The Effect of Using Platelet Rich Fibrin (PRF) as a Scaffold in Revascularization on Apical Periodontitis Healing in Mature Teeth: Clinical Study

Abstract

Background & aim: Revascularization procedure was limited to immature necrotic teeth treatment, while nonsurgical traditional endodontic is still the most acceptable treatment for mature necrotic teeth. However, researchers' attention turned to apply revascularization on mature teeth and to start studies to improve protocols for getting the best results.

An essential component of regenerative endodontics (including revascularization) is the appropriate scaffold that allows stem cell adhesion, proliferation, and differentiation.  Usually, blood clot is used as a scaffold, then blood derivatives such as platelet rich fibrin (PRF) have been started to be used due to its fibrin composition capable of sustained release of growth factors and inflammatory cytokines. The aim of this study is to evaluate the effectiveness of platelet rich fibrin on periapical lesions healing when it’s used as a scaffold in mature teeth revascularization and compare it with blood clot scaffold.

Materials and Methods: the sample of this study consisted of 20 single rooted, straight permanent mature teeth with periapical lesions. Revascularization was performed in two main sessions. In the first session, the teeth were isolated using a rubber dam, prepared mechanically and chemically, and a triple antibiotic dressing was applied. In the second session, the sample was randomly distributed into 2 groups: bleeding was induced into the canal to achieve blood clot in one group and PRF with blood clot was applied in the other.  Then all teeth were sealed using five mineral oxides and glass ionomer cement and finally restored with composite. The cases were followed up at different time intervals (1, 3, 6, 12 and 18 months) to evaluate the presence of signs and symptoms and the periapical lesion healing. Data were subjected to Mann-Whitney U statistical test to study the significance of differences in the frequency of the treatment success between the two groups, with (P-value ≤ 0.05) as the level of significance.

Results: Both of the studied groups showed success in the revascularization treatment, without statistically significant differences.

Conclusions: Within the limitations of this in vivo study, it could be concluded that revascularization is effective in the healing of apical lesions if the used scaffold was only blood clot or in combination with PRF, with slightly favorable results when PRF is used as scaffold.