Evaluation of platelet concentrates in regenerative endodontics: a systematic review and meta-analysis.

Objectives: The aim of this systematic review is to compare the effectiveness of advanced platelet concentrates as regenerative endodontic therapeutic alternatives to blood clot (BC) revascularization in immature permanent necrotic teeth. Methods: Randomized controlled trials (RCTs) comparing regenerative endodontic therapies using platelet-rich plasma (PRP), platelet-rich fibrin (PRF), or platelet pellet (PP) with the BC revascularization approach in immature permanent necrotic teeth were systematically searched in PubMed, Scopus, Cochrane Library, and Web of Science until May 2025. Data was extracted and analyzed both qualitatively and quantitatively. Study quality was assessed using the Cochrane Risk of Bias tool. A meta-analysis was conducted using IBM SPSS software (version 29.0), with success rates expressed as risk ratios and 95% confidence intervals (CIs). Results: The initial search yielded 4,917 studies. After removing duplicates and applying eligibility criteria, 15 RCTs were included. Meta-analysis indicated no significant difference in the risk ratio (RR), as the BC method has similar success rates with PRP (10 studies; RR = 1.01; 95% CI, 0.94-1.09; p = 0.76) and PRF (8 studies; RR = 0.98; 95% CI, 0.89-1.08; p = 0.65) at 12 months. The primary outcomes evaluated were based on clinical and radiographic success. Conclusions: Current evidence suggests PRP, PRF, and BC are all effective in treating immature permanent necrotic teeth with similar success rates. However, further research is needed to assess long-term outcomes.