Treatment Outcomes Following Root Perforation Repair in Permanent Teeth: A Systematic Review and Meta-Analysis.

INTRODUCTION: This systematic review and meta-analysis aimed to evaluate the treatment outcomes of root perforation repair in permanent teeth and identify relevant prognostic factors. METHODS: A comprehensive search of PubMed, Embase, Scopus, Cochrane Library, Web of Science, and Google Scholar identified studies published between January 2000 and February 2026. Studies reporting treatment outcomes of repaired root perforations in permanent teeth with ≥12 months of follow-up were included. Two investigators independently performed study selection, data extraction, and risk of bias assessment using the Joanna Briggs Institute Critical Appraisal Checklist. Level and certainty of evidence were assessed using the Oxford Centre for Evidence-Based Medicine Levels of Evidence and the Grading of Recommendations Assessment, Development and Evaluation approach. Random-effects meta-analyses estimated the proportion of favorable outcomes and associations with preoperative prognostic factors. RESULTS: Nine observational studies evaluating non-surgical root perforation repair were included, of which seven contributed to the meta-analysis. The pooled favorable outcome was 89.7% (95% CI: 83.0%-94.9%). Smaller perforations (≤3 mm) were associated with higher odds of a favorable outcome than larger defects (OR=2.69; 95% CI: 1.29-5.59; p=0.008), while maxillary teeth demonstrated higher odds than mandibular teeth (OR=2.31; 95% CI: 1.12-4.75; p=0.023). Tooth type, perforation location, gender, preoperative radiolucency, and preoperative signs and symptoms were not significantly associated with favorable outcomes. CONCLUSIONS: Non-surgical root perforation repair appears to be associated with generally favorable treatment outcomes, particularly in smaller perforations (≤3 mm) and maxillary teeth. These findings should be interpreted cautiously given the substantial clinical heterogeneity and low-certainty evidence.