Comparative Evaluation of the Regenerative Capacity of Two Platelet Concentrates

Not Applicable

Interventions: Procedure: Injectable platelet-rich fibrin
Procedure: Platelet-rich plasma

Brief Summary: Injectable platelet-rich fibrin (I-PRF) is a flowable blood concentrate that is entirely natural and allows ease of access and flow within the root canal. It was first developed in 2014 by modifying the centrifugation parameters. I-PRF has great potential in the field of endodontics. At present, it is still in its infancy and needs to be explored with regard to its regenerative efficacy.

To the best of our knowledge, this study is the first to clinically and comparatively investigate Platelet-rich plasma (PRP) and I-PRF.

Detailed Description: An ideal treatment option for an immature necrotic tooth is the regeneration of pulp-like tissue that is capable of boosting the continuation of normal root development. The use of platelet concentrates for that purpose is a clinically relevant, minimally invasive approach which has a promising potential of reducing the healing period. Among which, the most commonly employed is the Platelet-Rich Plasma that is not entirely natural. It involves the use of non-autologous anticoagulants such as bovine thrombin to maintain the fluid consistency which prevents clot formation and thus impairs wound healing, affects the coagulation process and can also trigger an immune reaction, thereby, suppressing regeneration.

PRP offers a short-term release of most of the growth factors unlike the Platelet-Rich Fibrin which allows for a more sustained release. PRF does not require any biochemical handling of blood and is easy to procure but due to the gel-like consistency, its adaptability within the root canal requires excessive removal of root dentin.

In addition, the application of recombinant growth factors within the root canal is associated with high cost which hinders its applicability in the common clinical practice.

Therefore, a new regenerative technique is required that combines the advantages of both PRP and PRF while overcoming their drawbacks.

Recruitment & Eligibility

Inclusion Criteria

Patients having necrotic maxillary anterior tooth/teeth due to caries or trauma
Radiographic criteria: preoperative radiograph showing incomplete root formation with a wide apical foramen.
Positive patient/guardian compliance for participation in the study.

Exclusion Criteria

Uncooperative patient
Lack of patient commitment to the treatment plan and the follow-up period
Mature necrotic anterior teeth due to caries or trauma
Vital maxillary anterior teeth with open apices
Non-restorable teeth
Grossly decayed or fractured teeth that require post and core as final restorations
Presence of periodontal pockets
Radiographically: presence of external or internal root resorption, fracture lines or cracks

Arm && Interventions

Group	Intervention	Description
Injectable platelet-rich fibrin	Injectable platelet-rich fibrin	A platelet concentrate will be prepared from the patient's own blood in plain plastic tubes, without the use of anticoagulants, and applied immediately within the root canal before coagulation.
Platelet-rich plasma	Platelet-rich plasma	A platelet concentrate will be prepared from the patient's own blood in tubes containing anticoagulants to maintain the fluid consistency and applied within the root canal.

Primary Outcome Measures

Name	Time	Method
Increase in root length	one year follow-up	root length will be measured on the preoperative and postoperative radiographs and the percentage increase in length will be calculated

Secondary Outcome Measures

Name	Time	Method
Restoration of tooth sensitivity	one year	sensitivity will be measured by an electric pulp tester

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