• Hydroxyapatite combined with collagen membrane showed the highest treatment efficacy and lowest adverse reaction rate for apical bone defects.
• Network meta-analysis ranked 10 interventions, with hydroxyapatite + collagen membrane outperforming other materials.
• Gelatin sponge had the highest adverse reaction rate, followed by blank control, suggesting potential risks with certain materials.
• The study highlights the need for more high-quality randomized controlled trials to validate these findings.