Regenerative Evaluation of Immature Roots using PRF and Artificial Scaffolds in Necrotic Permanent Teeth: A Clinical Study

Abstract

The aim of this study is to evaluate and compare the regenerative potential of natural scaffold [platelet-rich fibrin (PRF)] and artificial scaffolds (commercially available collagen, placentrex, and chitosan) in necrotic immature permanent teeth. Necrotic immature permanent maxillary incisors with or without radiographic evidence of periapical lesion were included. Access opening was done under rubber dam isolation. Canal disinfection was done using minimal instrumentation, copious irrigation, and double antibiotic paste as interappointment medicament for 4 weeks. After 4 weeks, asymptomatic teeth were divided into four groups on the basis of scaffolds used for the revascularization procedure: group I (PRF); group II (collagen); group III (placentrex); group IV (chitosan). The clinical and radiographic evaluations of teeth were done at 3, 6, and 12 months after the procedure and compared with baseline records. Clinically, patients were completely asymptomatic throughout the study period. Radiographically, all cases showed an improvement in terms of periapical healing, apical closure, root lengthening, and dentinal wall thickening. PRF and collagen gave better results than placentrex and chitosan in terms of periapical healing, apical closure, and dentinal wall thickening. Revascularization procedure is more effective and conservative over apexification in the management of necrotic immature permanent teeth. This study has shown that PRF and collagen are better scaffolds than placentrex and chitosan for inducing apexogenesis in immature necrotic permanent teeth.