Comparison of Revascularization and Apexification Using Mineral Trioxide Aggregate in Young Human Immature Nonvital Teeth: A Systematic Review and Meta-Analysis.

The management of immature nonvital permanent teeth in young patients remains a clinical challenge due to open apices and incomplete root development. Revascularization (RET) and apexification using mineral trioxide aggregate (MTA) are the two most widely used treatment modalities, but their comparative effectiveness remains debated. The present systematic review and meta-analysis compared RET and MTA apexification for treating immature nonvital teeth in patients aged 6-18 years. A comprehensive search was performed across PubMed, Scopus, Web of Science, and other dental databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eight studies published between 2016 and 2023, including three randomized controlled trials and five retrospective studies, met the inclusion criteria. Outcomes assessed included clinical success and failure rates, and radiographic changes in root length, root width, and apical diameter. The pooled analysis included 627 teeth. RET showed a higher but statistically nonsignificant clinical success rate (risk ratio, RR = 1.12; 95% confidence interval, CI: 0.99-1.27) and a lower failure rate with apexification (RR = 0.64; 95% CI: 0.28-1.44). RET resulted in significantly greater increases in root length (SMD = 0.31), root width (SMD = 0.61), and apical diameter reduction (SMD = 0.53). No significant heterogeneity or publication bias was detected. Both RET and MTA apexification are effective in achieving periapical healing in immature nonvital teeth. However, RET offers superior regenerative outcomes in root development. Despite a higher risk of discoloration, RET may be the preferred option when proper case selection and aseptic protocols are ensured.