International Journal of Clinical Pediatric Dentistry

Register      Login

VOLUME 12 , ISSUE 4 ( July-August, 2019 ) > List of Articles

RESEARCH ARTICLE

Regenerative Endodontic Treatment of Bilateral Necrotic Immature Permanent Maxillary Central Incisors with Platelet-rich Plasma versus Blood Clot: A Split Mouth Double-blinded Randomized Controlled Trial

Keywords : Blood clot, Immature permanent necrotic maxillary bilateral central incisors, Platelet-rich plasma, Regenerative endodontic treatment

Citation Information : Regenerative Endodontic Treatment of Bilateral Necrotic Immature Permanent Maxillary Central Incisors with Platelet-rich Plasma versus Blood Clot: A Split Mouth Double-blinded Randomized Controlled Trial. Int J Clin Pediatr Dent 2019; 12 (4):332-339.

DOI: 10.5005/jp-journals-10005-1656

License: CC BY-NC 4.0

Published Online: 01-12-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Abstract

Aim: Clinical and radiographic assessment of the regenerative potential of bilateral immature permanent maxillary central incisors with necrotic pulps using blood clot (BC) and platelet-rich plasma (PRP) scaffolds. Trial design: This is a split mouth double-blinded parallel randomized controlled clinical trial. Subjects and methods: Randomization and blinding: the study started with 15 patients with bilateral maxillary immature permanent central incisors with necrotic pulp. The two upper bilateral central incisors were randomly assigned to either the control (BC scaffold) group I or examined (PRP scaffold) group II. Participant: 13 patients aged 8–14 years fulfilled the study requirements. A follow-up was done for 3, 6, 9, and 12 months. Standardized radiographs were collected during the follow-up period, and radiographic changes were measured using Image J software. Primary outcome measured were clinical: pain, mobility, swelling, and sinus/fistula. Radiographic outcome included increased root length and increase in root thickness. Secondary outcomes were clinical: discoloration and sensibility test. Radiographic outcome included an increase in bone density measurements and a decrease in apical diameter. Standardized radiographs were collected during the follow-up period, and radiographic changes were measured using Image J software. Results: All 26 treated teeth survived during the 12-month follow-up period with 100% success rate. PRP-treated teeth showed a statistically significant increase in radiographic root length, width, periapical bone density, and a decrease in apical diameter when compared with BC. At the end of 12 months, all treated teeth did not respond to the sensibility test. BC displayed a significantly higher amount of crown discoloration compared to the PRP group. Conclusion: For necrotic immature teeth, regenerative endodontic treatment using PRP is a desirable alternative to BC and shows excellent 12-months prognosis.


PDF Share
  1. Cvek M. Prognosis of luxated non-vital maxillary incisors treated with calcium hydroxide and filled with gutta-percha. A retrospective clinical study. Endo Dent Traumat 1992;8(2):45–55. DOI: 10.1111/j.1600-9657.1992.tb00228.x.
  2. Andreasen J, Farik B, et al. Long-term calcium hydroxide as a root canal dressing may increase risk of root fracture. Dent Traumat 2002;18(3):134–137. DOI: 10.1034/j.1600-9657.2002.00097.x.
  3. Simon S, Rilliard F, et al. The use of mineral trioxide aggregate in one-visit apexification treatment: a prospective study. Int Endo J 2007;40(3):186–197. DOI: 10.1111/j.1365-2591.2007.01214.x.
  4. Holden D, Schwartz S, et al. Clinical outcomes of artificial root-end barriers with mineral trioxide aggregate in teeth with immature apices. J Endo 2008;34(7):812–817. DOI: 10.1016/j.joen.2008.04.003.
  5. Murray P, Garcia-Godoy F, et al. Regenerative endodontics: a review of current status and a call for action. J Endo 2007;33(4):377–390. DOI: 10.1016/j.joen.2006.09.013.
  6. Verma P, Fouad A. What is the Public Health Need for Regenerative Endodontics? J Endo 2012;38(3):47.
  7. Shah N, Logani A, et al. Efficacy of Revascularization to Induce Apexification/Apexogensis in Infected, Nonvital, Immature Teeth: A Pilot Clinical Study. J Endod 2008;34(8):919–925. DOI: 10.1016/j.joen.2008.05.001.
  8. Marx RE, Carlson ER. Platelet-rich plasma: Growth factor enhancement for bone grafts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;85(6):638–646. DOI: 10.1016/S1079-2104(98)90029-4.
  9. Cotti E, Mereu M, et al. Regenerative treatment of an immature, traumatized tooth with apical periodontitis: report of a case. J Endo 2008;34(5):611–616. DOI: 10.1016/j.joen.2008.02.029.
  10. Jung IY, Lee SJ, et al. Biologically based treatment of immature permanent teeth with pulpal necrosis: a case series. J Endo 2008;34(7):876–887. DOI: 10.1016/j.joen.2008.03.023.
  11. Chueh L, Ho Y, et al. Regenerative endodontic treatment for necrotic immature permanent teeth. J Endo 2009;35(2):160–164. DOI: 10.1016/j.joen.2008.10.019.
  12. Petrino J, Boda K, et al. Challenges in regenerative endodontics: a case series. J Endo 2010;36(3):536–541. DOI: 10.1016/j.joen.2009. 10.006.
  13. Torabinejad M, Faras H. A clinical and histological report of a tooth with an open apex treated with regenerative endodontics using platelet-rich plasma. J Endo 2012;38(6):864–868. DOI: 10.1016/j.joen.2012.03.006.
  14. Soares A, Lins FF, et al. Pulp revascularization after root canal decontamination with calcium hydroxide and 2% chlorhexidine gel. J Endo 2013;39:417–420. DOI: 10.1016/j.joen.2012.10.005.
  15. Pozos-Guillén A, Chavarría-Bolaños D, et al. Split-mouth design in Paediatric Dentistry clinical trials. Eur J Paediatr Dent 2017;18:1–5. DOI: 10.1007/s40368-017-0268-x.
  16. Wang H, Chow S-C. Sample Size Calculation for Comparing Proportions. Wiley Encyclopedia of Clinical Trials; 2007.
  17. Pandis N, Polychronopoulou A, et al. Sample calculation for split-mouth designs. Am J Orthod Dentofacial Orthop 2011;140(4):142–146.
  18. Galler KM, Krastl G, et al. European Society of Endodontology position statement: Revitalization procedures. Int Endod J 2016;49:717–723. DOI: 10.1111/iej.12629.
  19. American Association of Endodontics Clinical considerations for a regenerative procedure. Available at: www.aae.org, 2018.
  20. Hamanaka EF, Poi WR, et al. A method for the geometric standardization of intraoral radiographs for long-term follow up of replanted teeth: a case report. Dent Traumatol 2012;29(2):121–126. DOI: 10.1111/j.1600-9657.2012.01145.x.
  21. Dohan DM, Choukroun J. PRP, cPRP, PRF, PRG. How to find your way in the jungle of platelet concentrates. Oral Surg Oral Med Oral Pathol Oral Radiol Endo 2007;103:305–316. DOI: 10.1016/j.tripleo.2006.10.009.
  22. Nagy MM, Tawfik HE, et al. Regenerative Potential of Immature Permanent Teeth with Necrotic Pulps after Different Regenerative Protocols. J Endod 2014;40(2):192–198. DOI: 10.1016/j.joen.2013.10.027.
  23. Lesaffre E, Philstrom B, et al. The design and analysis of split-mouth studies: what statisticians and clinicians should know. Stat Med 2009;28(28):3470–3482. DOI: 10.1002/sim.3634.
  24. Lovelace TW, Henry MA, 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;37:133–138. DOI: 10.1016/j.joen.2010.10.009.
  25. Estefan BS, El Batouty KM, 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.
  26. Nosrat A, Kim JR, et al. Tissue Engineering Considerations in Dental Pulp Regeneration. Iran Endod J 2014;9(1):30–40.
  27. Kontakiotis EG, Filippatos CG, et al. Regenerative endodontic therapy: a data analysis of clinical protocols. J Endod 2015;41:146–154. DOI: 10.1016/j.joen.2014.08.003.
  28. Martin DE, De Almedia JFA, et al. Concentration-dependent effect of sodium hypochlorite on stem cells of apical papilla survival and differentiation. J Endod 2014;40:51–55. DOI: 10.1016/j.joen.2013.07.026.
  29. Thibodeau B, Teixeira F, et al. Pulp revascularization of immature dog teeth with apical periodontitis. J Endo 2007;33(6):680–689. DOI: 10.1016/j.joen.2007.03.001.
  30. http://www.consort-statement.org/ visited 19 October 2018.
  31. Torabinejad M, Faras H. A clinical and histological report of a tooth with an open apex treated with regenerative endodontics using platelet-rich plasma. J Endo 2012;38(6):864–868. DOI: 10.1016/j.joen.2012.03.006.
  32. Saoud TMA, Zaazou A, et al. Clinical and radiographic outcomes of traumatized immature permanent necrotic teeth after revascularization/revitalization therapy. J Endod 2014;40:1946–1952. DOI: 10.1016/j.joen.2014.08.023.
  33. Alagl A, Bedi S, 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.
  34. Shivashankar VY, Johns DA, et al. Comparison of the Effect of PRP, PRF and Induced Bleeding in the Revascularization of Teeth with Necrotic Pulp and Open Apex: A Triple Blind Randomized Clinical Trial. J Clin Diagn Res 2017;11(6):34–39.
  35. Jadhav G, Shah N, et al. Revascularization with and without platelet-rich plasma in nonvital, immature, anterior teeth: A pilot clinical study. J Endod 2012;38(12):1581–1587. DOI: 10.1016/j.joen. 2012.09.010.
  36. Turky M, Kataia MA, et al. Revascularization Induced Maturogenesis of Human Non-Vital Immature Teeth via Platelets-Rich Plasma (PRP): Radiographic Study. J Dent Oral Health 2017;3(9):97–101.
  37. Bezgin T, Yilmaz AD, et al. Concentrated platelet-rich plasma used in root canal revascularization: 2 case reports. Int Endod J 2014;47:41–49. DOI: 10.1111/iej.12144.
  38. Banchs F, Trope M. Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol? J Endo 2004;30(4):196–200. DOI: 10.1097/00004770-200404000-00003.
  39. Lieberman J, Trowbridge H. Apical closure of non-vital permanent incisor teeth where no treatment was performed: case report. J Endod 1983;9(6):257–260. DOI: 10.1016/S0099-2399(86)80025-5.
  40. Gronthos S, Mankani M, et al. Postnatal human dental pulp stem cells (DPSCs) in vitro and in vivo. Proc Natl Acad Sci 2000;97(25):625–630. DOI: 10.1073/pnas.240309797.
  41. Torabinejad M, Turman M. Revitalization of tooth with necrotic pulp and open apex by using platelet-rich plasma: A case report. J Endod 2011;37(2):265–268. DOI: 10.1016/j.joen.2010.11.004.
  42. Torabinejad M, Faras H. A clinical and histological report of a tooth with an open apex treated with regenerative endodontics using platelet-rich plasma. J Endo 2012;38(6):864–868. DOI: 10.1016/j.joen.2012.03.006.
  43. Cehreli ZC, Isbitiren B, et al. Regenerative endodontictreatment (revascularization) of immature necrotic molars medicated with calcium hydroxide: a case series. J Endod 2011;37:1327–1330. DOI: 10.1016/j.joen.2011.05.033.
  44. Yang J, Yuan J, et al. Pulp Regeneration: Current Approaches and Future Challenges. Front Physiol 2016;58(7):1–8. DOI: 10.3389/fphys.2016.00058.
  45. Wang X, Thibodeau B, et al. Histologic characterization of regenerated tissues in canal space after the revitalization/revascularization procedure of immature dog teeth with apical periodontitis. J Endod 2010;36:56–63. DOI: 10.1016/j.joen.2009.09.039.
  46. Shokouhinejad N, Nekoofar MH, et al. Evaluation and Comparison of Occurrence of Tooth Discoloration after the Application of Various Calcium Silicate-based Cements: An Ex Vivo Study. J Endod 2016;42(1):140–144. DOI: 10.1016/j.joen.2015.08.034.
  47. Carlson E, Roach RB. Platelet-Rich Plasma. Clinical Applications in dentistry. J Am Dent Assoc 2002;133:1383–1386.
  48. Murray PE. Mini review of the clinical efficacy of platelet-rich plasma, platelet-rich fibrin and blood-clot revascularization for the regeneration of immature permanent teeth. World J Stomatol 2018;6(1):1–5. DOI: 10.5321/wjs.v6.i1.1.
  49. He L, Zhong J, et al. Treatment of Necrotic Teeth by Apical Revascularization: Meta-analysis. Sci Rep 2017;7(1):1–11.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.