The Efficacy Of Platelet-Rich Plasma Compared To Blood Clot Revascularization In Induction Of Continuous Root Development In Non-vital Immature Tooth Of Children And Young Adults.A Systematic Review And Meta-Analysis

Introduction: Blood clot revascularization(BCR)and platelet-rich plasma(PRP)are stem cell based regenerative endodontic treatment(RET)with potential to regenerate pulpal tissue.It was null hypothesized that platelet-rich plasma is more effective than blood clot revascularization because of platelet’s higher potential to heal.So the aim of this study was to evaluate the clinical efficacy of platelet-rich plasma compared to blood clot in the induction of continuous root development in immature non-vital tooth.Methods: The review was carried out in accordance with Cochrane review guidelines.Electronic database searches were done for clinical studies.Cochrane collaboration Risk of bias(ROB)assessment tool was used to assess randomized control trials(RCT)whilst NewcastleOttawa Scale(NOS)was used for non-randomised control trials.Meta-analysis was performed on the six included randomized control trials using Revman 5.3 statistical software.Fixed effect model was used to synthesize the data and outcome measured as odds ratio.Confidence interval(CI)was estimated at 95 %,significant effect level at P<0.05 and substantial heterogeneity at I2 > 50 %.Results: A total of 270 clinical studies were identified through the initial searches.After the screening and eligibility criteria were applied,with 23 studies were included for systematic review and six(6)randomised control trials for meta-analysis.The ROB across studies were generally low for both RCT and non RCT.In the synthesis of results,four measuring variables were included as subgroups to assess the success rates.Clinically,the primary data from the pool were in favour of platelet-rich plasma treatment in all the subgroups.However,statistically there was no significant difference between platelet-rich plasma and blood clot interventions.The summary effect for all subgroups indicated that both interventions yielded favourable outcomes.The P-values of all the subgroups were above the significant effect level(P<0.05),showing no significant difference.In apical closure;OR = 1.89 [0.92,3.86],I2 = 40 % and P = 0.08,in root dentine wall thickening;OR = 1.27[0.42,3.86],I2 = 70 % and P = 0.67 while in root lengthening;OR = 1.15 [0.37,3.54],I2 =32 % and P = 0.81,and in apical healing;OR = 1.16 [0.40,3.36],I2 = 0 and P = 0.79.Conclusion: In conclusion,although Platelet-rich plasma clinically gives favourable outcomes,statistically it is not significantly different compared to Blood clot intervention.Therefore,the null hypothesis can be rejected;that Platelet-rich plasma is not more effective than Blood clot revascularization but can be an alternative treatment in the induction of continuous root development in non-vital immature tooth in regenerative endodontic treatment.