Citation Information :
Singh A, Shah A, Raman N, Ramola V, Gupta P, Gupta S. Comparison between Different Combinations of Alendronate, Platelet-rich Fibrin, Hydroxyapatite in Bone Regeneration in Endodontic Surgeries Using Cone-beam Computed Tomography. J Contemp Dent Pract 2022; 23 (3):337-342.
Aim: To compare different combinations of alendronate, platelet-rich fibrin (PRF), and hydroxyapatite in bone regeneration in endodontic surgeries using cone-beam computed tomography (CBCT).
Methods and subjects: During this study, 28 patients were selected who were found to have pathology in the periapical area in the anterior region. The study subjects were categorized into four categories, each consisting of seven subjects. Category one—there was no placement of any material; category two—PRF; category three—hydroxyapatite along with PRF; category four—alendronate along with PRF. Root canal treatment followed by endodontic surgery in each patient was carried out. Volumetric analysis of the lesions was carried out before surgery and 12 months after surgery using CBCT. Analysis of variance (ANOVA) test and Tukey post-hoc test were used for statistical analysis.
Results: There was a maximum change in the volume of lesions in the study subjects in which PRF was used along with hydroxyapatite in comparison to other combination of materials. There was no significant difference when PRF was placed along with alendronate in comparison to study subjects when PRF was placed alone. The difference was not significant when PRF was placed in defects of bone in comparison to study subjects when no materials were placed in the defects of bone.
Conclusion: It can be concluded from the current research that PRF along with hydroxyapatite is a better option for the healing of defects of bone in surgeries performed in the area around the root apex in endodontic patients. But further studies should be carried out with a large sample size and for a longer duration.
Clinical significance: It is a very important consideration that there should be healing of the lesion after surgery around the root apex by actual bone regeneration. The healing of the larger lesions does not take place easily as compared with the lesions having a small size. This is because there is healing by secondary intention where there is formation of scar instead of actual healing by formation of bone. There are several methods by which proper bone regeneration can be obtained.
Tsesis I, Rosen E, Taschieri S, et al. Outcomes of surgical endodontic treatment performed by a modern technique: An updated meta-analysis of the literature. J Endod 2013;39:332–339. PMID: 23402503.
Melcher AH. On the repair potential of periodontal tissues. J Periodontol 1976;47:256–260. PMID: 775048.
Çaliskan MK, Tekin U, Kaval ME, et al. The outcome of apical microsurgery using MTA as the root-end filling material: 2- to 6-year follow-up study. Int Endod J 2016;49:245–254. PMID: 25819748.
Peñarrocha M, Martí E, García B, et al. Relationship of periapical lesion radiologic size, apical resection, and retrograde filling with the prognosis of periapical surgery. J Oral Maxillofac Surg 2007;65:1526–1529. PMID: 17656278.
Tiwari UO, Chandra R, Tripathi S, et al. Comparative analysis of platelet.rich fibrin, platelet-rich fibrin with hydroxyapatite and platelet-rich fibrin with alendronate in bone regeneration: A cone-beam computed tomography analysis. J Conserv Dent 2020;23:348–353. DOI: https://www.jcd.org.in/text.asp?2020/23/4/348/307140.
Hiremath H, Motiwala T, Jain P, et al. Use of second-generation platelet concentrate (platelet-rich fibrin) and hydroxyapatite in the management of large periapical inflammatory lesion: A computed tomography scan analysis. Indian J Dent Res 2014;25:517–520. PMID: 25307920.
Pradeep K, Kudva A, Narayanamoorthy V, et al. Platelet-rich fibrin combined with synthetic nanocrystalline hydroxy apatite granules in the management of radicular cyst. Niger J Clin Pract 2016;19:688–691. PMID: 27538563.
Knapen M, Gheldof D, Drion P, et al. Effect of leukocyte- and platelet-rich fibrin (L-PRF) on bone regeneration: A study in rabbits. Clin Implant Dent Related Res 2015;7:34–45. PMID: 24004245.
Kruse C, Spin-Neto R, Wenzel A, et al. Cone beam computed tomography and periapical lesions: A systematic review analysing studies on diagnostic efficacy by a hierarchical model. Int Endod J 2015;48:815–828. PMID: 25283541.
Jang JW, Yun JH, Lee KI, et al. Osteoinductive activity of biphasic calcium phosphate with different rhBMP-2 doses in rats. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;113:480–487. PMID: 22676929.
Ahlowalia MS, Patel S, Anwar HM, et al. Accuracy of CBCT for volumetric measurement of simulated periapical lesions. Int Endod J 2013;46:538–546. PMID: 23216253.
Reddy GT, Kumar TM, Veena KM. Formulation and evaluation of Alendronate Sodium gel for the treatment of bone resorptive lesions in Periodontitis. Drug Deliv 2005;12:217–222. PMID: 16044536.
Patel S, Durack C, Abella F, et al. European Society of Endodontology. European Society of Endodontology position statement: The use of CBCT in endodontics. Int Endod J 2014;47:502–504. PMID: 24815882.
Angeramea D, DeBiasib M, Kastriotia I, et al. Application of platelet-rich fibrin in endodontic surgery: A pilot study. GiornaleItaliano Endodonzia 2015;29:51–57.
Monga P, Grover R, Mahajan P, et al. A comparative clinical study to evaluate the healing of large periapical lesions using platelet-rich fibrin and hydroxyapatite. Endodontology 2016;28:27–31.
Liang YH, Jiang L, Gao XJ, et al. Detection and measurement of artificial periapical lesions by cone-beam computed tomography. Int Endod J 2014;47:332–338. PMID: 23815501.
Gupta J, Gill AS, Sikri P. Evaluation of the relative efficacy of an alloplast used alone and in conjunction with an osteoclast inhibitor in the treatment of human periodontal infrabony defects: A clinical and radiological study. Indian J Dent Res 2011;22:225–231. PMID: 21891890.
Orstavik D. Time-course and risk analyses of the development and healing of chronic apical periodontitis in man. Int Endod J 1996;29:150–155. PMID: 9206419.
Tiselius HG, Ackermann D, Alken P, et al. Guidelines on urolithiasis. Eur Urol 2001;40:362–371. DOI: 10.1159/000049803. PMID: 11713390.
van der Borden WG, Wang X, Wu MK, et al. Area and 3-dimensional volumetric changes of periapical lesions after root canal treatments. J Endod 2013;39:1245–1249. PMID: 24041385.
Shivashankar VY, Johns DA, Vidyanath S, et al. Combination of platelet rich fibrin, hydroxyapatite and PRF membrane in the management of large inflammatory periapical lesion. J Conserv Dent 2013;16:261–264. PMCID: PMC3698593. PMID: 23833463.
Li F, Jiang P, Pan J, et al. Synergistic application of platelet-rich fibrin and 1% alendronate in periodontal bone regeneration: A meta-analysis. Hindawi Biomed Res Int 2019;4:1–12. PMCID: PMC6720370. PMID: 31531371.
Dutra BC, Oliveira AM, Oliveira PA, et al. Effect of 1% sodium alendronate in the non-surgical treatment of periodontal intraosseous defects: A 6-month clinical trial. J Appl Oral Sci 2017;25:310–317. PMCID: PMC5482254. PMID: 28678950.
Patel S, Wilson R, Dawood A, et al. The detection of periapical pathosis using periapical radiography and cone beam computed tomography-part 1: Pre-operative status. Int Endod J 2012;45:702–710. PMID: 22188219.
Patel S, Wilson R, Dawood A, et al. The detection of periapical pathosis using digital periapical radiography and cone beam computed tomography-part 2: A 1-year post-treatment follow-up. Int Endod J 2012;45:711–723. PMID: 22775142.
Estrela C, Bueno MR, Azevedo BC, et al. A new periapical index based on cone beam computed tomography. J Endod 2008;34:1325–1331. PMID: 18928840.
Fike JW. Assessment of Changes in the Size of Periapical Radiolucencies 3-12 Months Post Non-Surgical Root Canal Treatment using CBCT Imaging: A Pilot Study. Virginia Commonwealth University; 2016. DOI: https://doi.org/10.25772/QY9X-ZQ05.
D'Addazio PS, Carvalho AC, Campos CN, et al. Cone beam computed tomography in Endodontics. Int Endod J 2016;49:311–312. doi: 10.1111/iej.12600. PMID: 26849487.