Platelet-rich Fibrin Membrane Research Articles

Platelet-rich Fibrin – A Narrative Review

Abstract Platelets play a crucial role in the hemostasis and wound healing process. Platelets synthesize growth factors that activate cells such as fibroblasts, macrophages, and mesenchymal cells which are trapped within the fibrin matrix and promote wound healing. Platelet-rich fibrin (PRF) contains a human blood protein and it is composed of a tetra molecular structure with cytokines, platelets, and stem cells which act as biodegradable scaffold tissue regenerating cells. PRF is a healing biomaterial with no inflammatory reactions which can be used alone or in combination with bone grafts. This platelet gel has advantages such as promoting wound healing, bone growth and maturation, and hemostasis, and it can also be used as a membrane. PRF membrane can be used in oral, maxillofacial, ear, nose, throat, and plastic surgery. In dentistry, the biggest advantage of PRF as a membrane is that it is both autologous in nature and can be prepared chairside.

Biomaterials in endodontics: a review

Biomaterials have evolved over the past three decades and are relatively specialized, highly biocompatible, but low-strength dental materials. Bioactive materials can interact with living tissues or systems. The newly emerging bioactive category of dental materials has expanded clinical uses in restorative dentistry and endodontics. Examples of bioactive materials are Calcium Silicate containing Mineral Trioxide Aggregate (Portland cement); Calcium Silicate cements lacking aluminium and containing phosphate: Bioagrregate, iRoot SP and iRoot BP (Endosequence), Calcium Silicate cements containing predominantly Tricalcium Silicate: Bio-active Glass, Calcium Phosphate based materials: Tricalcium Phosphate, Hydroxyapatite, Calcium Phosphate cements and Calcium Aluminate based materials: GIC based luting cements; Bioactive Glass. Other biomimetic materials include Emdogain, Platelet Rich Plasma, Platelet Rich Fibrin, Bone grafts and barrier membranes. Thus, the objective of this review was to compare and review the composition, and properties of these bioactive materials in endodontics

Attached gingiva augmentation before implant placement using injectable-platelet rich fibrin and collagen membrane: A case report

The aim was to observe the gain in keratinized tissue width using apically positioned flap (APF) along with injectable- platelet rich fibrin (i-PRF) and collagen membrane. Keratinized gingiva around dental implants may enhance aesthetics, facilitate restorative procedures and plaque control. Tissue engineering materials have recently gained popularity in periodontal plastic surgeries because autogenous grafts are associated with significant patient morbidity. In the patient-centered era, minimally invasive patient friendly technique to augment keratinized gingiva should be developed. Fifty-four years old sytemically healthy female patient was referred from department of prosthodontics for keratinized gingiva reconstruction. APF along with collagen membrane soaked in i-PRF was performed and followed-up for 3 months. Keratinized tissue width increased from 1mm preoperatively to 3mm after 4 weeks of surgery. This augmented width remains stable up to 3 months of follow-up i-PRF along with collagen membrane could be a promising technique to augment keratinized gingiva.

Evaluation of root biomodification as an adjunct to platelet-rich fibrin versus amniotic membrane and coronally advanced flap in class I and class II gingival recession defects: A randomized controlled study

Evaluation of root biomodification as an adjunct to platelet-rich fibrin versus amniotic membrane and coronally advanced flap in class I and class II gingival recession defects: A randomized controlled study

Comparison of Sub-epithelial Connective Tissue Graft and Platelet Rich Fibrin in Peri-implant Soft Tissue Augmentation: A Randomized Clinical Split-mouth Study

Aims and Background: Gingival phenotype has a crucial impact on the peri-implant marginal bone stability. The aim of this clinical trial is to assess and compare the efficacy of the sub-epithelial connective tissue graft (SCTG) and platelet-rich fibrin (PRF) in improving the peri-implant soft tissue phenotype and enhancing esthetic outcomes. Materials and Methods: The present study was a split-mouth randomized controlled clinical trial. A total of ten patients who had bilateral missing teeth in the maxillary esthetic zone with a thin gingival phenotype were included in this study. For each study participant, one randomly selected site was treated with SCTG, while the other was treated with PRF membrane during dental implant placement. Treatment outcomes included the assessment of the facial gingival thickness using cone-beam computed tomography (CBCT) at the baseline (T0) and 6 months postoperatively (T1), and the Pink esthetic score (PES) at T1 and 3 months later after prosthesis placement (T2). Results and Discussion: Both treatment options resulted in a significant increase in gingival tissue thickness at T1 compared with T0, and in PES at T2 compared with T1 (p ˂ 0.05). Conclusion: PRF is an effective alternative to SCTG in augmenting peri-implant soft tissue phenotype and improving esthetic outcomes. This would help overcome the complications associated with harvesting the SCTG and increasing patients’ satisfaction. Clinical Trial Registration ID: ISRCTN11961919.

Management of mucosal fenestration using Platelet Rich Fibrin membrane following root resection.

Mucosal fenestration associated with maxillary first molar is rare but challenging to treat when there is loss of marginal bone along with buccally oriented root angulation. The exposed root within the oral cavity along with large mucosal defect makes it susceptible to plaque accumulation and infection. This case report showcases the management of mucosal fenestration associated with mesiobuccal root of Left Maxillary first molar by root resection and Platelet rich fibrin membrane.

Radiological Comparative Study Between Conventional and Nano Hydroxyapatite With Platelet-Rich Fibrin (PRF) Membranes for Their Effects on Alveolar Bone Density.

The entry of the concept of nanotechnologies into the field of biomaterials has improved the results of their use in regenerative therapies based on the principles of tissue engineering, due to its improvement of the physical properties of materials manufactured in this way, so it has become possible to produce particles of hydroxyapatite in nano sizes. This study will evaluate the efficacy of applying nanohydroxyapatite paste and platelet-rich fibrin (PRF) as a barrier membrane in comparison with traditionalhydroxyapatite (a powder consisting of macro-sized particles) and PRF as a barrier membrane in symmetrically extracted alveoli of the mandible. The research sample consisted of 40 lower alveoli (symmetrical) of the extracted teeth. The study samples were divided randomly into two groups. Group 1: A paste of nanohydroxyapatite with PRF as a barrier membrane was applied to one side of the extraction. Group 2: Hydroxyapatite powder with PRF as a barrier membrane was applied to the alveolus from the opposite side of Group 1 (the opposite side of the extraction). Three radiographs were performed by cone beam conventional tomography (CBCT) in three consecutive periods to conduct the radiological study (T0: immediately after extraction and grafting, T1: after three months, T2: after six months). The mean of the radiographic bone density of the hydroxyapatite powder group at time T0 is 824.36 HU with a standard deviation of ±277.29 HU, and at time T1 is 1119.93 HU with a standard deviation of ±306.93 HU, and at time T2 is 1074.14 HUwith a standard deviation of ±223.62 HU, with statistically significant differences when comparing the amount of change in radiographic bone density at time T0 and T1 withP < 0.05, and at time T0 and T2 with P < 0.05, but there were no significant differences when comparing the amount of change in radiographic bone density in T1 and T2 times with P > 0.05. The mean radiographic bone density of the nanohydroxyapatite paste group at time T0 is 629.88 HU with a standard deviation of ±193.64 HU, and at time T1 is 960.67 HU with a standard deviation of ±256.88 HU, and at time T2 is 743.87 HU with a standard deviation of ±180.96 HU, and in the time T0 and T1 with P < 0.05, and in the time T0 and T2 with P < 0.05, and in the time T1 and T2 with P < 0.05. Statistically, significant differences have been found between bone density change T1, T2in the nanohydroxyapatite paste group and bone density change T1, T2in the hydroxyapatite powder group P<0.05, which expresses a greater loss of density in the nanohydroxyapatite group, and thus the resorption of the bone graft and the placement of new bone tissue. Within the limits of our study, the results demonstrated that the use of traditional hydroxyapatite powder and nanohydroxyapatite paste increases the radiographic bone density, nanohydroxyapatite paste has a greater absorbency after 3 months compared with traditional hydroxyapatite powder which helps replace it by natural bone tissue.

Platelet-rich fibrin (PRF) graft and amniotic membrane graft on transforming growth factor-β (TGF-β) and type 1 collagen post conjunctival excision

Background: Conjunctiva, when injured, can heal spontaneously. However, in extensive wounds, wound healing is often accompanied by scarring and wound contraction. Currently, for cases of disease and trauma to the surface of the eyeball, it can be reconstructed using the amniotic membrane, but there are still weaknesses in the use of amnion. Platelet-rich fibrin (PRF) is currently being developed for the reconstruction of ocular surface wounds. Methods: A total of 20 male New Zealand rabbits (20 eyes) were divided into two groups. In the first group, conjunctival excision and PRF membrane graft suturing were performed on the right eye conjunctival defect, while the second group had an amniotic membrane sutured on the right eye conjunctival defect. On the 14th day, enucleation was carried out and continued with histopathological examination using immunohistochemistry using TGF antibodies and type 1 collagen to evaluate the levels of TGF and type 1 collagen in the conjunctiva. Results: The results after 14 days of treatment showed that there was a very significant difference in TGF Beta expression between the AMT group and the PRF group (p = 0.007*; &lt;0.05). However, in the expression of type 1 collagen, there was no significant difference in the expression of type 1 collagen between the AMT group and the PRF group (p = 0.791; &gt;0.05). Conclusion: There were differences in the expression of TGF-β and type 1 collagen in the administration of the PRF membrane compared to the administration of the amniotic membrane after conjunctival excision of experimental male New Zealand rabbits on day 14.

Comparison of Sub-epithelial Connective Tissue Graft and Platelet Rich Fibrin in Peri-implant Soft Tissue Augmentation: A Randomized Clinical Split-Mouth Study

Aims and Background: Gingival phenotype has a crucial impact on the peri-implant marginal bone stability. The aim of this clinical trial is to assess and compare the efficacy of the sub-epithelial connective tissue graft (SCTG) and platelet-rich fibrin (PRF) in improving the peri-implant soft tissue phenotype and enhancing esthetic outcomes. Material and Methods: The present study was a split-mouth randomized controlled clinical trial. A total of ten patients who had bilateral missing teeth in the maxillary esthetic zone with a thin gingival phenotype were included in this study. For each study participant, one randomly selected site was treated with SCTG while the other was treated with PRF membrane during dental implant placement. Treatment outcomes included the assessment of the facial gingival thickness using cone-beam computed tomography (CBCT) at the baseline (T0) and 6 months postoperatively (T1), and the Pink esthetic score (PES) at T1 and 3 months later after prosthesis placement (T2). Results and discussion: Both treatment options resulted in a significant increase in gingival tissue thickness at T1 compared with T0, and in PES at T2 compared with T1 (p ˂ 0.05). Conclusion: PRF is an effective alternative to SCTG in augmenting peri-implant soft tissue phenotype and improving the esthetic outcomes. This would help overcome the complications associated with harvesting the SCTG and increasing patients’ satisfaction.

COMPARATIVE CLINICAL, RADIOGRAPHICAL AND HISTOLOGICAL EVALUATION OF CORONAL PULPOTOMY TECHNIQUE WITH PRF AND A NOVEL CROSSLINKED PRF AS AN ALTERNATIVE TO PULPECTOMY FOR PRESERVING THE TOOTH VITALITY IN CONTEXT OF TISSUE ENGINEERING.

Background: Removal of infected pulp tissue from the coronal portion leads to preservation of a remaining vital and functioning pulp. Preservation of pulp vitality by pulpotomy is one of the universally accepted treatment procedure with the aid of latest bioactive materials leading to a more conservative approach in the management of teeth involving the pulp based on clinical conditions To comparatively evaluate the . Aim: clinical and radiological and histological outcome of platelet-rich brin (PRF) and the novel crosslinked PRF (C-PRF) developed by us as pulpotomy agent in context of tissue engineering in permanent teeth. 20 permanent mol Materials and Methods: ar teeth from 20 healthy patient aged 18-40 years with permanent molar teeth cariously exposed pulps and diagnosed clinically as irreversible pulpitis were selected for the study. Written consent from the patients was taken. The patients were then randomly divided into 2 groups (n=10) . One group received PRF pulpotomy anther group received our novel crosslinked PRF (C-PRF) pulpotomy. In all patients coronal pulp was removed after preparation of the access cavity with rubber dam under Lignocaine 2 % local anaesthesia. After hemostasis, exposed pulps were covered using PRF membrane with Biodentine or C-PRF with Biodentine, and then all teeth were restored with glass-ionomer cement. Clinical and radiographic evaluation was undertaken at 1 day, 3month and 6 months intervals. The results were analyzed using appropriate statistical tests. After around six months one case of each group third molar teeth was extracted due to positional problem and causation of cheek ulceration. Histological examination of the extracted teeth was done. Statistical Analysis was performed with he Results: lp of Epi Info (TM) 7.2.2.2 EPI INFO is a trademark of the Centers for Disease Control and Prevention (CDC). Test of proportion was used to nd the Standard Normal Deviate (Z) to compare the difference proportions. p&lt;0.05 was taken to be statistically signicant. C-PRF could improve the prognosis Conclusion: of pulpotomy procedures of mature permanent

The impact of gender and peripheral blood parameters on the characteristics of L-PRF membranes.

The purpose of this study was to evaluate the impact of gender and peripheral blood parameters on the characteristics of Leucocyte-and Platelet-Rich Fibrin (L-PRF) membranes and to describe histologically three different zones of L-PRF membranes. Blood was collected from twenty healthy donors (10 men and 10 women). Peripheral blood parameters including leucocyte and platelet counts, and fibrinogen levels were recorded. L-PRF membranes were prepared to quantify the release of growth factors (PDGF, VEGF, BMP-2, and BMP-9) at 1, 2, 3 and 7 days and for histological examination. Three zones within each L-PRF membrane (face, body, and tail) were analysed separately, quantifying the area of leucocytes, platelets, and fibrin in percentage. The Young's modulus of the membranes was also considered (during tensile and compression tests). Women had significantly higher fibrinogen levels in their peripheral blood, and a higher release of BMP-9, whereas men showed a significantly higher Young's modulus in compression tests. The histology revealed significant differences in cellular content and fibrin concentration between the 3 areas, with the face being biologically the richest. Several factors influenced the final characteristics of L-PRF membranes. These need to be taken into consideration when interpreting the results of research, but especially in clinical practice.

Does the diabetes status of an individual have effects on mechanical and biologic properties of platelet-rich fibrin? An in vitro comparative evaluation.

Clinical research in the field of regeneration presents challenges for regulating inflammation and speeding up healing and regenerative processes, which are lacking in individuals with diabetes. Platelet-rich fibrin (PRF) has shown promising results in regeneration. Variations in its properties are attributed mainly to the centrifugation method and other parameters. Hence, the present in vitro study on leukocyte-PRF (L-PRF) and advanced-PRF (A-PRF) membranes, with varying protocols amongst diabetes, was conducted. Sixty-four PRF membranes from 30 individual's venous blood samples (16 nondiabetic and 16 diabetic) were assessed for platelet parameters, tensile strength, strain, and growth factor release. The resulting data were statistically analyzed. The A-PRF membrane had better tensile strength, strain, and growth factor level in comparison with the L-PRF membrane in healthy individuals. Significantly (P < .05) higher strain and growth factor levels in the A-PRF membrane and marginally higher tensile strength in the L-PRF membrane were seen in diabetic individuals. The nondiabetic A-PRF membrane had better tensile strength, strain, and growth factor release. Well-controlled diabetic individuals had higher growth factor release, suggesting the use of A-PRF membrane as a suitable autogenous regenerative material.

Histopathological study to determine the effects of platelet rich fibrin membrane crafting on skin healing compared with MEBO scar ointment in rabbit

The present study aimed to compare between the use of platelet rich fibrin membrane (PRFM) and MEBO scar ointment for cutaneous wound healing as a model treatment. For this reason, forty two local breed rabbits have been divided into four groups, the first three groups were subjected to full thickness skin wound using biopsy punch instrument (diameter 8 mm) on the dorsal thoracic side. Rabbits in the first group leaved without treatment, while in the second group we planted the PRFM in biopsy site, the third group treated with MEBO scar ointment. Wound healing process was observed grossly and microscopically at day 3, 7, 10 and 12 post operation. All groups showed normal healing process with competitive advantage to PRFM and MEBO groups respectively compared with untreated group, PRFM was better than the MEBO group, the advantage characterized by less inflammatory reaction, fast reepitheliazation, granulation tissue formation, fibroplasias and angiogenesis.

Promenade to enhanced aesthetics: Gingival recession coverage in combination of modified coronally advanced tunnel technique with T-PRF, A case report

A dentist's top priority is aesthetics, and one of the primary interest in aesthetic dentistry is recession coverage. A unique therapy option for a variety of mucogingival abnormalities with variable results is platelet rich fibrin membrane. Due to rising cosmetic demand, treating gingival recession has become a significant therapeutic issue. There have been several surgical procedures designed to achieve consistent cosmetic root coverage. In more detail, the purpose of periodontal regeneration surgery is to complete wound healing and periodontal unit regeneration Recent advancements in dentistry include the preparation and use of a concentrated solution of the growth factors found in platelets is termed platelet-rich fibrin (PRF). These growth factors contribute to Postulated as promoters of tissue regeneration and wound healing.

Effect of platelet-rich fibrin (PRF) membranes on the healing of infected skin wounds.

Tissue engineering focuses on wound healing and tissue regeneration. Platelet-rich fibrin (PRF) is a fibrin matrix containing cytokines, growth factors and cells that are gradually released into the wound over time. This study aimed to evaluate the effect of PRF membranes on wound repair and microbial control in infected wounds. Skin wounds were performed on the dorsum of rats using a 6mm diameter metal punch. The defects were randomly assigned into four groups (n = 12/each) accordingly to the treatment: G1, noninfected wound filled only with clot; G2, noninfected wound with PRF; G3, infected wound (S. aureus) without PRF; G4, infected wound (S. aureus) with PRF. After 7 and 14days, macroscopic and histological analyses of the wounds were performed. Furthermore, the quantification of β-defensin in PRF was measured by ELISA. At 14days, the groups with PRF (G2 and G4) had wound sizes significantly smaller than the original defects (6mm) (p < 0.05) and significantly smaller than those not treated with PRF, in both the infected and noninfected groups (p < 0.05). Furthermore, the groups with infected wounds (G3 and G4) demonstrated a significantly lower inflammation score in the PRF group than in the noninfected groups (p < 0.05). In vitro analysis of β-defensin was performed in all PRF membrane groups, and the median value was 1.444pg/mL. PRF in the wounds of both control and infected rats played an important role in the modulation of tissue healing, most notably in infected sites.

Atraumatic Extraction Followed By Immediate Implant Placement In An Infected Tooth Socket: A Clinical And Radiographic Study

Aim and Objectives: The present study was undertaken to assess success rate of immediately placed implant in infected dento- alveolar sockets with simultaneous placement of PRF gel in the horizontal gap between implant and bone, PRF membrane covering implant using a two stage protocol. Methods : Implants were immediately placed in 12 patients following a 2-stage submerged protocol. The extraction sockets were irrigated with tetracycline solution. PRF was used to fill the gap between the implant body and the surrounding socket wall. The final restoration was placed after 3-months following implant placement. The modified plaque index (MPI) and modified bleeding index (MPI) were measured at baseline and 3 months. Vertical and horizontal bone loss was measured at baseline, 6 and 9 months using IOPA with grid scale. Result : The mean FMPI score was 0.35±0.03 and at 6 months it was 0.25±0.03. At 9 months follow up, the FMPI was slightly increased as compared to the baseline, but the increase was not significant. The mean horizontal bone level at mesial surface of implant at baseline was 0.20±0.25mm, at 9 months it was increased to 0.25±0.26mm at mesial surface. Immediate implants with placement of PRF in infected extraction socket, as a 2 stage protocol resulted in horizontal alveolar bone crest resorption of 0.26mm and 0.3 mm on the mesial and distal surface of implant respectively. Conclusion : Atraumatic extraction followed by placement of implant in infected socket with placement of PRF and implant covered by PRF membrane resulted in 100% survival rate. Clinical and radiographic data after 3 months of loading showed that peri- implant tissue was healthy and marginal bone resorption values were minimal around implants.

The use of an autologous platelet-rich fibrin (PRF) membrane for the treatment of deep corneal ulcers in dogs

The aim of this study was to evaluate the clinical efficacy of a platelet-rich fibrin (PRF) membrane, which is considered to be a new alternative surgical method in the treatment of vision-threatening corneal ulcers in dogs. Fourteen dogs (17 eyes) of various breeds and ages with deep corneal ulcers were treated surgically with a PRF membrane transplantation. The corneal ulcer of all the patients was closed with an autologous platelet-rich fibrin membrane. In the first 10 days after the operation, it was observed that the fibrin membrane partially melted, and corneal epithelialization and granulation tissue occurred in and around the ulcer area due to the graft material. Pain was significantly relieved, and conjunctival inflammation was noticeably improved. From the 20th day after the surgery, the granulation tissue was gradually cleaned. It was determined that all the eyes had vision. The most common complications after surgery were corneal pigmentation and fibrosis of varying severity. The use of autologous fibrin membranes is a safe and effective surgical alternative for the closure and healing of corneal ulcers. Our findings show that the autologous platelet-rich fibrin membrane is useful and effective in treating canine corneal deep ulcers.

Assessment of Bone Density around Dental Implants Using Two Platelet-Rich Fibrin Protocols (A Comparative Clinical Study)

Aims: The current study aimed to compare bone density means around dental implants covered with one of two platelet rich fibrin preparation protocols (Standard-Platelet Rich Fibrin and Advanced-Platelet Rich Fibrin) using standard intraoral digital periapical radiographs. Materials and methods: A total of ten male patients with an age range of 28-51 years participated in this split-mouth clinical study. The patients were divided into two groups based on the platelet rich fibrin (PRF) protocol to be used with dental implant insertion into positive control (S-PRF) and study group (A-PRF). Each patient represented the two groups in which he received 2 dental implants; ten implants for each group (a total of 20 dental implants) of standard length and diameter in the posterior mandibular extraction sites of ipsilateral or contralateral side. In the positive control group, the standard PRF protocol was to be used to prepare the PRF clot. In the study group, the advanced PRF protocol was to be used to prepare the PRF clot. Both PRF membranes were to be instilled inside the osteotomy bed during dental fixture installation. Following the installation of dental implants and as a basis for comparison between both groups, densitometric analysis of bone around dental implants at immediate, four, eight and twelve weeks scheduled visits were made. Results: Total densitometric analysis results showed no significant difference within S-PRF group, within A-PRF group and between both groups, with the highest mean (167.07) being at twelve weeks after surgery in the A-PRF group. Conclusions: Both S-PRF and A-PRF, similarly enhanced and maintained bone density (synergistic effect) throughout the of study and as disclosed by densitometric values. The use of PRF in its current forms seems to be an accepted minimally invasive approach with good clinical results.

Onlay platelet-rich fibrin membrane versus free gingival graft in increasing the width of keratinized mucosa around dental implants: A split-mouth randomized clinical study.

Background. This study aimed to compare the use of the platelet-rich fibrin membrane (PRF) versus the free gingival graft (FGG) during the second stage of the dental implant to increase the amount of keratinized mucosa around dental implants. Methods. Fifteen patients with bilaterally missing teeth and deficient width of the keratinized mucosa (KM) were recruited for a spit-mouth randomized controlled trial. After implant placement on the control sides, onlay FGG was used, whereas, on the other side (study side), onlay PRF membranes were applied to augment the KM. One month and three months after augmentation, the increase in keratinized mucosa width, bone level around the implants, and soft tissue health were evaluated and compared. The shrinkage percentage was also calculated for both grafts. Results. There was a significant increase in the width of KM in the FGG and PRF groups; however, it was observed that FFG resulted in significantly better results than PRF, with no significant difference in peri-implant soft tissue health or bone level. Conclusion. Within the limitations of this study, it was concluded that the onlay PRF membrane could increase the keratinized mucosa width around dental implants with the advantages of a lower surgical time and less postoperative discomfort and pain for the patients in comparison to the FGG. However, FGG had a significantly higher ability to augment and increase keratinized mucosa around dental implants.

MANAGEMENT OF RADICULAR CYST IN FAMILIAL HYPOPHOSPHATEMIC RICKETS USING LEUKOCYTE- AND PLATELET-RICH FIBRIN MEMBRANE

Familial hypophosphatemic rickets (FHR) substantially affects the process of bone remodeling. A 17-year-old male patient with FHR was seen in dental service complaining of mobility of tooth 11. The patient had suffered a trauma in the anterior region of the maxilla 3 years ago. He had received adequate immediate treatment but did not return for follow-up consultations. Clinically, he presented crown darkening and tooth mobility. Radiographically, a well-defined unilocular lesion of 2 cm was observed, suggestive of a periapical cyst. Paraendodontic surgery was performed to remove the root fragments and the lesion, followed by the local application of leukocyte- and platelet-rich fibrin membrane. Histopathologic examination confirmed the diagnosis of periapical cyst. A satisfactory bone repair was observed after 10 months. This case report highlights the importance of alternative surgical therapies in challenging conditions, such as patients with FHR.