Use of platelet-rich plasma for regeneration in non-vital immature permanent teeth: Clinical and cone-beam computed tomography evaluation

Abstract

Objective This study was performed to assess the clinical and radiological outcomes of a revascularization procedure in immature teeth with apical periodontitis using platelet-rich plasma (PRP). The PRP protocol and conventional revascularization protocol, which used a blood clot as the scaffold, were compared. Methods Thirty non-vital immature permanent teeth were randomly categorized into two groups. After disinfecting the root canal space with triple antibiotic paste (1:1:1 ciprofloxacin, metronidazole, and cefaclor), a tissue scaffold was created using either PRP or a blood clot (control) and covered with white mineral trioxide aggregate. All cases were followed up clinically and radiographically for 12 months. Differences in bone density, root length, and lesion size were calculated using preoperative and postoperative computed tomography images. The means of the differences in individual parameters in the blood clot and PRP groups were compared using the Mann-Whitney U test. Results After 5 months, sensitivity tests (cold and electric pulp tests) elicited a delayed positive response in 23 sites. At 12 months, cone-beam computed tomography revealed resolution or a decrease in lesion size and an increase in bone density in all 30 (100%) teeth. Additionally, continued root development was observed in 22 (73%) teeth and early root growth was observed in the test group (mineral trioxide aggregate with PRP). Conclusions The results of this study suggest that PRP can serve as a successful scaffold for regenerative endodontic treatment. With the exception of a significant increase in root length, the results of treatment with PRP were not significantly different from those of the conventional protocol using a blood clot as the scaffold.

Keywords: Regenerative endodontics; blood clot; cone-beam computed tomography; immature permanent teeth; mineral trioxide aggregate; platelet-rich plasma.

Figure 1.

Preoperative cone-beam computed tomography image showing periapical radiolucencies (decreased bone density compared with adjacent normal bone) and root length measured for both the control site (blood clot) and test site (platelet-rich plasma).

Figure 2.

Postoperative cone-beam computed tomography image showing significant increase in bone density in periapical region and increase in root length of test site (mineral trioxide aggregate + platelet-rich plasma).

Figure 3.

Sagittal scan used for measurement of diameter and depth using the built-in measurement tool.

Figure 4.

Identification of mesial and distal cementoenamel junctions on axial plane using coronal view of cone-beam computed tomography image.