Comparison of autologous platelet concentrates versus blood clot as scaffolds in regenerative endodontics: A systematic review and meta-analysis

Objectives Regenerative endodontics (RE) is among the first-choice treatments for patients with non-vital immature permanent teeth (IPT). This study compares the efficacy of autologous platelet concentrates (APCs) versus blood clots (BC) in RE treatment for non-vital IPT. Methods We performed a literature search in seven databases from January 1970 to June 2025. Quality assessment was performed using Excel to implement RoB 2 from the Cochrane Handbook. Meta-analyses were performed by dividing studies into two groups concerning the type of scaffold (BC or APCs). Results Ten studies met the eligibility criteria and were included in the analyses, exhibiting moderate to low certainty evidence quality. Across analyses, heterogeneity ranged from low to substantial (I² = 0–60%; τ² = 0-0.18), and no statistically significant differences were observed between APCs and BC for primary (resolution of signs and symptoms and periapical healing) or secondary (apical closure and neurogenesis return) RE outcomes (all P > 0.05). Conclusions APCs and BC demonstrated comparable performance in RE. Given its clinical simplicity and low cost, BC should be considered the preferred scaffold, while APCs may represent an alternative when apex bleeding induction is not feasible. Clinical significance When treating non-vital immature permanent teeth, clinicians may expect similar regenerative outcomes using blood clots or autologous platelet concentrates; however, blood clots offer a simpler and more cost-effective first-line scaffold, with platelet concentrates reserved for cases where bleeding induction is not feasible.