A comparative evaluation of Advanced Platelet-Rich Fibrin (A-PRF) and Platelet-Rich Fibrin (PRF) as a Scaffold in Regenerative Endodontic Treatment of Traumatized Immature Non-vital permanent anterior teeth: A Prospective clinical study

Abstract

Background: Regenerative endodontic treatment (RET) is a promising treatment alternative for traumatized immature non-vital teeth. Advanced platelet-rich fibrin (A-PRF) contains significantly more growth factors than Platelet-rich fibrin (PRF) and has not been evaluated as a scaffold in RET. The aim of the present study was to evaluate and compare A-PRF and PRF as scaffolds in the RET concerning periapical healing, and root development of traumatized immature non-vital teeth.

Material and methods: In the present study, RET was performed on 30 traumatized immature non-vital maxillary incisors in 28 patients aged between 8-27 years. Minimal mechanical debridement and irrigation with 1.5% sodium hypochlorite and 17% ethylenediaminetetraacetic acid was performed. Canals were disinfected using modified triple antibiotic paste consisting of ciprofloxacin, metronidazole and cefaclor. Based on the type of scaffold, teeth were randomly assigned into A-PRF (n=15) and PRF groups (n=15). Periapical healing, apical response and quantitative root dimensions (length and thickness) were analyzed radiographically after 12 months follow-up.

Results: Nineteen patients with 21 teeth (A-PRF n=11, PRF n=10) completed the follow-up and 9 patients were excluded. Clinically, patients in both the groups were asymptomatic. The survival rates for A-PRF and PRF were 78.5% and 77.5%, respectively. No statistically significant differences were detected between A-PRF and PRF regarding periapical healing and type of apical response (p& 0.05). The difference in the pre-operative and follow-up root thickness and root length in both A-PRF and PRF groups were statistically significant (p< 0.05).

Conclusions: Based on short-term results of 13 months, both A-PRF and PRF can be used as scaffold in regenerative endodontic treatment of traumatized immature non-vital teeth. A-PRF could be recommended in such cases since it yielded more root dentin thickness which is crucial for reinforcing immature teeth. Key words:Regenerative endodontic treatment, dental trauma, Non-vital teeth, immature teeth, platelet-rich fibrin, advanced platelet-rich fibrin.

Figure 1

Radiographic root measurement methods, using ImageJ software. (A) Root length measurement (B) pulp space width measurement, and (C) total root width measurement. The root thickness was determined subtracting pulp space width from the total root width.

Figure 2

Formula.

Figure 3

Study flow diagram.

Figure 4

Pre-operative radiographs with periapical lesion and immature apex (A,B and C for A-PRF and D,E and F for PRF) and final follow-up respective radiographs (G,H and I for A-PRF and J, K and L for PRF). (G) #21, A-PRF treated, 20-year-old male with a 16-month follow-up shows periapical healing with increased root thickening and root maturation. (H) #21, A-PRF treated, 17-year-old male with 17-months follow-up shows periapical healing with no significant continuation of root development. (I) #21, A-PRF treated, 12-year-old male, a 15-months follow-up reveals periapical healing with closed root apex (J) #11, PRF treated, 12-years-old male with 12 months follow-up, minimal periapical healing with thickening of canal walls and continued root maturation (K) #11, PRF treated, 17-year-old, male with 12-months follow-up, periapical healing and root apex closed (L) #21, PRF-treated, 8-year-old female, 12 months follow-up, periapical healing with root apex closed.