Iranian Endodontic Journal

Abstract

Introduction: Regenerative endodontic therapy (RET) promotes root maturation in immature necrotic permanent teeth; however, the relative efficacy of various scaffolds remains unclear. This review synthesizes cone-beam computed tomography (CBCT)-based evidence to evaluate and compare post-RET root development across different scaffold materials. Materials and Methods: The review followed PRISMA 2020 and was prospectively registered in PROSPERO. Electronic databases and grey literature were searched for records published between January 2000 and February 2026. Clinical studies assessing root development by CBCT used alone or alongside conventional radiography were eligible and grouped by scaffold material to enable inter-material comparison. Root length change, dentinal wall thickness change, and apical closure served as the CBCT-assessed outcomes. Methodological quality was appraised using RoB-2 and ROBINS-I, and certainty of evidence was rated with GRADE. Owing to substantial heterogeneity, findings were synthesized narratively. Results: Twelve studies (466 teeth) were included. All scaffold types showed root-length increases (0.21–2.42 mm). Specifically, the conventional blood clot group exhibited root-length gains of 0.50–1.64 mm and apical closure in 65–73% of teeth. The blood clot produced modest but reproducible improvements; platelet concentrates (PRP, PRF) showed inconsistent outcomes; concentrated growth factor and chitosan-based scaffolds yielded favourable but limited evidence; L-PRF was comparatively less effective. Head-to-head comparisons, drawn from small, heterogeneous studies, were study-specific and did not establish clear superiority of any scaffold. Overall certainty of evidence was low to very low. Conclusions: Low- to very-low-certainty evidence suggests root maturation post-RET, though the superiority of scaffolds over blood clots remains inconclusive. Future research requires standardized CBCT protocols, consistent outcome reporting, and adequately powered comparative trials.