International Journal of Clinical Pediatric Dentistry

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VOLUME 16 , ISSUE S2 ( September, 2023 ) > List of Articles


Comparative Evaluation of the Regenerative Potential of Blood Clot and Platelet-rich Fibrin in Young Permanent Teeth Based on the Revised American Academy of Endodontics Clinical Considerations for Regenerative Procedure: 2016

Aarathi J Prakash, Saraswathi V Naik, Prabhakar Attiguppe

Keywords : Advanced platelet-rich fibrin, American Academy of Endodontics regenerative protocol 2016, Blood clot, Necrotic young permanent teeth, Stem cells of apical papilla

Citation Information :

DOI: 10.5005/jp-journals-10005-2654

License: CC BY-NC 4.0

Published Online: 01-11-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Aim: To compare and evaluate the regenerative potential of blood clots and platelet-rich fibrin (PRF) in IYNPT based on the revised American Academy of Endodontics (AAE) clinical considerations for regenerative endodontics 2016. Materials and methods: A total of 20 patients (7–12 years) with immature young necrotic permanent teeth were included and irrigation and disinfection were done using the revised AAE protocol. Teeth were randomly categorized into PRF scaffolding and conventional bleeding technique. The cases were followed up for 1, 3, and 6 months for clinical and radiographic evaluation. Result: At 6 months there was no significant difference between the groups in terms of clinical healing and periapical healing. A significant statistical difference was noted at the end of 6 months with respect to apical closure within the PRF group. A significant difference was seen in the increase in dentin thickness between groups with PRF showing more increase. Conclusion: The PRF scaffold can be used as it induces the regenerative potential of stem cells at the apex.

  1. Mahla RS. Stem cells applications in regenerative medicine and disease therapeutics. Int J Cell Biol 2016;2016(1):6940283. DOI: 10.1155/2016/6940283
  2. Rafter M. Apexification: a review. Dent Traumatol 2005;21(1):1–8. DOI: 10.1111/j.1600-9657.2004.00284.x
  3. Muhamad A, Azzaldeen A, Hanali A. Mineral trioxide aggregate (MTA) in apexification. Endodontology 2013;25(2);97–101. DOI: 10.4103/0970-7212.352338
  4. Lee BN, Moon JW, Chang HS, et al. A review of the regenerative endodontic treatment procedure. Restor Dent Endod 2015;40(3):179–187. DOI: 10.5395/rde.2015.40.3.179
  5. Ostby BN. The role of the blood clot in endodontic therapy. An experimental histologic study. Acta Odontol Scand 1961;19:324–353.
  6. Martin DE, De Almeida JF, Henry MA, et al. Concentration-dependent effect of sodium hypochlorite on stem cells of apical papilla survival and differentiation. J Endod 2014;40(1):51–55. DOI: 10.1016/j.joen.2013.07.026
  7. Shivashankar VY, Johns DA, Maroli RK, 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):ZC34–ZC39. DOI: 10.7860/JCDR/2017/22352.10056
  8. American Association of Endodontists[Internet].Chicago: AAE Clinical Consideration for a Regenerative Procedure. Revised 6-8-16; 2016 [cited 2017 oct12]. Available from:
  9. Dohan Ehrenfest DM, Rasmusson L, Albrektsson T. Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF). Trends Biotechnol 2009;27(3):158–167. DOI: 10.1016/j.tibtech.2008.11.009
  10. 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.
  11. Orstavik D, Kerekes K, Eriksen HM. The periapical index: a scoring system for radiographic assessment of apical periodontitis. Endod Dent Traumatol 1986;2(1):20–34. DOI: 10.1111/j.1600-9657.1986.tb00119.x
  12. 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
  13. Bose R, Nummikoski P, Hargreaves K. A retrospective evaluation of radiographic outcomes in immature teeth with necrotic root canal systems treated with regenerative endodontic procedures. J Endod 2009;35(10):1343–1349. DOI: 10.1016/j.joen.2009.06.021
  14. Galler KM. Clinical procedures for revitalization: current knowledge and considerations. Int Endod J 2016;49(10):926–936. DOI: 10.1111/iej.12606
  15. Hargreaves KM, Diogenes A, Teixeira FB. Paradigm lost: a perspective on the design and interpretation of regenerative endodontic research. J Endod 2014;40(4 Suppl.):S65–S69. DOI: 10.1016/j.joen.2014.01.023
  16. Hargreaves KM, Diogenes A, Teixeira FB. Treatment options: biological basis of regenerative endodontic procedures. J Endod 2013;39(3 Suppl):S30–S43. DOI: 10.1016/j.joen.2012.11.025
  17. Zhao S, Sloan AJ, Murray PE, et al. Ultrastructural localisation of TGF-beta exposure in dentine by chemical treatmentHistochem J 2000;32(8):489–494. DOI: 10.1023/a:1004100518245
  18. Pang NS, Lee SJ, Kim E, et al. Effect of EDTA on attachment and differentiation of dental pulp stem cells. J Endod. 2014 40(6):811–817.
  19. Ruparel NB, Teixeira FB, Ferraz CC, et al. Direct effect of intracanal medicaments on survival of stem cells of the apical papilla. J Endod 2012;38(10):1372–1375. DOI: 10.1016/j.joen.2012.06.018
  20. Althumairy RI, Teixeira FB, Diogenes A. Effect of dentin conditioning with intracanal medicaments on survival of stem cells of apical papilla. J Endod 2014;40(4):521–525. DOI: 10.1016/j.joen.2013.11.008
  21. 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
  22. Galler KM, Buchalla W, Hiller KA, et al. Influence of root canal disinfectants on growth factor release from dentin. J Endod 2015;41(3):363–368. DOI: 10.1016/j.joen.2014.11.021
  23. Narang I, Mittal N, Mishra N. A comparative evaluation of the blood clot, platelet-rich plasma, and platelet-rich fibrin in regeneration of necrotic immature permanent teeth: a clinical study. Contemp Clin Dent 2015;6(1):63–68. DOI: 10.4103/0976-237X.149294
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