Prospective cohort study of regenerative potential of non vital immature permanent maxillary central incisors using platelet rich fibrin scaffold

Selvakumar Kritika,V Sujatha,Sekar Mahalaxmi,Senthil Kumar Renganathan,N Srinivasan

doi:10.1038/s41598-021-93236-2

Abstract

Regenerative endodontic procedures have gained momentum as a treatment modality of young immature permanent teeth. Literature reports reveal that platelet-rich fibrin (PRF) stimulates growth factors and induces regeneration. This study was undertaken to assess the regenerative potential of non-vital immature permanent maxillary central incisors using PRF with a follow-up for 2 yrs. 19 patients in the age group of 9–25 yrs with immature, non-vital permanent maxillary central incisors (n = 23) with/without signs and/or symptoms of periapical pathosis and open apex were included in this study. In the first appointment, access opening, canal disinfection and triple antibiotic paste placement were done. In the subsequent visit, PRF was prepared and placed inside the canal. Access was sealed with Mineral trioxide aggregate plug and composite. The patient was reviewed up to 24 mths. The mean difference was statistically analyzed using Friedman test followed by Dunn post hoc test and adjusted by Bonferroni correction (p < 0.05). As per AAE guidelines, the primary and secondary goals were achieved. A significant (p < 0.001) gradual increase in the root length, thickness of dentinal walls and decrease in apical diameter were observed. Within the limitations of this study, PRF placement was clinically and radiographically effective in inducing regeneration of non-vital immature permanent teeth.

Highlights

Regenerative endodontic procedures have gained momentum as a treatment modality of young immature permanent teeth
Tissue engineering and tissue regeneration form the backbone of regenerative endodontics procedures (REP); the former utilizes specific stem cells, three-dimensional scaffolds and growth factors to regenerate pulp-dentin complex (PDC), the latter involves disinfection and revascularization of the PDC4,5. do Couto et al stated that the disinfection of the immature teeth in REP can be judiciously achieved with the use of triple antibiotic paste (TAP)[6]
The current clinical recommendations by the American Association of Endodontists (AAE) for REP suggests the use of TAP or calcium hydroxide, when comparatively analysing, TAP and double antibiotic paste showed increased antimicrobial activity compared to calcium h ydroxide[7]

Summary

Introduction

Regenerative endodontic procedures have gained momentum as a treatment modality of young immature permanent teeth. This study was undertaken to assess the regenerative potential of non-vital immature permanent maxillary central incisors using PRF with a follow-up for 2 yrs. 19 patients in the age group of 9–25 yrs with immature, non-vital permanent maxillary central incisors (n = 23) with/without signs and/or symptoms of periapical pathosis and open apex were included in this study. Within the limitations of this study, PRF placement was clinically and radiographically effective in inducing regeneration of non-vital immature permanent teeth. Do Couto et al stated that the disinfection of the immature teeth in REP can be judiciously achieved with the use of triple antibiotic paste (TAP)[6]. Visser et al reported that the platelet concentrates have increased concentration of growth factors and increased cellular proliferation when compared to the blood clot[10]

Methods

Results

Discussion

Conclusion