Comparative analysis of tooth discoloration induced by different intracanal medicaments in regenerative endodontics: A systematic review and network meta-analysis

Aim: The aim of this study was to conduct a systematic review of the literature and network meta-analysis (NMA) to analyze tooth discoloration induced by different intracanal medicaments in regenerative endodontics. Methods: The research question was formulated based on the PICOS strategy. A comprehensive electronic literature search was conducted through Cochrane, Medline, PubMed, and Google Scholar using MeSH words, text words, and Boolean operators. Based on the specified inclusion and exclusion criteria, targeted studies from January 2010 to June 2024 comparing the discoloration potential of different intracanal medicaments were selected. The selected articles were subjected to quality assessment, and the risk of bias was evaluated using the quality assessment tool for in vitro studies. Results: Eight articles have been selected for systematic review, and five articles could be included in the NMA, which was carried out using MetaInsight v6.4.0 software with a Bayesian random-effects model, and treatment effects were expressed as mean differences in color change (ΔE values, CIE Lab units). All the studies included presented with a medium risk of bias except for one study that showed a low risk of bias. The meta-analysis ranks calcium hydroxide and chlorhexidine (CHX) with minimal discoloration, whereas triple antibiotic paste (TAP) and 3Mix showing highest discoloration. Conclusion: This systematic review and NMA conclusively revealed that minocycline-containing TAP exhibits the greatest propensity for inducing tooth discoloration. In contrast, TAP formulations incorporating doxycycline or clindamycin pose a moderate risk, whereas calcium hydroxide and CHX evidenced highest color stability.