title: A comparative evaluation of endodontic treatments for immature necrotic permanent teeth based on clinical and radiographic outcomes: a systematic review and meta-analysis.
abstract: BACKGROUND
  Dental trauma and deep caries are frequent findings in children and adolescents that may lead to pulp necrosis in young permanent teeth. As a consequence, the root stops its development, and managing these immature teeth becomes challenging due to the presence of open apexes and fragile dentinal walls.
  
  
  OBJECTIVE
  We aimed to carry out a systematic review including a meta-analysis to compare the endodontic treatments available in the management of immature necrotic permanent teeth and determine which one provides the best clinical and radiographic outcomes.
  
  
  METHODS
  The literature was screened via PubMed/MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials databases until August 2015 to select randomized clinical trials that compared at least two different treatments regarding immature necrotic permanent teeth comprising clinical and radiographic success as outcome. Two reviewers independently performed the screening and evaluation of the articles. A total of 648 studies were retrieved from the databases, in which only 14 were selected to full-text analysis by the appliance of inclusion criteria. After the exclusion criteria, the remaining seven studies had their data extracted and assessed for bias risk. Pooled-effect estimates were obtained comparing clinical and radiographic success rates among MTA Versus other treatments.
  
  
  RESULTS
  Evaluation of clinical (Z = 2.32, P = 0.02, OR = 5.37, 95% CI: 1.29-22.23, I = 0%) and radiographic (Z = 2.45, P = 0.01, OR = 4.31, 95% CI: 1.34-13.82, I = 0%) outcomes favored the MTA (control group) when compared to other endodontic treatments (P < 0.05). No evidence of heterogeneity was detected among the studies (I < 50%), whereas a moderate risk of bias was identified in five of them.
  
  
  CONCLUSIONS
  Although almost all of the identified studies presented moderate risk of bias, MTA apexification seems to produce overall better clinical and radiographic success rates among the endodontic treatment available in immature necrotic permanent teeth.
authors.affiliation: Specialist in Pediatric Dentistry, Federal University of Rio Grande do Sul - UFRGS, Porto Alegre, RS, Brazil.
authors.forename: Gabriel Ferreira
authors.initials: GF
authors.lastname: Nicoloso
authors.affiliation: Specialist in Pediatric Dentistry, Federal University of Rio Grande do Sul - UFRGS, Porto Alegre, RS, Brazil.
authors.forename: Isabel Garcia
authors.initials: IG
authors.lastname: Pötter
authors.affiliation: Department of Stomatology, Federal University of Santa Maria - UFSM, Santa Maria, RS, Brazil.
authors.forename: Rachel de Oliveira
authors.initials: RO
authors.lastname: Rocha
authors.affiliation: Department of Conservative Dentistry, Federal University of Rio Grande do Sul - UFRGS, Porto Alegre, RS, Brazil.
authors.forename: Francisco
authors.initials: F
authors.lastname: Montagner
authors.affiliation: Department of Surgery and Orthopedics, Federal University of Rio Grande do Sul - UFRGS, Porto Alegre, RS, Brazil.
authors.forename: Luciano
authors.initials: L
authors.lastname: Casagrande
mesh_terms: D000293:Adolescent; D002648:Child; D003790:Dental Pulp Necrosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D019229:Dentition, Permanent; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D011861:Radiography, Dental; D019553:Tooth, Nonvital