Use of second-generation platelet concentrate (platelet-rich fibrin) and hydroxyapatite in the management of large periapical inflammatory lesion: A computed tomography scan analysis

Abstract

Periapical surgery is required when periradicular pathosis associated with endodontically treated teeth cannot be resolved by nonsurgical root canal therapy (retreatment), or when retreatment was unsuccessful, not feasible or contraindicated. Endodontic failures can occur when irritants remain within the confines of the root canal, or when an extraradicular infection cannot be eradicated by orthograde root canal treatment. Foreign-body responses toward filling materials, toward cholesterol crystals or radicular cysts, might prevent complete periapical healing. We present here a case report wherein, combination of platelet-rich fibrin (PRF) and the hydroxyapatite graft was used to achieve faster healing of the large periapical lesion. Healing was observed within 8 months, which were confirmed by computed tomography, following improved bone density. PRF has many advantages over platelet-rich plasma. It provides a physiologic architecture that is very favorable to the healing process, which is obtained due to the slow polymerization process.

Plasma Rich in Growth Factors in the Treatment of Endodontic Periapical Lesions in Adult Patients: Case Reports

“…Only few case reports have been presented of permanent, mature teeth with periapical lesions treated with RCT combined with surgical procedures, including curettage of the defect and sometimes apical resection [27][28][29][30][31][32][33][34][35][36][37][38]. The defects were filled with either platelet concentrate alone or platelet concentrate mixed with bone substitutes [27][28][29][30][31][32][33][34][35][36][37][38]. Despite the fact that all of the published cases were successful, they do not support the exact role of PRF in the process of healing.…”

“…So far, there have not been any manuscripts published analyzing the clinical effects of conventional RCT with supplementary PRF application in the treatment of periapical lesions in mature teeth. Only few case reports have been presented of permanent, mature teeth with periapical lesions treated with RCT combined with surgical procedures, including curettage of the defect and sometimes apical resection [27][28][29][30][31][32][33][34][35][36][37][38]. The defects were filled with either platelet concentrate alone or platelet concentrate mixed with bone substitutes [27][28][29][30][31][32][33][34][35][36][37][38].…”

Plasma Rich in Growth Factors in the Treatment of Endodontic Periapical Lesions in Adult Patients: A Narrative Review

“…All of the published case reports [130][131][132][133][134][135][136][137][138][139][140][141] revealed satisfactory bone healing after placing PRF or PRF mixed with bone substitutes inside the bone defects. However, they do not explain and answer the fundamental question if additional use of PRF in endodontic surgery is more beneficial for the patient than the conventional surgical procedures performed without any additional supplementation.…”

Efficacy of Platelet Rich Plasma (PRP) Gel in Bone Regeneration of Periapical Cystic Lesion

“…The most frequent odontogenic cyst of teeth bearing areas is the periapical cyst occurring approximately 62% of jaw cysts [5,6]. The periapical cyst of jaws is raised after stimulation of odontogenic epithelium through inflammation causing obliteration of periradicular tissues, loss of lamina dura along with development of radiolucent void in circular to ovoid shape [7,8].…”