Intracanal calcification following regenerative endodontic treatment: a systematic review and meta-analysis

Objectives Calcification is a common finding in endodontic cases after regenerative endodontic therapy (RET). We aimed to identify the prevalence of intracanal calcification after RET and to compare intracanal calcification outcomes in RET using either calcium hydroxide [Ca(OH)(2)] or antibiotics. Materials and methods We searched PubMed, Web of Science, ProQuest Dissertations & Theses, and Scopus databases for clinical, cross-sectional, case-control, and cohort RET studies published until May 2020 in the English language and reporting a calcified case after RET. The Cochrane risk-of-bias tool for randomized trials and Risk of Bias In Non-randomized Studies of Interventions were used for bias assessment. Meta-analyses were performed, overall and separately, for intracanal medicaments using a random-effects model with weighted inverse variance methods. Subgroup analysis was performed according to the calcification type. Results Eight studies were included. The overall prevalence of intracanal calcification after RET was 30.7% (95% confidence interval [CI]: 0.15-0.45, I-2=92.6%), 46.5% with Ca(OH)(2) vs. 25.8% with antibiotic-based intracanal medicaments. Subgroup analyses for complete calcification outcome showed a higher prevalence of complete calcification in the Ca(OH)(2) group (46.5%, 95% CI: 0.17-0.68, I-2 = 80.9%) than in the antibiotic group (10%, 95% CI: - 0.04-0.43, I-2 = 82.1%). Conclusions Based on the studies included, available evidence shows a statistically significant association between complete calcification and Ca(OH)(2) paste as an intracanal medicament. Other contributing factors, such as blood clot formation and follow-up time, might also play an essential role in forming intracanal calcification. Clinical relevance This study highlights the significant association between complete calcification and Ca(OH)(2) paste.