International Journal of Clinical Pediatric Dentistry

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VOLUME 15 , ISSUE 4 ( July-August, 2022 ) > List of Articles


Advanced Platelet-rich Fibrin-mediated Regeneration of Necrotic Immature Permanent Teeth: A Clinico-radiographic Observational Study

Tulika Wakhloo, Sagrika Shukla, Ashi Chug, Mridul Dhar

Keywords : Advanced platelet-rich fibrin, Immature permanent teeth, Necrotic pulp, Open apex, Pediatric dentistry, Regenerative endodontic treatment

Citation Information : Wakhloo T, Shukla S, Chug A, Dhar M. Advanced Platelet-rich Fibrin-mediated Regeneration of Necrotic Immature Permanent Teeth: A Clinico-radiographic Observational Study. Int J Clin Pediatr Dent 2022; 15 (4):402-406.

DOI: 10.5005/jp-journals-10005-2408

License: CC BY-NC 4.0

Published Online: 17-12-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Aim: The objective of the study was to assess the regenerative potential of advanced platelet-rich fibrin (APRF) in the regenerative treatment of necrotic immature permanent teeth (NIPT) in the maxillary incisor region. Study design: After institutional review board clearance, 10 children aged between 8 and 14 years with NIPT in the maxillary incisor region undergoing APRF treatment were enrolled in a prospective clinico-radiographic exploratory observational study. Baseline clinical, radiographic, and vitality testing before the start of treatment were noted. Patients were followed up at 3, 6, and 12 months posttreatment. Results: After 3, 6, and 12 months of follow-up, all patients (100%) showed complete resolution of clinical signs and symptoms. All patients (100%) showed periradicular healing, and 9 out of 10 patients (90%) showed a clear hard tissue bridge formation at various levels in the root canal on postoperative radiographs. None of the patients (0%) showed a positive response to vitality testing. Conclusion: APRF is a promising biomaterial in regenerative endodontic treatment (RET). Future randomized trials can be planned to establish superiority or equivalence to conventional PRF.

  1. Kim SG, Malek M, Sigurdsson A, et al. Regenerative endodontics: a comprehensive review. Int Endod J 2018;51(12):1367–1388. DOI: 10.1111/iej.12954
  2. Hotwani K, Sharma K. Platelet rich fibrin - a novel acumen into regenerative endodontic therapy. Restor Dent Endod 2014;39(1):1–6. DOI: 10.5395/rde.2014.39.1.1
  3. Murray PE, Garcia-Godoy F, Hargreaves KM. Regenerative endodontics: a review of current status and a call for action. J Endod 2007;33(4):377–390. DOI: 10.1016/j.joen.2006.09.013
  4. Chisini LA, Grazioli G, Francia A, et al. Revascularization versus apical barrier technique with mineral trioxide aggregate plug: a systematic review. Giornaleitaliano di endodonzia 2018;32(1):9–16. DOI: 10.1016/j.gien.2018.03.006
  5. Santhakumar M, Yayathi S, Retnakumari N. A clinicoradiographic comparison of the effects of platelet-rich fibrin gel and platelet-rich fibrin membrane as scaffolds in the apexification treatment of young permanent teeth. J Indian Soc Pedod Prev Dent 2018;36(1):65–70. DOI: 10.4103/JISPPD.JISPPD_180_17
  6. Choukroun J, Ghanaati S. Reduction of relative centrifugation force within injectable platelet-rich-fibrin (PRF) concentrates advances patients’ own inflammatory cells, platelets and growth factors: the first introduction to the low speed centrifugation concept. Eur J Trauma Emerg Surg 2018;44(1):87–95. DOI: 10.1007/s00068-017-0767-9
  7. Current considerations for regenerative procedures. American Association of Endodontists, (AAE) 2018
  8. Keswani D, Pandey RK. Revascularization of an immature tooth with a necrotic pulp using platelet-rich fibrin: a case report. Int Endod J 2013;46(11):1096–1104. DOI: 10.1111/iej.12107
  9. Sharma S, Mittal N. A comparative evaluation of natural and artificial scaffolds in regenerative endodontics: a clinical study. Saudi Endod J 2016;6(1):9–15. DOI: 10.4103/1658-5984.171995
  10. Choukroun J. Advanced PRF& i-PRF: platelet concentrates or blood concentrates. J Periodontal Med Clin Pract 2014;1(1):3.
  11. Gordon S. Alternative activation of macrophages. Nat Rev Immunol 2003;3(1):23–35. DOI: 10.1038/nri978
  12. Shah R, M GT, Thomas R, et al. An update on the protocols and biologic actions of platelet rich fibrin in dentistry. Eur J Prosthodont Restor Dent 2017;25:64–72. DOI: 10.1922/EJPRD_01690Shah09
  13. Rajasekharan S, Martens LC, Cauwels RG, et al. Biodentine™ material characteristics and clinical applications: a review of the literature. Eur Arch Paediatr Dent 2014;15(3):147–158. DOI: 10.1007/s40368-014-0114-3
  14. Prabhakar AR, Rani NS, Yavagal C. Revascularization of immature necrotic teeth with platelet-rich fibrin and blood clot. Int J Oral Health Sci 2016;6(1):4–10. DOI: 10.4103/2231-6027.186657
  15. Lolato A, Bucchi C, Taschieri S, et al. Platelet concentrates for revitalization of immature necrotic teeth: a systematic review of the clinical studies. Platelets 2016;27(5):383–392. DOI: 10.3109/09537104.2015.1131255
  16. 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.x
  17. Prasad J, de Ataide IN, Chalakkal P, et al. Comparison between the outcomes of two platelet-rich concentrates on apexogenesis in young permanent incisors requiring endodontic retreatment. Contemp Clin Dent 2018;9(Suppl 1):S156–S159. DOI: 10.4103/ccd.ccd_9_18
  18. Duncan, Henry, Cooper, et al. Clinical approaches in endodontic regeneration current and emerging therapeutic perspectives. Springer; 2019;189.
  19. Wang X, Thibodeau B, Trope M, 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(1):56–63. DOI: 10.1016/j.joen.2009.09.039
  20. Lv H, Chen Y, Cai Z, et al. The efficacy of platelet-rich fibrin as a scaffold in regenerative endodontic treatment: a retrospective controlled cohort study. BMC Oral Health 2018;18(1):139. DOI: 10.1186/s12903-018-0598-z
  21. Lei L, Chen Y, Zhou R, et al. Histologic and immunohistochemical findings of a human immature permanent tooth with apical periodontitis after regenerative endodontic treatment. J Endod 2015;41(7):1172–1179. DOI: 10.1016/j.joen.2015.03.012
  22. 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
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