Platelet-Rich Plasma and Platelet-Rich Fibrin Can Induce Apical Closure More Frequently Than Blood-Clot Revascularization for the Regeneration of Immature Permanent Teeth: A Meta-Analysis of Clinical Efficacy.

Peter E Murray

doi:10.3389/fbioe.2018.00139

Abstract

The purpose of this review was to compare the clinical efficacy of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), vs. blood clot revascularization (BCR) for the regeneration of immature permanent teeth. A survey of the literature identified 222 cases of immature permanent teeth which had been given PRP, PRF or BCR regeneration treatment with at least a year-long follow-up in 12 different articles. A meta-analysis of the 222 immature permanent teeth after 1 year, were compared to assess the ability of PRP, PRF, and BCR to accomplish apical closure, a periapical lesion healing response, root lengthening, and dentinal wall thickening. The mean success rate for apical closure or reduction after 1 year was: PRP (85.1%) PRF (85.2%), and BCR (58.8%). The mean success rate for root lengthening after 1 year was: BCR (64.1%), PRP (64.2%), and PRF (74.1%). The periapical lesion healing response was 88.9% for BCR, 100% for PRP, and 100% for PRF. Dentinal wall thickening was 100% for BCR, 100% for PRP, and 100% for PRF. Apical closure occurred more frequently following PRP and PRF than with BCR (Fischer test, P < 0.0011), for all the other effects the PRP, PRF, and BCR treatments were similarly effective (Fischer tests, P > 0.05). In conclusion, the fractured or decayed immature permanent teeth of children and young adults aged 6 years to 28 which have a restorable crown, but thin dentinal walls may be regenerated by using a revascularization procedure which draws blood and stem cells into a disinfected root canal space. Although BCR is most common revascularization method, apical closure may occur more frequently if PRF and PRP are used instead of BCR for the regeneration of immature permanent teeth. The proper use of regenerative procedures can be very successful at the disinfection of bacteria from the periapical region of immature permanent teeth, which helps to heal localized lesions, and avoid the need for complex apical surgery, in addition to regenerating tissues to strengthen the structure of immature teeth, to help prevent tooth fracture and tooth loss.

Highlights

Endodontic treatments can save millions of caries-diseased and fractured permanent mature teeth, which are restorable
The aim of this study was to compare the clinical efficacy of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), vs. blood clot revascularization (BCR) for the regeneration of 222 immature permanent teeth after 1 year, compared using a metaanalysis for their ability to accomplish apical closure, a periapical lesion healing response, root lengthening, and dentinal wall thickening
To change clinician opinions and to gain a wider acceptance of RETs to be used to help save children’s traumatized teeth it was necessary to determine if the PRP, PRF, and BCR procedures could make RET more successful or if they were effective

Summary

Introduction

Endodontic treatments can save millions of caries-diseased and fractured permanent mature teeth, which are restorable. Caries-diseased and traumatized permanent incompletely developed teeth, can have a poor prognosis when treated by conventional root canal therapy (Harlamb, 2016). Incompletely developed teeth require a “regenerative endodontic procedure” (REP) which can regenerate replacement pulp to mineralize and thicken the thin dentinal walls, thereby, strengthening the structure of the tooth. REPs appear to be a promising treatment for permanent immature diseased and injured teeth, they can be problematic: REPs might not always result in complete root formation, and may not completely reduce the chances of root fracture (Bose et al, 2009), the success of REPs need to be investigated to identify how to avoid failures, and increase their rate of success

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