Restor Dent Endod.  2022 Nov;47(4):e41. 10.5395/rde.2022.47.e41.

Evaluation of blood clot, plateletrich plasma, and platelet-rich fibrin– mediated regenerative endodontic procedures in teeth with periapical pathology: a CBCT study

• Markandey S
• Adhikari HD

• KMID: 2548145
• DOI: http://doi.org/10.5395/rde.2022.47.e41

Abstract

Objectives
This study compared the clinical and radiological outcomes of regenerative endodontic procedures (REPs) using blood clots (BCs), platelet-rich plasma (PRP), and platelet-rich fibrin (PRF) through intraoral periapical radiography (IOPAR) and cone-beam computed tomography (CBCT).
Materials and Methods
Forty-five single-rooted necrotic teeth with periapical pathology were randomly allocated to receive BC, PRP, or PRF as an individual scaffold. Outcomes were evaluated in 35 teeth in 23 patients with a follow-up period of 12–24 months through qualitative IOPAR scoring and quantitative CBCT measurements. Healing of periapical lesions and in immature teeth, changes in the apical foramen diameter (AFD), root wall thickness (RWT), and root length (RL) were assessed. A p value less than 0.05 was considered to indicate statistical significance.
Results
All teeth were asymptomatic except 1 in the PRP group. Periapical lesion healing was seen in all except 2 teeth in the BC group and 3 in the PRP group. Both IOPAR and CBCT revealed no significant differences in bone healing or changes in AFD, RWT, and RL among the 3 groups. A positive pulp sensibility response to the cold test was seen in 2 teeth in the BC group, but none to the electric pulp test. Intracanal calcification (ICC) was evident in more teeth in the BC group than in the PRP and PRF groups, and was also significantly higher in immature teeth.
Conclusions
Our results revealed that BC, PRP, and PRF have similar potential as scaffolds in REPs, and ICC may be a concern for long-term outcomes.

Keyword

Blood clot; Platelet rich plasma; Platelet rich fibrin; Regenerative endodontic procedure

Figure

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  Figure 1 Flow chart of the study.BC, blood clot; PRP, platelet-rich plasma; PRF, platelet-rich fibrin.

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  Figure 2 Intraoral periapical radiograph evaluation. (A, B) Blood clot group: No. 1: bone healing (BH)-3, apical closure (AC)-3, root wall thickness (RWT)-3, root length (RL)-1. (C, D) Platelet-rich plasma group: No. 1 (tooth #21): BH-3, AC-3, RWT-3, RL-3, No. 2 (tooth #22: mature): BH-3. Platelet-rich fibrin group: No. 1 (tooth #11): BH-3, AC-3, RWT-3, RL-2, No. 2 (tooth #12: mature): BH-3. Arrow indicates intracanal calcification.

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  Figure 3 Three cases: platelet-rich plasma group: increased lesion size postoperatively. (A, B) No. 8. (C, D) No. 11. (E, F) No. 12.

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  Figure 4 Intracanal calcification. (A, B) No. 2 of the blood clot group: apical one-third. (C, D) No. 3 of the platelet-rich plasma group: apical one-third. (E, F) No. 7 of the platelet-rich fibrin group: coronal one-third close to Biodentine.

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  Figure 5 Increased lesion size and gray values in No. 11 of the platelet-rich plasma group.HU, Hounsfield unit; SD, standard deviation.

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  Figure 6 Decrease in periapical lesion area and gain in gray values (Hounsfield unit [HU]). (A) No. 1 of the blood clot group. (B) No. 1 of the platelet-rich plasma group. (C) No. 1 of the platelet-rich fibrin group.SD, standard deviation.

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  Figure 7 No. 1 of the blood clot group. (A) Decrease in the apical foramen diameter, (B) increase in root wall thickness, and (C) increase in root length.

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  Figure 8 No. 1 of the platelet-rich plasma group. (A) Decrease in apical foramen diameter, (B) increase in root wall thickness, and (C) increase in root length.

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  Figure 9 No. 1 of the platelet-rich fibrin group. (A) Decrease in apical foramen diameter, (B) increase in root wall thickness, (C) increase in root length.

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  Figure 10 Intracanal calcification. (A) No. 6 in the blood clot group: discernible on cone-beam computed tomography only, (B) No. 3: platelet-rich plasma group: diffuse in nature, (C) No. 7: platelet-rich fibrin group: calcific bridge apical to Biodentine.

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