The Efficacy of Advanced Platelet-rich Fibrin in Revascularization of Immature Necrotic Teeth

Abstract

The present study aims to compare advanced platelet-rich fibrin (A-PRF) and conventional blood clot as scaffolds in the regenerative endodontic procedure (REP) and to evaluate their effectiveness in the development of traumatized nonvital immature teeth roots. Regenerative endodontic procedure was carried out on 20 traumatized nonvital immature maxillary incisors of 17 patients between the ages of 8 and 12 years. Irrigation with 1.5% sodium hypochlorite (NaOCl) and 17% ethylene diamine tetra-acetic acid was done following minimal mechanical debridement. Canal disinfection was achieved using calcium hydroxide paste. According to the scaffold type, teeth were randomly allocated into A-PRF (n = 10) and conventional blood-clot groups (n = 10). Apical width and root dimensions (length and thickness) were analyzed radiographically and statistically after 3-, 6-, and 12-month follow-up. Fifteen patients with 18 teeth (A-PRF n = 9, blood clot n = 9) completed the follow-up, and 2 patients were excluded. Patients in both groups were asymptomatic. There was a significant increase within each group in respect to root length, root thickness at one- and two-thirds, and root apex width for all timepoints. While percent of change between the two groups was statistically insignificant. Regenerative endodontic procedure for traumatized immature nonvital teeth with either conventional blood clot or A-PRF as scaffold was comparable, except in cases where adequate bleeding cannot be achieved. Advanced platelet-rich fibrin provides a suitable scaffold that can be used in REP of teeth with close proximity to vital structures such as inferior alveolar nerve (IAN) or mental nerve, where using a sharp instrument to induce bleeding can cause damage and also in cases where adequate bleeding cannot be achieved.