Aim: This randomized controlled trial evaluated the efficacy of platelet-rich fibrin (PRF) and concentrated growth factor (CGF) as scaffolds in the regenerative endodontic procedure (REP) using clinical and radiographic parameters along with cone-beam computed tomographic (CBCT) analysis.
Materials and methods: The apexogenesis procedure was performed in 16 teeth. They were randomly divided into two groups of eight teeth each: group I and group II. In group I PRF was used as the scaffold and in group II CGF was used as the scaffold. They were evaluated for pain, pulpal vitality, tenderness on percussion, and mobility, and also evaluated using digital radiographs at 3, 6, 12, and 18 months interval. The response of the teeth was graded using Chen and Chen criteria. Increase in root length, reduction in the apical foramen dimension, and reduction in periapical lesion volume were evaluated using CBCT scans taken preoperatively and at 18 months.
Results: At the end of 3 months, 50% of teeth without periapical pathology were found to be vital in both groups. At the end of 18 months, 60% of the teeth in both groups showed increase in root length, all teeth showed closure of apical foramen, and reduction in the volume of periapical lesion. However, there was no statistically significant difference between the groups (p < 0.05).
Conclusion: The clinical and radiographic features reported in this study revealed that both PRF and CGF act as effective scaffolds in REP for regeneration of pulp-dentin complex with promising results.
Clinical significance: Apexogenesis by revascularization has not been used regularly for the treatment of nonvital teeth with open apex because the results are not reliable. Since platelet concentrates like PRF and CGF are rich in growth factors; when apexogenesis is performed by REP using these platelet concentrates, desirable results can be achieved in a short duration of time. They also accelerate the healing of periapical lesions present in such cases. With the increased success rate of apexogenesis with REP, many clinicians would prefer to use REPs as a treatment option for teeth with open apex.
Andreasen JO, Ravn JJ. Epidemiology of traumatic dental injuries to primary and permanent teeth in a Danish population sample. Int J Oral Surg 1972;1(5):235–239. DOI: 10.1016/s0300-9785(72)80042-5.
Bastone EB, Freer TJ, McNamara JR. Epidemiology of dental trauma: A review of the literature. Aust Dent J 2000;45(1):2–9. DOI: 10.1111/j.1834-7819.2000.tb00234.x.
Estefan BS, El Batouty KM, Nagy MM, et al. Influence of age and apical diameter on the success of endodontic regeneration procedures. J Endod 2016;42(11):1620–1625. DOI: 10.1016/j.joen.2016.06.020.
Lovelace TW, Henry MA, Hargreaves KM, et al. Evaluation of the delivery of mesenchymal stem cells into the root canal space of necrotic immature teeth after clinical regenerative endodontic procedure. J Endod 2011;37(2):133–138. DOI: 10.1016/j.joen.2010.10.009.
Alagl A, Bedi S, Hassan K, et al. Use of platelet-rich plasma for regeneration in non-vital immature permanent teeth: Clinical and cone-beam computed tomography evaluation. J Int Med Res 2017;45(2):583–593. DOI: 10.1177/0300060517692935.
Pinto N, Harnish A, Cabrera C, et al. An innovative regenerative endodontic procedure using leukocyte and platelet-rich fibrin associated with apical surgery: A case report. J Endod 2017;43(11):1828–1834. DOI: 10.1016/j.joen.2017.07.002.
Alkofahi H, Maghaireh A, Fnaish M, et al. Application of platelet-rich fibrin as regeneration assistant in immediate auototransplantation of third molar with unformed roots: Case report and review of literature. Case Rep Dent 2020;2020:8170646. DOI: 10.1155/2020/8170646.
Lima KC, Fava LR, Siqueira JF Jr. Susceptibilities of Enterococcus faecalis biofilms to some antimicrobial medications. J Endod 2001;27(10): 616–619. DOI: 10.1097/00004770-200110000-00004.
Rizk HM, Salah Al-Deen MSM, Emam AA. Comparative evaluation of platelet rich plasma (PRP) versus platelet rich fibrin (PRF) scaffolds in regenerative endodontic treatment of immature necrotic permanent maxillary central incisors: A double blinded randomized controlled trial. Saudi Dent J 2020;32(5):224–231. DOI: 10.1016/j.sdentj.2019.09.002.
Jin R, Song G, Chai J, et al. Effects of concentrated growth factor on proliferation, migration, and differentiation of human dental pulp stem cells in vitro. J Tissue Eng 2018;9:2041731418817505. DOI: 10.1177/2041731418817505.
Roberts-Clark D, Smith AJ. Angiogenic growth factors in human dentine matrix. Arch Oral Biol 2000;45(11):1013–1016. DOI: 10.1016/s0003-9969(00)00075-3.
Adhikari HD, Gupta A. Report of a case of platelet-rich fibrin-mediated revascularization of immature12 with histopathological evaluation. J Conserv Dent 2018;21(6):691–695. DOI: 10.4103/JCD.JCD_286_18.
Bhaktiar H, Esmaeili S, Fakhr Tabatabayi SF, et al. Second – generation platelet concentrate (platelet rich fibrin) as a scaffold in regenerative endodontics: A case series. J Endod 2017;43(3):401–408. DOI: 10.1016/j.joen.2016.10.016.
Shetty H, Shetty S, Kakade A, et al. Three dimensional qualitative and quantitative analyses of the effect of periradicular lesions on the outcome of regenerative endodontic procedures: A prospective clinical study. Clin Oral Investig 2021;25(2):691–700. DOI: 10.1007/s00784-020-03583-z.
Rodella LF, Favero G, Boninsegna R, et al. TGF-beta1 and VEGF after fresh frozen bone allograft insertion in oral-maxillo-facial surgery. Histol Histopathol 2010;25(4):463–471. DOI: 10.14670/HH-25.463.
Majka M, Janowska-Wieczorek A, Ratajczak J, et al. Numerous growth factors, cytokines and chemokines are secreted by human CD34(+) cells, myeloblasts, erythroblasts, and megakaryoblasts, and regulate normal hematopoiesis in an autocrine/paracrine manner. Blood 2001;97(10):3075–3085. DOI: 10.1182/blood.v97.10.3075.
Fangfang Xu, Qiao L, Zhao Y, et al. The potential application of concentrated growth factor in pulp regeneration: An in vitro and in vivo study. Stem Cell Res Ther 2019;10(1):134. DOI: 10.1186/s13287019-1247-4.
Huan Jun, Dou Lei, Yan Qifang, et al. Effects of concentrated growth factors on the angiogenic properties of dental pulp cells and endothelial cells: An in vitro study. Braz Oral Res 2018;32:e48. DOI: 10.1590/1807-3107bor-2018.vol32.0048.
Shivashankar VY, Johns DA, Vidyanath S, et al. Platelet rich fibrin in the revitalization of tooth with necrotic pulp and open apex. J Conserv Dent 2012;15(4):395–398. DOI: 10.4103/0972-0707.101926.
Li Z, Liu L, Wang L, et al. The effects and potential applications of concentrated growth factor in dentin–pulp complex regeneration. Stem Cell Res Ther 2021;12(1):357. DOI: 10.1186/s13287-021-02446y.
Nivedhitha MS, Jacob B, Ranganath A. Concentrated growth factor: A novel platelet concentrate for revascularization of immature permanent teeth – A report of two cases. Case Rep Dent 2020;2020:1329145. DOI: 10.1155/2020/1329145.
Hong S, Chen W, Jiang B. A comparative evaluation of concentrated growth factor and platelet-rich fibrin on the proliferation, migration, and differentiation of human stem cells of the apical papilla. J Endod 2018;44(6):977–983. DOI: 10.1016/j.joen.2018.03.006.
Chen MY, Chen KL, Chen CA, et al. Responses of immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscess to revascularization procedures. Int Endod J 2012;45(3): 294–305. DOI: 10.1111/j.1365-2591.2011.01978.