Comparative success rates of regenerative endodontic procedures versus traditional root canal therapy: a meta-analysis of long-term clinical outcomes

Background Root canal treatment (RCT) has been the treatment of choice for managing pulpal necrosis and periapical pathologies due to its predictable outcomes. However, its inability to re-establish pulp function has given rise to regenerative endodontic procedures (REPs). This systematic review and meta-analysis compares overall success rates of RCT and REPs.Methods A systematic search yielded nine studies meeting inclusion criteria. Meta-analyses using random effects models with subgroup analysis comparing RCT and REP outcomes.Results The pooled success rate for REPs was 90% (95% CI: 83-94%), with low heterogeneity (I² = 22%). RCT achieved 89% success (95% CI: 77%-95%), with higher heterogeneity (I² = 90%). Confidence intervals showed no significant difference in overall success. However, REPs demonstrated additional benefits in sensibility restoration, with up to 56% of treated teeth responding to testing, and showed advantages in continued root development for immature teeth.Conclusion Both approaches yield high success rates. While RCT remains the definitive treatment for mature teeth, REPs offer promising results for immature teeth, particularly when biological regeneration is desired. Further research with longer follow-up is needed to establish optimal protocols.