Table 3.
Data extraction from included studies – the clinical protocol.
| Author | Etiology of Pulp Necrosis | Presence of Periapical Lesion | Instrumentation | Irrigation Method |
Intracanal Medication |
Recall Time (in Weeks) | Preparation Protocol of APC | Access Restoration |
|---|---|---|---|---|---|---|---|---|
| Alagl et al., 2017 [16] | Secondary to trauma/caries | Yes | No | 2.5% NaOCl (20 mL), sterile saline (20 mL), and 0.12% CHX (10 mL), followed by 17% EDTA after 3 weeks | TAP | 3 | PRP was prepared according to the description by Dohan et al. [48]. PRP was combined with equal volumes of sterile solution containing 10% calcium chloride and sterile bovine thrombin (100 U/mL) to achieve coagulation. | NR |
| Bezgin et al., 2015 [17] | Secondary to trauma/caries | Yes | No | 2.5% NaOCl (20 mL), sterile saline (20 mL), and 0.12% CHX (10 mL), followed by 5% EDTA (20 mL) after 3 weeks | TAP | 3 | PRP was prepared according to the description by Dohan et al. [48]. PRP was combined with equal volumes of sterile solution containing 10% calcium chloride and sterile bovine thrombin (100 U/mL) to achieve coagulation. | Final restoration was completed with white MTA (Angelus, Londrina, Brazil), reinforced GI cement (Ketac Molar Easymix; 3M ESPE, Seefeld, Germany) and composite resin (Filtek Supreme XT; 3M ESPE, St Paul, MN, USA) |
| Elsheshtawy et al., 2020 [18] | Secondary to trauma and Dens invaginatus | Yes | No | 20 mL of 5.25% NaOCl. At recall, 20 mL of 2.5% NaOCl, followed by 20 mL sterile saline and 10 mL of 17% EDTA solution | TAP | NR | PRP was prepared according to Dohan et al. [48], after which concentrated platelet-rich plasma (cPRP) was prepared and introduced inside dry root canals using a sterile 30 G syringe. The canal was then backfilled with cPRP to a level just beneath the CEJ and left to clot for 10 min | MTA, using a layer of reinforced GI (Riva self-cure, SDI limited, Bayswater, Victoria, Australia), followed by resin composite (Filtek Z250 universal restorative, 3 mol L, 3M ESPE, St. Paul, MN, USA) |
| Jadhav et al., 2012 [19] | Secondary to trauma/caries | No | Minimal (#60H file) | 2.5% NaOCl (copious irrigation) | TAP | NR | PRP: 8 mL of blood drawn by venipuncture of the antecubital vein was collected in a 10 mL sterile glass tube coated with an anticoagulant (acid citrate dextrose) and centrifuged at 2400 rpm for 10 min to separate PRP and platelet-poor plasma (PPP) from the red blood cell fraction. The topmost layer (PRP + PPP) was transferred to another tube and again centrifuged at 3600 rpm for 15 min to separate the PRP to precipitate at the bottom of the glass tube. This was mixed with 1 mL 10% calcium chloride to activate the platelets and to neutralize the acidity of acid citrate dextrose. | Resin-modified GI cement (Photac-Fill; 3M ESPE, St Paul, MN, USA) |
| Rizk et al., 2019 [20] | Secondary to trauma | Yes | No | 20 mL 2% NaOCl for 5 min, followed by 20 mL 17% EDTA. | TAP | 3 | PRP was prepared according to the description by Dohan et al. [48]. PRP was combined with equal volumes of sterile solution containing 10% calcium chloride and sterile bovine thrombin (100 U/mL) to achieve coagulation. PRF: 10 mL blood was collected in a sterile tube without anticoagulant and centrifuged immediately for 10 min at a speed of 3000 rpm. | An MTA orifice plug extending 2–3 mm in the canal was used to seal the canal orifice then GI (GC America, Alsip, IL, USA) and composite (Z250, 3M ESPE) were applied to give an effective and durable seal |
| Ragab et al., 2019 [21] | Secondary to trauma | Yes | No | 20 mL of 5.25% NaOCl followed by 20 mL sterile saline. | DAP | 3 | PRF was prepared by drawing 12 mL sample of whole blood intravenously from the patient’s right antecubital vein and centrifuged at 3000 rpm for 12 min. | MTA plus Light Cure GI cement |
| Mittal et al., 2019 [22] | Secondary to trauma/caries | Yes | Minimal (#30k file) | 2.5% NaOCl (copious irrigation). | DAP | 4 | PRF was prepared by drawing 5 mL of venous blood from the patient, collected in a dried glass test tube, and centrifuged at 2700 rpm for 12 min. | GI cement followed by composite resin |
| Shivashankar et al., 2017 [23] | Secondary to trauma/caries | No | Minimal | 5.25% NaOCl (copious irrigation). | TAP | 3 | NR | NR |
| Hazim Rizk et al., 2020 [24] | Trauma, Caries | Yes | No | 20 mL of 2.5% NaOCl followed by 20 mL of 17% EDTA. At recall 20 mL sterile saline followed by 20 mL 17% EDTA solution | TAP | 3 | PRP and PRF was prepared according to Dohan and Choukroun (2007) [49] method. | MTA, using a layer of GI (GC America, Alsip, IL, USA) followed by composite (Z 250, 3 M ESPE) |
| Jiang et al., 2017 [25] | Trauma, Broken central cusp | Yes | NO | 20 mL 1.25% NaOCl. At recall, 20 mL 17% EDTA. | Ca(OH)2 paste | 2 | NR | A layer of Filtek Z250 composite resin (3M ESPE, Irvine, CA; 3–4 mm) was placed over the capping material for the final restoration. |
| Narang et al., 2015 [26] | Secondary to trauma/caries | Yes | Minimal | 2.5% NaOCl (copious irrigation) | TAP | 4 | NR | Resin-modified GI cement was placed extending 3–4 mm in the canal. Access cavity was sealed with composite (Clearfil Majesty, Kuraray Medical Inc., Tokyo, Japan). |
| Meschi et al., 2021 [27] | Trauma, Caries, Anatomic anomaly (dens invaginatus) | Yes | No | 20 mL 1.5% NaOCl and subsequently with 20 mL saline. At recall, 30 mL EDTA 17% 1 mm short of the working length. | DAP | 2 | Blood samples were centrifuged. Fibrin clots were collected after centrifugation, and 2 of them were transformed into membranes after 5 min of pressure under a sterile glass plate. | Tooth was sealed by means of a GI lining and composite restoration. |
| Ulusoy et al., 2019 [28] | Secondary to trauma | Yes | No | 20 mL 1.25% NaOCl. At recall, 2% CHX, saline and 1 mL 17% EDTA. | TAP | 4 | PRP: Citrated blood was centrifuged in a standard laboratory centrifuge PK 130 (ALC International; ColognoMonzese, Italy) for 15 min at 1250 rpm to obtain PRP without erythrocytes and leukocytes. PRF: 10 mL blood was collected in a sterile tube without anticoagulant and centrifuged immediately for 10 min at a speed of 3000 rpm (Andreas Hettich Group, Ltd., Tuttlingen, Germany). | MTA coronal barrier was sealed with a thin GI base, and final coronal restorations were placed at the same visit using acid etch composite resin. |
| Jayadevan et al., 2021 [33] | Trauma | No | Minimal (#80–120K file) | 1.5% NaOCl solution (20 mL) followed by saline and 17% EDTA. Recall session, copious and gentle irrigation with saline and 20 mL of 17% EDTA. | TAP | 4 | A-PRF or PRF was freshly prepared using a centrifuge (R-8C Laboratory centrifuge, Remi Lab, Mumbai, India). For PRF, 10 mL of intravenous blood was drawn into a tube without anticoagulant and centrifuged at 2700 rpm for 12 min. For A-PRF, 10 mL of intravenous blood was drawn into a tube without anticoagulant and centrifuged at 1500 rpm for 14 min. | GI cement (GC, Fuji IX, GC India) was placed gently in a thickness of about 3–4 mm over the Biodentine and the access was temporized with Cavit. Post regenerative treatment consisted of non-vital bleaching or composite restoration. These procedures were performed after a period of one week. |
| Peng et al., 2017 [29] | Anatomic, Caries, Trauma | Yes | Minimal (#30K file) | 5.25% NaOCl solution (20 mL) | TAP | 1–4 | NR | Conventional GI cement (Fuji IX, Fuji Corporation, Osaka, Japan) was placed over the blood clot at the level of CEJ, followed by phosphoric acid etching for 30 s, a single-bond adhesive agent, and placement of Filtek Z250 composite resin (3M ESPE, Irvine, CA, USA). Instead of GI cement, mixture of ProRoot MTA (Dentsply Tulsa Dental, Johnson City, TN, USA) with 3 mm thickness was placed at the level of the CEJ. |
| Lv et al., 2018 [30] | Dens evaginatus, Tooth fracture | Yes | Minimal (35 K-file) | 20 mL of 1% NaOCl followed by 10 mL of 17% EDTA solution | TAP | 4 | PRF was prepared as described by Choukroun et al. [50]. Immediately before surgery, 5 mL of whole blood was drawn into 10 mL test tubes without anticoagulant reagent and was centrifuged at 400× g for 10 min. The PRF layer was separated using sterile scissors, and PRF clots were pressed into a membranous film with sterile dry gauze. | A 3-mm-thick layer of MTA was placed followed by a moist cotton pellet and Cavit. One week later, the Cavit was removed and replaced with a bonded resin restoration (Filtek Z350 XT: 3M ESPE Dental Products, St Paul, MN, USA). |
| Cheng et al., 2022 [31] | Secondary to trauma | No | Minimal or No | 0.5–1.5% NaOCl and saline or NaOCl in combination with saline and 17% EDTA | TAP | 2 | CGF was prepared from the patient’s intravenous blood. After immediate differential centrifugation of blood, CGF was represented as the buffy coat in the middle layer. Then the CGF layer was separated using sterile scissors. | Teeth were restored with a bio-ceramic material [i.e., MTA (Dentsply Sirona, Ballaigues, Switzerland) or iRoot BP Plus (Innovative Bioceramix Inc, Vancouver, BC, Canada)] followed by various restorative materials. |
| Chueh et al., 2009 [32] | Trauma | Yes | No | 2.5% NaOCl | Ca(OH)2 paste | 1–2 | NR | The access was sealed with temporary filling materials or resin. |
| Bonte et al., 2014 [34] | Trauma | Yes | No | Active 3% NaOCl | - | - | - | Composite resin |
| Santhakumar et al., 2018 [35] | Trauma and Dental caries | Yes | No | 3% NaOCl followed by saline | TAP | 3 | A 5 mL blood sample was taken from the patient’s anticubital vein. The blood was centrifuged without anticoagulant at 3000 rpm for 10 min, and PRF gel was obtained at the bottom of the test tube and was removed with a sterile tweezer. After obtaining PRF gel, it was squeezed using especially designed PRF compression device to remove the excess fluid. The membrane obtained was cut linearly in the shape of root canal space for ease of placement. | Triple sealed with MTA (ProRoot MTA), type II GI cement (Fugi 2) and composite material (3M ESPE). |
| Kandemir Demirci et al., 2019 [36] | Trauma, Dens invaginatus, Caries | Yes | No | 2.5% NaOCl solution. At recall, 2.5% NaOCl, 17% EDTA followed by 2% CHX | Ca(OH)2 powder mixed with saline | 1 | - | Bonded composite resin |
| Tek et al. 2021 [37] | Trauma | Yes | Yes | 2.5% NaOCl solution. Recall 2.5% NaOCl solution followed by distilled water | Ca(OH)2 paste | 1 | - | Resin composite (3M ESPE Filtek Ultimate Seefeld, Germany) |
| Kinirons et al., 2001 [38] | Trauma | NR | No | NR | - | - | - | NR |
| Lin et al., 2017 [39] | Secondary to trauma/Dens evaginatus | Yes | Minimal (#25 K file) | 20 mL 1.5% NaOCl, 0.9% physiological saline, 20 mL 17% EDTA | TAP | 3 | - | GI cement followed by composite resin |
| Xuan et al., 2018 [40] | Secondary to trauma | Yes | No | NR | NR | 4 | The pulp tissue for hDPSC isolation was harvested using standard sterile techniques. Autologous hDPSCs were obtained from the patient’s maxillary deciduous canine tooth. | NR |
| Alobaid et al., 2014 [41] | Secondary to Trauma | Yes | No | 20 mL 17% EDTA | TAP | 3 | PRP and PRF were prepared according to the method of Dohan and Choukroun (2007) [49]. | An MTA orifice plug extending 2–3 mm in the canal was used to seal the canal orifice then GI (GC America, Alsip, IL, USA) and composite (Z 250, 3 M ESPE) to give an effective and durable seal. |
| Casey et al., 2022 [42] | Secondary to trauma | Yes | Minimal | Varying concentrations of NaOCl, CHX, and/or EDTA | TAP | 2 | NR | Resin bonded restoration |
| Caleza-Jimenez et al., 2022 [43] | Trauma, Caries | Yes | No | 1.5–2.5% NaOCl and 17% EDTA | TAP | 2 | NR | Composite restoration |
| Pereira et al., 2021 [44] | Trauma | No | Minimal | 6% NaOCl, 2% CHX, saline solution, and EDTA 17% or Ca(OH)2 and 2% CHX gel | TAP | 3 | NR | Resin bonded restoration |
| Jeeruphan et al., 2012 [45] | Secondary to trauma/Caries | No | Minimal | 5.25% NaOCl | TAP | 3 | NR | NR |
| Silujjai et al., 2017 [46] | Secondary to trauma/Caries/Dens evaginatus | Yes | No | 1.5–2.5% NaOCl followed by 17% EDTA | Ca(OH)2 or TAP | NR | NR | MTA plus bonded restoration |
| Chen et al., 2016 [47] | Dens evaginatus | Yes | Minimal (#25 K file) | Copious 2.5% NaOCl | NR | NR | NR | NR |
Legend: APC = autologous platelet concentrate; NR = not reported; NaOCl = sodium hypochlorite; CHX = chlorhexidine; EDTA = ethylene diamine tetra-acetic acid; DAP = double antibiotic paste; TAP = triple antibiotic paste; Ca(OH)2 = calcium hydroxide; GI = glass ionomer; PRP = platelet-rich plasma; cPRP = concentrated platelet-rich plasma; PPP = platelet-poor plasma; PRF = platelet-rich fibrin; CEJ = cementoenamel junction; MTA = mineral trioxide aggregate; hDPSC = human dental pulp stem cells.