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      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

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          Abstract

          Objectives

          The research aims to assess the regenerative potential of Platelet Rich Plasma (PRP) versus Platelet Rich Fibrin (PRF) scaffolds in immature permanent maxillary central incisors with necrotic pulps, clinically and radiographically.

          Trial design

          Double blinded parallel randomized controlled trial was implemented to identify the results.

          Subject & methods

          The proposed study was conducted among 30 patients with maxillary necrotic permanent immature central incisors but only 26 patients fulfilled the study requirements. Group I was treated with PRP and Group II with PRF scaffolds. Follow up has been done every 3 months for one year. Primary outcomes were measured clinically: Pain, Mobility, Swelling, and Sinus/fistula. Radiographically: increase root length and width. Secondary outcomes were clinically: Discoloration and Sensibility test. Radiographically: increase in bone density measurements and decrease in apical diameter. Standardized radiographs were collected during the follow up period, and radiographic changes were measured by using Image J software. Statistical analysis was performed on 25 patients who had completed the study.

          Results

          All 25 patients' teeth were survived during the 12-month follow-up period . PRP showed marginal increase in radiographic root length and width, periapical bone density and a decrease in apical diameter. No statistical significant differences were observed when it was compared with PRF. The teeth which were treated did not respond to sensibility test at the end of the study. PRF displayed statistical significant higher amount of crown discoloration when compared to PRP group .

          Conclusions

          For necrotic immature teeth, revascularization using PRP is an appropriate alternative to PRF and showed excellent 12-months prognosis.

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          Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part I: technological concepts and evolution.

          David Dohan, Joseph Choukroun, Antoine Diss … (2006)
          Platelet-rich fibrin (PRF) belongs to a new generation of platelet concentrates geared to simplified preparation without biochemical blood handling. In this initial article, we describe the conceptual and technical evolution from fibrin glues to platelet concentrates. This retrospective analysis is necessary for the understanding of fibrin technologies and the evaluation of the biochemical properties of 3 generations of surgical additives, respectively fibrin adhesives, concentrated platelet-rich plasma (cPRP) and PRF. Indeed, the 3-dimensional fibrin architecture is deeply dependent on artificial clinical polymerization processes, such as massive bovine thrombin addition. Currently, the slow polymerization during PRF preparation seems to generate a fibrin network very similar to the natural one. Such a network leads to a more efficient cell migration and proliferation and thus cicatrization.
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            Apexification: a review.

            Mary Rafter (2005)
            This paper reviews the rationale and techniques for treatment of the non-vital immature tooth. The importance of careful case assessment and accurate pulpal diagnosis in the treatment of immature teeth with pulpal injury cannot be overemphasized. The treatment of choice for necrotic teeth is apexification, which is induction of apical closure to produce more favorable conditions for conventional root canal filling. The most commonly advocated medicament is calcium hydroxide, although recently considerable interest has been expressed in the use of mineral trioxide aggregate. Introduction of techniques for one-visit apexification provide an alternative treatment option in these cases. Success rates for calcium hydroxide apexification are high although risks such as reinfection and tooth fracture exist. Prospective clinical trials comparing this and one-visit apexification techniques are required.
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              Regenerative endodontic treatment (revascularization) for necrotic immature permanent molars: a review and report of two cases with a new biomaterial.

              Ali Nosrat, Amir Seifi, Saeed Asgary (2011)
              Revascularization is a valuable treatment in immature necrotic teeth that allows the continuation of root development. In this article we describe successful revascularization treatment of 2 necrotic immature first mandibular molars. The clinical and radiographic examinations showed extensive coronal caries, immature roots, and periapical radiolucencies in mandibular first molars of a 9-year-old boy and an 8-year-old girl. The exam findings suggested revascularization treatment in both cases, which was started with irrigation of the canals by using NaOCl 5.25% for 20 minutes, followed by 3 weeks of triple antibiotic (metronidazole, ciprofloxacin, and minocycline) paste dressing. Next, the antibiotic paste was removed, bleeding was induced in the canals, and calcium enriched mixture (CEM) cement was placed over blood clots. In radiographic and clinical follow-ups both cases were asymptomatic and functional, periapical radiolucencies were healed, and roots continued to develop. Revascularization is a realistic treatment in immature necrotic molars. In addition, placing CEM cement as a new endodontic biomaterial over the blood clot formed inside the canals provided good seal and favorable outcomes. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
              Article 0 comments Cited 79 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Hazim Mohamed Rizk
                Journal
                Journal ID (nlm-ta): Saudi Dent J
                Journal ID (iso-abbrev): Saudi Dent J
                Title: The Saudi Dental Journal
                Publisher: Elsevier
                ISSN (Print): 1013-9052
                ISSN (Electronic): 1658-3558
                Publication date PMC-release: 21 September 2019
                Publication date (Print): July 2020
                Publication date (Electronic): 21 September 2019
                Volume: 32
                Issue: 5
                Pages: 224-231
                Affiliations
                Pediatric Dentistry, Preventive & Dental Public Health Department, Faculty of Dentistry, Suez Canal University, Egypt
                Author notes
                [* ]Corresponding author. hazimrizk@ 123456hotmail.com
                Article
                Publisher ID: S1013-9052(19)30642-X
                DOI: 10.1016/j.sdentj.2019.09.002
                PMC ID: 7336024
                PubMed ID: 32647469
                SO-VID: 59bd80af-df53-4188-a4a1-7ae7bf73d03c
                Copyright © © 2019 King Saud University
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 19 June 2019
                Date revision received : 9 September 2019
                Date accepted : 12 September 2019
                Categories
                Subject: Original Article

                Keywords: platelet rich plasma,platelet‑rich fibrin,immature necrotic permanent maxillary central incisors,revascularization/revitalization
                Data availability:
                Keywords: platelet rich plasma, platelet‑rich fibrin, immature necrotic permanent maxillary central incisors, revascularization/revitalization

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