative interventions. Commonly used scaffolds include PRP, PRF, and collagen; however, hyaluronic acid has also demonstrated promising treatment outcomes. Objective: To evaluate whether hyaluronic acid (HA) provides superior regenerative outcomes compared to PRP, PRF, and collagen scaffolds. Methods: A systematic electronic search was conducted across PubMed, Scopus, and EBSCOhost. A total of 952 articles were identified in the initial search, of which 19 articles were included in the final review. Due to heterogeneity, a narrative synthesis was performed. Results: PRF demonstrated the most consistent improvement in root development and dentinal wall thickening. Apical closure and periapical healing were achieved across all scaffold types. Evidence for HA was limited, with no clear superiority identified. Conclusions: Current evidence does not support the superiority of HA over established scaffolds. Further standardised clinical trials are required to make definitive comparisons on scaffold effectiveness.