Context-dependent effectiveness of autologous platelet concentrates in regenerative endodontic procedures and periapical surgery: A systematic review and meta-analysis
Shivkumar P. Mantri, Niharika A. Gupta, Sneha S. MantriAbstract
Objectives:
To evaluate the clinical effectiveness of autologous platelet concentrates (APCs) compared with conventional approaches across regenerative endodontic contexts, including regenerative endodontic procedures (REPs) in immature and mature permanent teeth and periapical surgery.
Methods:
A systematic search of PubMed, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and supplementary sources was conducted from January 2000 to April 2026. Randomized and prospective clinical studies comparing APCs (platelet-rich plasma, platelet-rich fibrin, and derivatives) with conventional scaffolds or treatments were included. Outcomes assessed were clinical success, periapical healing, root development, pulp sensibility, and postoperative pain. Risk of bias was evaluated using Cochrane RoB 2 and ROBINS-I tools. Meta-analyses were performed using random-effects models with risk ratios (RRs), risk differences (RDs), or mean differences (MDs).
Results:
Thirty-nine studies were included. In immature teeth, APCs showed no significant difference compared with blood clot scaffolds in periapical healing (RD = 0.04; 95% confidence interval (CI): −0.08–0.16) and demonstrated comparable root development outcomes. In mature teeth, APC-based REPs showed no significant improvement in radiographic healing (RR = 0.99; 95% CI: 0.70–1.40), while pulp sensibility outcomes were highly heterogeneous and not statistically significant. In periapical surgery, APCs used as adjunctive biomaterials significantly improved radiographic healing (RR = 1.95; 95% CI: 1.27–2.98) and showed a nonsignificant reduction in postoperative pain (MD = −3.96; 95% CI: −9.36–1.44).
Conclusions:
APCs provide clinical outcomes comparable to conventional approaches in regenerative endodontics, particularly in immature teeth. Their benefits appear context-dependent, with improved early healing in periapical surgery but no consistent advantage in pulp sensibility or long-term outcomes. APCs should be considered biologically active adjuncts rather than replacements for conventional treatment.