Efficacy of mixture of injectable-platelet rich fibrin and type-1 collagen particles on the closure of through-and-through periapical bone defects - A randomized controlled trial.

Abstract

To determine the efficacy of a combination of injectable-platelet rich fibrin and type-1 collagen particles on the healing of through-and-through periapical bone defect and subsequent closure of bony window. The clinical trial was registered in ClinicalTrials.gov(NCT04391725). Thirty eight individuals with radiographic evidence of periapical radiolucency in maxillary anterior teeth and confirmed loss of palatal cortical plates in cone beam computed tomographic imaging were randomly assigned to either experimental group(n=19) or the control group(n=19). Mixture of i-PRF and collagen as a graft was applied to the defect in adjunct to periapical surgery in experimental group. No guided bone regeneration procedures were used in the control group. The healing was evaluated using Molven's(2D) and modified PENN 3D(3D) criteria. Percentage reduction of the buccal and palatal bony window area, and complete closure of through-and-through periapical bony window (tunnel defect) were assessed using Radiant Diacom viewer software(Version 4.0.2). The reduction in the periapical lesion area and volume was measured using Corel DRAW and ITK Snap software. Thirty four participants(18 and 16 in the experimental and control group, respectively) reported for follow-up at 12 months. There was 96.9% and 97.96% reduction of buccal bony window area in experimental and control groups respectively. Similarly, palatal window showed 99.03% and 100% reduction in experimental and control groups respectively. No significant difference in both buccal and palatal window reduction was noticed between the groups. A total of 14 cases(7 in experimental and 7 in control group) showed complete closure of through-and-through bony window. No significant difference in clinical, 2D and 3D radiographic healing, percentage reduction in area and volume was observed between experimental and control group(P>0.05). Neither the area nor the volume of lesion, and the size of buccal or palatal window had significant effect on healing of through-and-through defects. Endodontic microsurgery results in high success rate in large peripical lesions with through-and-through communication with more than 80% reduction in volume of lesion and size of both buccal and palatal window after one year. Mixture of type-1 collagen particles and i-PRF, adjunct to periapical micro-surgery did not improve the healing in through-and-through periapical defects.