Effectiveness of concentrated growth factors in regenerative endodontic treatment of immature permanent teeth - A systematic review and meta-analysis

Aim: The aim of this review was to study the effectiveness of concentrated growth factors (CGFs) for regenerative endodontic treatment (RET) in necrotic immature permanent teeth. Methods: Two independent reviewers were involved in a literature search across five databases to identify clinical trials published up until June 2024. The quality of included clinical trials was evaluated using the revised Cochrane risk of bias tool (RoB 2.0) for randomized controlled trials (RCTs) and the Newcastle–Ottawa scale for retrospective studies. The certainty of evidence was further assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. A random-effect meta-analysis of standard mean difference was used to compute the summary risk ratio (and relative 95% confidence interval [CI]) between interventions. Results: In total, five studies were included, comprising two randomized clinical trials and three retrospective studies. Risk of bias assessment indicated that both RCTs had a low risk of bias, while two retrospective studies showed a low risk, and one had moderate concerns due to sample size limitations and nonrespondent factors. A combined hazard ratio of 1.00 with a 95% CI suggests no statistical difference between groups. The present meta-analysis revealed that CGF exhibits higher efficacy compared to platelet-rich fibrin (PRF) and blood clot with RET. Conclusion: This systematic review provides evidence that both CGF and PRF yielded positive results in terms of clinical and radiological outcomes. The choice between CGF and PRF may be influenced by factors such as the clinician’s preference, patient-specific considerations, and the intended therapeutic outcome. Moreover, conducting further high-quality clinical trials could yield a greater understanding of the advantages and disadvantages of CGF and PRF in different clinical situations.