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      The efficacy of platelet-rich fibrin as a scaffold in regenerative endodontic treatment: a retrospective controlled cohort study

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          Abstract

          Background

          Blood Clot (BC) or platelet concentrates have been used as scaffold in regenerative endodontic treatment (RET). The aim of this retrospective study was to compare the performance of platelet-rich fibrin (PRF) with BC in inducing root development and periapical lesion healing after tooth revascularization.

          Methods

          Five patients receiving RET using PRF as a scaffold were matched 1:1 to a previous cohort of 5 patients who underwent tooth revascularization by provoking periapical bleeding. Clinical signs and symptoms were examined at follow-ups. Periapical lesion healing and root development were monitored radiographically. The resolution of clinical signs and symptoms as well as periapical radiolucency was observed in all patients (100%).

          Results

          Root elongation, dentinal wall thickening and apex closure were found in most cases (80% in both groups). There was no significant difference between the groups in terms of clinical sign resolution, root development and periapical healing.

          Conclusions

          Within the limits of this study, PRF achieved comparable outcomes to BC in terms of clinical sign and symptom resolution, periapical lesion healing and continued root development in RET.

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          Most cited references34

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          Tissue engineering.

          R. Langer, J Vacanti (1993)
          The loss or failure of an organ or tissue is one of the most frequent, devastating, and costly problems in human health care. A new field, tissue engineering, applies the principles of biology and engineering to the development of functional substitutes for damaged tissue. This article discusses the foundations and challenges of this interdisciplinary field and its attempts to provide solutions to tissue creation and repair.
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            Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part V: histologic evaluations of PRF effects on bone allograft maturation in sinus lift.

            Joseph Choukroun, Antoine Diss, Alain Simonpieri … (2006)
            Platelet-rich fibrin (PRF) belongs to a new generation of platelet concentrates, with simplified processing and without biochemical blood handling. The use of platelet gel to improve bone regeneration is a recent technique in implantology. However, the biologic properties and real effects of such products remain controversial. In this article, we therefore attempt to evaluate the potential of PRF in combination with freeze-dried bone allograft (FDBA) (Phoenix; TBF, France) to enhance bone regeneration in sinus floor elevation. Nine sinus floor augmentations were performed. In 6 sites, PRF was added to FDBA particles (test group), and in 3 sites FDBA without PRF was used (control group). Four months later for the test group and 8 months later for the control group, bone specimens were harvested from the augmented region during the implant insertion procedure. These specimens were treated for histologic analysis. Histologic evaluations reveal the presence of residual bone surrounded by newly formed bone and connective tissue. After 4 months of healing time, histologic maturation of the test group appears to be identical to that of the control group after a period of 8 months. Moreover, the quantities of newly formed bone were equivalent between the 2 protocols. Sinus floor augmentation with FDBA and PRF leads to a reduction of healing time prior to implant placement. From a histologic point of view, this healing time could be reduced to 4 months, but large-scale studies are still necessary to validate these first results.
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              Evaluation of the delivery of mesenchymal stem cells into the root canal space of necrotic immature teeth after clinical regenerative endodontic procedure.

              Margaret K. Hargreaves, Christopher T Lovelace, Ronald M A Henry … (2011)
              Immature teeth with open apices treated with conventional nonsurgical root canal treatment often have a poor prognosis as a result of the increased risk of fracture and susceptibility to recontamination. Regenerative endodontics represents a new treatment modality that focuses on reestablishment of pulp vitality and continued root development. This clinical procedure relies on the intracanal delivery of a blood clot (scaffold), growth factors (possibly from platelets and dentin), and stem cells. However, to date, the clinical presence of stem cells in the canal space after this procedure has not been demonstrated. The purpose of this clinical study was to evaluate whether regenerative endodontic procedures are able to deliver stem cells into the canal space of immature teeth in young patients and to identify the possible tissue origin for these cells. After informed consent, the first appointment consisted of NaOCl irrigation and treatment with a triple antibiotic paste. One month later, the root canal space was irrigated with sterile saline, and bleeding was evoked with collection of samples on paper points. Real-time reverse-transcription polymerase chain reaction and immunocytochemistry were conducted to compare the gene transcripts and proteins found in the root canal sample with levels found in the systemic circulation. Molecular analyses of blood collected from the canal system indicated the significant accumulation of transcripts for the stem cell markers CD73 and CD105 (up to 600-fold), compared with levels found in the systemic blood. Furthermore, this effect was selective because there was no change in expression of the differentiation markers ALK-P, DSPP, ZBTB16, and CD14. Histologic analyses demonstrated that the delivered cells expressed both CD105 and STRO-1, markers for a subpopulation of mesenchymal stem cells. Collectively, these findings demonstrate that the evoked-bleeding step in regenerative procedures triggers the significant accumulation of undifferentiated stem cells into the canal space where these cells might contribute to the regeneration of pulpal tissues seen after antibiotic paste therapy of the immature tooth with pulpal necrosis. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                Hongbing Lv: hongbinglu@126.com
                Yuemin Chen: chen.yue.min@qq.com
                Zhiyu Cai: caizhiyu@fjmu.edu.cn
                Lishan Lei: x6160@qq.com
                Ming Zhang: rogerzm@163.com
                Ronghui Zhou: 1059841754@qq.com
                Xiaojing Huang: hxiaoj@163.com
                Journal
                Journal ID (nlm-ta): BMC Oral Health
                Journal ID (iso-abbrev): BMC Oral Health
                Title: BMC Oral Health
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1472-6831
                Publication date (Electronic): 13 August 2018
                Publication date PMC-release: 13 August 2018
                Publication date Collection: 2018
                Volume: 18
                Electronic Location Identifier: 139
                Affiliations
                [1 ]ISNI 0000 0004 1797 9307, GRID grid.256112.3, School and Hospital of Stomatology, , Fujian Medical University, ; Fuzhou, 350002 China
                [2 ]ISNI 0000 0004 1758 0478, GRID grid.411176.4, Department of Stomatology, , Fujian Medical University Union Hospital, ; Fuzhou, 350001 China
                Article
                Publisher ID: 598
                DOI: 10.1186/s12903-018-0598-z
                PMC ID: 6090610
                PubMed ID: 30103724
                SO-VID: 6cc4710a-7dc4-4dce-a072-fe06e69c6509
                Copyright © © The Author(s). 2018
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 1 April 2017
                Date accepted : 30 July 2018
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2018

                ScienceOpen disciplines: Dentistry
                Keywords: apical periodontitis,human immature permanent tooth,blood clot,platelet-rich fibrin,regenerative endodontic treatment
                Data availability:
                ScienceOpen disciplines: Dentistry
                Keywords: apical periodontitis, human immature permanent tooth, blood clot, platelet-rich fibrin, regenerative endodontic treatment

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