Regenerative endodontic treatment in avulsed immature permanent teeth: A scoping review

This scoping review assessed the performance of regenerative endodontic treatment (RET) in avulsed immature permanent teeth, which presented a significant challenge in dental trauma management. This scoping review aims to evaluate RET outcomes, protocols, complications, and effectiveness in avulsed immature permanent teeth, identifying research gaps to advance clinical application. The review encompassed a comprehensive search of PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Scopus, and Science Direct, spanning over 20 years, supplemented by snowball searching. Full-text articles in any language were eligible if they were randomized/non-randomized clinical trials or prospective/retrospective cohort studies with at least 12 months of follow-up, following the PCC framework. Data were extracted using standardized forms, including author(s), publication year, study origin, aim, sample size, intervention protocol, follow-up, outcome measures, and measurement methods. Of the 1623 records reviewed, 14 studies met the inclusion criteria. These studies, involving 82 avulsed immature anterior teeth, demonstrated an overall success rate of 44 % (36/82) over a minimum 12-month follow-up, with success defined by periapical radiolucency resolution and positive root development. The included studies showed significant variability in RET protocols, with calcium hydroxide as the primary intracanal medicament, blood clot as the main scaffold, and 17 % (Ethylenediaminetetraacetic acid) EDTA with saline as the most common irrigation method. Notably, extra-alveolar time and storage conditions significantly influenced outcomes, with replantation within 60 min using a physiological medium yielding the best results. While RET demonstrates approximately 44 % success in treating avulsed immature teeth, the variability in treatment protocols and the limited sample sizes in current studies highlight the need for more extensive research and standardized protocols to validate its use by dental practitioners.