Evaluation of Bone Repair After Periapical Surgeries Using Leukocyte Platelet-Rich Fibrin (L-PRF) and Blood Clot: A Double-Blind Clinical Trial

doi:10.21203/rs.3.rs-1435200/v1

Download PDF

Article

Evaluation of Bone Repair After Periapical Surgeries Using Leukocyte Platelet-Rich Fibrin (L-PRF) and Blood Clot: A Double-Blind Clinical Trial

https://doi.org/10.21203/rs.3.rs-1435200/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

This study evaluated the effectiveness of the use of an autologous membrane of fibrin rich in platelets and leukocytes (LPRF) and blood clot, in bone repair after periapical surgery, in teeth with apical lesions. Methodology: Randomized clinical study of 64 teeth with periapical lesions submitted to apicectomy and retrograde filling with mineral trioxide aggregate (MTA). The teeth were divided into 2 groups according to the filling of the bone pocket: LPRF (n = 34) and only with blood clot (n = 30). The areas were measured twice, T0 after periapical surgery and T1 after 90 days, using cone beam computed tomography (CBCT) to assess bone pocket repair in cubic millimeters using the ITK-SNAP program. Results: Statistical analyses revealed significant reductions in the volume of bone stores in the LPRF group, with a 48.47% reduction compared to 29.25% for the blood clot group (p < 0.01), with the power of test at 99.86%. Conclusion: The use of LPRF membrane can be recommended as a bone site filler after periapical surgery compared to blood clot.

platelet-rich fibrin

apicectomy

bone repair

periapical surgery

periapical lesion

Proper disinfection of the root canal system is essential for the success of any endodontic therapy. However, due to the complexity of the pulp space, conventional endodontic treatment may not cure the apical infectious process.¹ Thus, sites of bacterial colonization and potential foci of infections may be created leading to the failure of the endodontic therapy. Under these conditions, periapical surgeries may be indicated as a complementary alternative when endodontic treatment has not fulfilled its function due to the difficulties of the root canal system.²

After removal of the infectious agent, bone repair of periapical lesions starts with clot formation and inflammation, either through endodontic retreatment or periapical surgery with or without retrograde filling. This procedure is followed by a proliferative phase, which comprises epithelialization, angiogenesis, formation of granulation tissue, collagen deposition, and finally, maturation with collagen contraction.³ In comparison, tissue repair occurs through regeneration, generating alveolar bone and periodontal ligament in the bone defect or through healing the site of the formation of fibrous connective tissue. For regeneration to occur, the use of membranes in periapical surgeries is used to prevent the migration of epithelial cells and connective tissue. This process allows for the migration of mesenchymal cells, forming new bone and periodontal ligament, thus improving the surgical prognosis.⁴

Tissue repair is a constant challenge in the area of regenerative dentistry, where several biomaterials have been studied to optimize and accelerate the healing process.^7,8 For example, Blatt et al.⁹ concluded that L‑PRF membranes associated with several alternative biosynthetic materials can improve osteogenesis and increase its indications for use.

In the search for more affordable biomaterials, a membrane of autologous origin derived from platelet-rich plasma (PRP), but enriched with fibrin and leukocytes, called platelet-rich fibrin with leukocytes (L‑PRF), has been used.⁵ Such membranes were developed in 2000 based on research with platelet rich plasma (PRP) to enhance the blood flow of open and chronic limb wounds with indications for amputations in diabetic patients. These membranes belong to a second generation of platelet aggregates of autologous origin, having a simplified process without biochemical manipulation of the blood or the addition of anticoagulants, as occurs in the process of PRP ⁵

Choukroun et al.⁵ emphasize that the L‑PRF collection and processing technique is simple and the membrane obtained has a high potential for hard tissue regeneration, especially in relation to soft tissue, through the accumulation of platelets and release of cytokines in a fibrin clot. L‑PRF membranes have essential characteristics that must be considered during wound healing: inclusion of host cells, three-dimensional fibrin matrix, and the accumulation of growth factors. These factors have synergistic effects that include improved soft tissue and bone-store filling as well as a marked improvement in the wound-healing process that serves as a natural guide to angiogenesis and enhancing local immunity. Future strategies to improve L‑PRF formulations and techniques are being investigated to further enhance clinical outcomes after regenerative procedures using this technology.⁶ The efficiency of L‑PRF in soft tissue repair is indisputable; however, the real efficiency of this membrane in bone repair is unclear.

The aim of this study was to evaluate the effectiveness of using L‑PRF membrane and blood clot in bone repair after surgical intervention in teeth with periapical lesions. The null hypothesis is that there will be no difference between L‑PRF membrane and blood clot, between the times regarding the evaluated criteria.

All patients signed an informed consent form to participate in the research, preserving their confidentiality. The PUC-PR Ethics Committee approved this undertaking under Number: 2,732,307 though Plataforma Brazil. In addition, this study was approved in International Clinical Trial Registry Platform through the Brazilian Clinical Trial Registry Platform under the code RBR-7wc8dnw, approved in 08/03/ 2022. This study is an experimental, interventional, double-blind, randomized clinical trial and all methods were performed in accordance with the ethical and clinical trial guidelines and regulations.

For this study, 64 periapical surgeries were performed on 31 patients that were divided into 2 groups: 34 teeth with L‑PRF membrane and 30 teeth filled only with clot. Patients with indication for periapical surgery were selected at the Dental Clinic (PUCPR). The random sequence of choice of filler from the bone pocket after periapical surgery was randomly performed for each patient in a blind manner. For participants who had two or more teeth selected for the research, the L‑PRF membrane and blood clot were drawn, from left to right.

The allocation secrecy corresponded to the drawing of the material to be applied using the following methodology: the #Random—Number Generator (Microsoft) program was used, which provides an interface for generating random numbers. The allocation sequence was generated according to the patients’ order of arrival. The surgical procedures were performed by a single operator.

The selection criteria included:

Aged between 18 and 60,
Presented an apical lesion in an anterosuperior tooth,
No access to conventional treatment,
Presence of an intracanal nucleus whose removal could cause risks of root fracture and consequent loss of the tooth;

Patients who returned with an active infectious process after endodontic retreatment, and
Presented radiographic imagery of a satisfactory filling of the root canal.

Patients with systemic diseases such as diabetes mellitus, blood dyscrasias, kidney diseases, liver cirrhosis, malnutrition, patients using immunosuppressive medications and with thrombocytopenia (below 150,000/mm³) did not take part in this study.

Surgical Procedure

For oral antisepsis in the preoperative period, 0.12% chlorhexidine gluconate (Riohex—Rioquímica) was used with mouthwash every 8 h for 30 s, and the same product at 0.2% was applied with a smear in the perioral regio. As a prophylactic measure 1 h before, 2 tablets of 500 mg of Amoxicillin were administered via oral if the patient did not present an allergy to the medication. If there was an allergy, a medication would be administered following the international protocol of the American Heart Association.¹⁰ For infiltrative anesthesia, one to two 1.8-ml tubes (Mepiadre 2% with DFL® Epinephrine) were used, complemented with the infra-orbital and nasopalatine technique. The incision was made with the aid of a number 15 scalpel blade.

In the anatomopathological examination, periapical lesions were collected using a dentin curette number 17/18 and placed in 10% formalin. Samples were sent for anatomopathological analysis at the Experimental Pathology Laboratory at PUCPR.

For access and 45° cuts at the root apexes, a straight handpiece turbine with spherical drill Number 5 were used (Dentsplay Maillefer—Switzerland) in a low-speed multiplier adapted to receive high-speed drills with sterile saline irrigation.¹¹ The cavity for the apex sealing was prepared with surgical ultrasound of the CVDentus brand with the R1B tip at a depth of 3 mm, irrigated with sterile serum.¹² The retro-obturation of the cavity in the apical region was sealed with MTA (Angelus®).^12-15

In this study, MTA was used as a retrograde filling, which is a bioceramic endodontic cement composed of mineral oxides containing calcium, silica, and bismuth in the form of fine hydrophilic particles. This material is effective for blocking contact with possible infection remaining inside the filled canal. Due to MTA’s effective sealing and less bacterial infiltration, it suffers little influence from blood and moisture in its composition.^13,15,23

In the L‑PRF group, the bone pocket was filled with an L‑PRF membrane obtained by collecting blood from the median cubital vein (venipuncture), before starting the surgery. Processing was executed by means of blood centrifugation at (1800xG) rpm for 10 min (Monserrat Centrifuge) with 2 to 4 nine milliliter dry glass tubes (BD Vacutainer®), and then placed in the centrifuge to prepare the PRF membranes. The control group (CS) had clot formation without the use of the L‑PRF membrane. For flap closure, Bioline® 4.0 resorbable suture threads were used.

Tomographic Evaluation

To assess bone repair, CT scans were performed in a SCANORA 3D cone beam computed tomography device (Soredex, Tuusula, Finland) from the Dental Clinic of the Pontifical Catholic University of Paraná. It was set at 60 × 60 mm (small FOV), 8mAs at 90 Kvp, 0.133-mm voxel size and 18–34 sec exposure time. The images were analyzed using OnDemand3D software. ^16,17

The degree of vestibulo-lingual, mesio-distal, and apical-coronary bone repair of the bone pocket was compared in both groups, considering two examiners calibrated by the intraclass correlation coefficient (ICC), through the measurements of the tomographic slices obtained by the CBCT. This quantitative analysis was performed using the ITK-SNAP, 18-22 processing software for monitoring CBCT of bone pocket repair. Three-dimensional virtual models with volumetric measurements in cubic millimeters were performed with the ITK-SNAP v 3.8.0 software, allowing the volumetric measurement of the reduction of bone stores in various regions measured in postoperative CBCT tomography at T0 (immediately after the surgery) and T1 90 d after surgery.

Image evaluation was performed by filling in the areas of bone stores in Sagittal mode, with the delineation of lesions in Polygon or by filling in the area with image hypodensity using frames or layers in each millimeter interval. Afterward, the frames of the teeth are filled from mesial to distal, where the program allows for interpolation and calculates the volume in cubic millimeters (mm³), thus obtaining the measurements of bone stores in the CBCT at two times: T0 and T1. The assessments made with the ITK-SNAP program prioritized sagittal images. The calibration is conducted in shades of gray, as the program allows for the standard adjustment.

Statistical analysis

The calculation of the ICC aimed to assess the agreement between the two evaluators for the variables initial volume, final volume, reduction volume, and percentage of volume reduction, was above 0.91, which is considered high when values fall between 0.75 and 1.0. A student’s t-test for paired samples was used to assess systematic error. The parametric student t-test for independent samples was used to compare whether there was a statistically significant difference in the percentage of volume reduction between the two groups.

An analysis of variance (ANOVA) test with repeated measurements was used to assess differences between groups, moments, and interactions between the group and moment, involving 2 groups and 2 moments (4 treatments). Levene’s homogeneity of variance test was used to indicate whether there were homogeneous variances for the dependent variable volume between group and moment, involving the 4 treatments. After the ANOVA test indicated differences between group and moment, the Games–Howell parametric test of multiple comparisons (2 to 2) was used for heterogeneous variances to indicate a statistically significant difference between groups and moments involving the 4 treatments.

Tomographic results

Analysis of tomographic images before and 90 d after the surgical procedure revealed a significant reduction in the volume of bone pockets treated with L‑PRF when compared to blood clot (p < 0.01) (Figure 1)

STATISTICAL RESULTS

Regarding the difference in the percentage of volume reduction (mm³) in relation to the group, the student’s t-test for independent samples considering homogeneous variances between the group was equal to 5.03, which was statistically significant, p < 0.01. The test power was 99.86%, indicating a difference between the volume reduction percentage (mm³) in relation to the group.

The results of this study showed a statistically significant difference in bone pocket repair when the L‑PRF membrane was used in relation to the blood clot. A significant difference was evident regarding the decrease in bone-store volume after 90 d, both for the L‑PRF membrane and for the blood clot. The group that used the L‑PRF was more effective in bone repair, reducing the size of the bone store in volume, than the group that used the blood clot, after 90 d. The decrease was 48.47% for the L‑PRF and 29.25% for the blood clot, and this percentage was also statistically significant (Table 1).

Figure 2 shows a graph with the confidence intervals (95%) for the mean values of the percentage of volume reduction (mm³) in relation to the group, where no significant reduction in volume is seen in the L‑PRF group.

The results of the anatomopathological exams of the lesions collected during the surgeries resulted in benign lesions: periapical granulomas (57.8%), apical periodontal cysts (28.1%), and lesions not found (14.1%) between ages, as well as between groups at a significance level of 5%. No loss of the sample occurred during the study.

This double-blind, randomized clinical trial compared the efficacy of two bone pocket fillers for bone repair, L‑PRF membrane and blood clot, after periapical surgery and periapical lesion removal. Both the L‑PRF membrane and the blood clot showed a decrease in bone-store volume after 90 d, however the L‑PRF membrane showed better results after 90 d, with a decrease of 48.47% in volume and 29.25% for the blood clot. The null hypothesis was rejected between the two fillers at the confidence level (95%) with p < 0.01 and the test power being 99.86%, indicating a difference between the Volume Reduction Percentage (mm³) with respect to the two evaluated fillers.

In this study, MTA was used as retrograde filling, which is a bioceramic endodontic cement composed of mineral oxides containing calcium, silica, and bismuth in the form of fine hydrophilic particles. This material is effective for blocking contact with possible infection remaining inside the filled canal. MTA is effective as a sealant as it reduces bacterial infiltration and suffers little influence from blood and moisture in its composition.^13,15,23 Regarding the better efficacy of the L‑PRF membrane, this may be justified because the clots left in the bone stores where the surgical procedure was performed have few growth-factor properties, which are slowly released during the angiogenesis process, differing from how this process occurs in the membranes of L‑PRF.²⁴

According to some authors, the use of L‑PRF membranes is a simple, less costly, and effective technique, as the fibrin membranes are acquired from the patient’s blood through collection in a plastic tube and processed in a calibrated centrifuge with a G-force and speed programmed for this purpose. L‑PRF membranes have a high potential for tissue regeneration. The accumulation of platelets and enrichment with fibrins and leukocytes releases more growth factors, which are essential to promote angiogenesis.^5,25,26

Angiogenesis is essential in repair processes dependent on growth factors arising from platelet degranulation, releasing more cytokines.²⁷ The main characteristic of platelets is the release of growth factors, highlighting the transforming growth factor beta (TGF-B), growth factor and its synergistic effects derived from platelets (PDGF), insulin-like growth factors (IGF).²⁸ Epithelial or epidermal growth factor (EGF),²⁹ and vascular endothelial growth factor (VEGF).³⁰

The preparation of membranes does not require anticoagulant in the container or the addition of gelling agent (bovine thrombin) as occurs in the process of PRP preparation.²⁸ After collecting blood in the tubes, it must be placed in the centrifuge to start the process within 3 min. After the centrifugation period, the membranes are removed from the tubes and placed in a metal box with a lid. After 2 min, the membranes are flat, with approximate sizes of 6 × 15 mm, ready to be used to fill the bone store, and are viable for up to 3 h.

Karan et al.²⁴ compared 40 teeth that underwent periapical surgery, separated into 4 groups (n = 10 each): (1). retrograde filling with MTA only, (2). retrograde filling with MTA and filling the lesion with L‑PRF, (3). filling only of the lesion with L‑PRF and (4). control group without any material. The groups that presented the best result regarding bone repair after 12 months were groups 1 and 2. These results were evaluated using CBCT, showing that MTA was the determining factor due to the blocking of contact with possible remaining infection from the interior of the treated channel.

Studies with similar methodologies, such as Singh et al.,³¹ Angerame et al.,³² and Kulkarni et al.³³ showed that bone repair of the surgical pocket using L‑PRF membranes was effective. However, the evaluation methods in the literature differ from this work; namely, digital periapical radiographs were used.

In contrast, this study used CBCT, which is more accurate than digital periapical exams. Moreover, the sample size in this study was larger than the others. CBCT is able to detect imaging of periapical lesions before they are apparent on conventional radiography.^33-35 Clinical studies have shown that periapical lesion imaging was detected in 20% of cases and 48% in CBCT.³⁶ In vivo studies where simulations of bone stores of periapical lesions were performed showed similar results.^23,37 Other studies have also demonstrated the effectiveness of CBCT^38-40 when analyzed with the ITK-SNAP program,²¹ which is a software application used to segment structures in 3D medical images.

Since their introduction, few clinical studies have focused on L‑PRF membranes. Research has mainly concentrated on the time to evaluate the repair and filling of bone pockets after periapical surgeries, comparing the effectiveness of the L‑PRF material over a 3-month evaluation time^41,42 or 4 months.⁴³ Further research is recommended with changes in strength and speed to increase the amount of growth factors, as well as an increase in leukocytes and mesenchymal progenitor cells, which were also detected using lower centrifugation speeds, reducing from 2,700 to 1,300 rpm and 12 to 8 min, thus prioritizing bone repair power.^6,44

Thus, the use of L‑PRF membrane in filling bone pockets after periapical surgeries is justified. In addition to having low cost, it does not present rejection because it is autologous, easy to acquire, and effective for the experiments conducted in this study. The limitations of the study were the difficulty in finding patients with indications for inclusion.

The use of L‑PRF membrane was more effective in bone repair after surgical intervention in teeth with periapical lesions when compared to blood clot after 90 d.

AUTHORS CONTRIBUTION

TPL, EC, OGF, YP were responsible for the literature search. TPL was responsible for the surgeries, RP, GGG, YP, EC, DC helped in the surgeries and data collection, TPL, GGG, OGF draft the manuscript. SAI, TLP, GGG, DC were responsible for the data analysis, data interpretation, and discussion. VPDW and EC conceived the idea for the study and corrected the manuscript, participated in its design and coordination, and provided the feedback on the revisions to the manuscript.

COMPETING INTERESTS STATEMENT

The authors declare no competing interests.

Basmadjian-Charles C, Farge P, Bourgeois D, Lebrun T. Factors influencing the long-term results of endodontic treatment: a review of the literature. Int Dent J. 2002;52(2):81-6.

2. Nair P. On the causes of persistent apical periodontitis: a review. Int Endod J. 2006;39(4):249-81.

3. Cobos MR, Ricardo JH, Samper EH, Camargo LM. Cicatrización y regeneración ósea de los maxilares después de una quistectomía: reporte de un caso y revisión de la literatura. Univ Odontol. 2011;30(65).

4. Sánchez-Torres A, Sánchez-Garcés MÁ, Gay-Escoda C. Materials and prognostic factors of bone regeneration in periapical surgery: A systematic review. Med Oral Patol Oral Cir Bucal. 2014;19(4):e419.

5. Choukroun J, Adda F, Schoeffler C, Vervelle A. Une opportunité en paro-implantologie: le PRF. Implantodontie. 2001;42(55):e62.

6. Fujioka‐Kobayashi M, Miron RJ, Hernandez M, Kandalam U, Zhang Y, Choukroun J. Optimized platelet‐rich fibrin with the low‐speed concept: growth factor release, biocompatibility, and cellular response. J Periodontol. 2017;88(1):112-21.

7. Nikolidakis D, Van Den Dolder J, Wolke JG, Jansen JA. Effect of platelet‐rich plasma on the early bone formation Around Ca‐P‐Coated And Non‐Coated Oral Implants In Cortical Bone. Clin Oral Implants Res. 2008;19(2):207-13.

8. Carrasco Luna J, Bonete Lluch D, Gomar Sancho F. Plasma rico en plaquetas vs. Plasma rico en factores de crecimiento. Rev Esp Cir Osteoartic. 2009; 44(239):127-40.

9. Blatt S, Thiem DG, Kyyak S, Pabst A, Al-Nawas B, Kämmerer PW. Possible Implications for Improved Osteogenesis? The Combination of Platelet-Rich Fibrin With Different Bone Substitute Materials. Front Bioeng Biotechnol.. 2021;9:186.

10. Members WC, Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin III JP, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2021;77(4):e25-e197.

11. Tsesis I, Rosen E, Schwartz-Arad D, Fuss Z. Retrospective evaluation of surgical endodontic treatment: traditional versus modern technique. J Endod. 2006;32(5):412-6.

12. Palma PJ, Marques JA, Casau M, Santos A, Caramelo F, Falacho RI, et al. Evaluation of root-end preparation with two different endodontic microsurgery ultrasonic tips. Biomedicines. 2020;8(10):383.

13. Galarça AD, Da Rosa WLdO, Da Silva TM, da Silveira Lima G, Carreño NLV, Pereira TM, et al. Physical and biological properties of a high-plasticity tricalcium silicate cement. BioMed Res Int. 2018 Nov 27; 2018.

14. Shetty H, Shetty S, Kakade A, Mali S, Shetty A, Neelakantan P. Three-dimensional qualitative and quantitative analyses of the effect of periradicular lesions on the outcome of regenerative endodontic procedures: A prospective clinical study. Clin Oral Investig. 2021;25(2):691-700.

15. Camilleri J, Pitt Ford TR. Mineral trioxide aggregate: a review of the constituents and biological properties of the material. Int Endod J. 2006;39(10):747-54.

16. Lorenzoni DC, Bolognese AM, Garib DG, Guedes FR, Sant’Anna EF. Cone-beam computed tomography and radiographs in dentistry: aspects related to radiation dose. Int J Dent. 2012;2012:813768. doi: 10.1155/2012/813768.

17. Tsiklakis K, Donta C, Gavala S, Karayianni K, Kamenopoulou V, Hourdakis CJ. Dose reduction in maxillofacial imaging using low dose Cone Beam CT. Eur J Radiol. 2005;56(3):413-7.

18. Pizer SM, Fritsch DS, Yushkevich PA, Johnson VE, Chaney EL. Segmentation, registration, and measurement of shape variation via image object shape. IEEE Trans Med Imaging. 1999;18(10):851-65.

19. Parirokh M, Torabinejad M. Mineral trioxide aggregate: a comprehensive literature review—part I: chemical, physical, and antibacterial properties. J Endod. 2010;36(1):16-27.

20. Torabinejad M, Parirokh M. Mineral trioxide aggregate: a comprehensive literature review—part II: leakage and biocompatibility investigations. J Endod. 2010;36(2):190-202.

21. Yushkevich PA, Gao Y, Gerig G, editors. ITK-SNAP: An interactive tool for semi-automatic segmentation of multi-modality biomedical images. Annu Int Conf IEEE Eng Med Biol Soc. 2016 Aug;2016:3342-5. doi: 10.1109/EMBC.2016.7591443.

22. Kauke M, Safi A-F, Grandoch A, Nickenig H-J, Zöller J, Kreppel M. Image segmentation-based volume approximation—volume as a factor in the clinical management of osteolytic jaw lesions. Dentomaxillofac Radiol. 2019 Jan;48(1):20180113. doi: 10.1259/dmfr.20180113.

23. Patel S, Dawood A, Mannocci F, Wilson R, Pitt Ford T. Detection of periapical bone defects in human jaws using cone beam computed tomography and intraoral radiography. Int Endod J. 2009;42(6):507-15.

24. Karan NB, Aricioğlu B. Assessment of bone healing after mineral trioxide aggregate and platelet-rich fibrin application in periapical lesions using cone-beam computed tomographic imaging. Clin Oral Investig. 2020;24(2):1065-72.

25. Choukroun J, Diss A, Simonpieri A, Girard MO, Schoeffler C, Dohan SL, et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part V: histologic evaluations of PRF effects on bone allograft maturation in sinus lift. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101(3):299-303.

26. Miron RJCJ. Fibrina Rica em Plaquetas na Odontontologia e Medicina Regenerativa e Estética, bases biológicas e aplicações clínicas. São Paulo: Quintessence; 2018.

27. Anitua E, Zalduendo M, Prado R, Alkhraisat M, Orive G. Morphogen and proinflammatory cytokine release kinetics from PRGF‐Endoret fibrin scaffolds: Evaluation of the effect of leukocyte inclusion. J Biomed Mater Res. Part A. 2015;103(3):1011-20.

28. Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part II: platelet-related biologic features. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101(3):10.

29. Consolaro A, Consolaro MFM. ERM functions, EGF and orthodontic movement or Why doesn't orthodontic movement cause alveolodental ankylosis? Dental Press J Orthod. 2010;15(2):24-32.

30. El Bagdadi K, Kubesch A, Yu X, Al-Maawi S, Orlowska A, Dias A, et al. Reduction of relative centrifugal forces increases growth factor release within solid platelet-rich-fibrin (PRF)-based matrices: a proof of concept of LSCC (low speed centrifugation concept). Eur J Trauma Emerg Surg. 2019;45(3):467-79.

31. Singh S, Singh A, Singh S, Singh R. Application of PRF in surgical management of periapical lesions. Natl J Maxillofac Surg. 2013;4(1):94.

32. Angerame D, De Biasi M, Kastrioti I, Franco V, Castaldo A, Maglione M. Application of platelet-rich fibrin in endodontic surgery: a pilot study. G Ital Endod. 2015;29(2):51-7.

33. Kulkarni MR, Mohan J, Bakshi PV. Platelet-Rich Fibrin as a Grafting Material in Periapical Surgery: A Case Series. Int J Periodontics Restorative Dent. 2019 July/Aug;39(4):e123–e27. doi: 10.11607/prd.3510.

34. Paula-Silva FWG, Wu M-K, Leonardo MR, Silva LAB, Wesselink PR. Accuracy of periapical radiography and cone-beam computed tomography scans in diagnosing apical periodontitis using histopathological findings as a gold standard. J Endod. 2009;35(7):1009-12.

35. Choukroun J, Ghanaati S. Reduction of relative centrifugation force within injectable platelet-rich-fibrin (PRF) concentrates advances patients’ own inflammatory cells, platelets and growth factors: the first introduction to the low speed centrifugation concept. Eur J Trauma Emerg Surg. 2018;44(1):87-95.

36. Patel S, Wilson R, Dawood A, Mannocci F. The detection of periapical pathosis using periapical radiography and cone beam computed tomography–Part 1: pre‐operative status. Int Endod J. 2012;45(8):702-10.

37. Soğur E, Gröndahl H-G, Baksı BG, Mert A. Does a combination of two radiographs increase accuracy in detecting acid-induced periapical lesions and does it approach the accuracy of cone-beam computed tomography scanning? J Endod. 2012;38(2):131-6.

38. Cotton TP, Geisler TM, Holden DT, Schwartz SA, Schindler WG. Endodontic applications of cone-beam volumetric tomography. J Endod. 2007;33(9):1121-32.

39. Kavitha M, Krishnaveni R, Swathi A, Abubacker M. Evaluation of Healing by Cone Beam Computed Tomography (CBCT) using Platelet‑Rich Plasma (PRP)+ β‑Tricalcium Phosphate (β‑TCP) and Platelet Rich Fibrin (PRF)+ β‑Tricalcium Phosphate (β‑TCP) in Periapical Lesions: Case Report. Niger J Clin Pract. 2020;23(7):1026-9.

40. Dudeja PG, Dudeja KK, Garg A, Srivastava D, Grover S. Management of a previously treated, calcified, and dilacerated maxillary lateral incisor: A combined nonsurgical/surgical approach assisted by cone-beam computed tomography. J Endod. 2016;42(6):984-8.

41. Temmerman A, Vandessel J, Castro A, Jacobs R, Teughels W, Pinto N, et al. The use of leucocyte and platelet‐rich fibrin in socket management and ridge preservation: a split‐mouth, randomized, controlled clinical trial. J Clin Periodontol. 2016;43(11):990-9.

42. Iftikhar N, Srivastava B, Gupta N, Gambhir N, Singh R. Surgical Management of Periapical Lesion in Maxilla Using Platelet-Rich Fibrin (PRF) As an Autologous Biomaterial: Case Report. 2019.

43. Bharathi R, Manasa H, Manjunath S, Anand V, Datta A, Shanthala D. Platelet-rich fibrin in the management of periapical lesions: a case series. Int J Prev Clin Dental Res. 2020;7(1):14.

44. Ghanaati S, Booms P, Orlowska A, et al. Advanced platelet-rich fibrin: A new concept for cell-based tissue engineering by means of inflammatory cells. J. Oral implantol 2014; 40:679-689.

Table 1. Descriptive statistics of the percentage of volume reduction variable (mm³) with respect to the group

Group	N	Mean	SD	Standard Error	Confidence Interval (95%)
Group	N	Mean	SD	Standard Error	LI	LS
Control (blood coat)	30	−29.25 (a)	12.61	2.30	−33.96	−24.54
Sample (L‑PRF)	34	−48.47 (b)	17.24	2.95	−54.49	−42.46

Note: Different letters indicate a statistically significant difference between the mean values of the percentage of volume reduction (mm³), with respect to the group. Student’s t-test for independent samples (p < 0.01).

No competing interests reported.

Download PDF

Version 1

posted

You are reading this latest preprint version

Evaluation of Bone Repair After Periapical Surgeries Using Leukocyte Platelet-Rich Fibrin (L-PRF) and Blood Clot: A Double-Blind Clinical Trial

Status:

Version 1

Abstract

Figures

Introduction

Materials And Methods

Results

Tomographic results

Discussion

Conclusion

Declarations

References

Tables

Additional Declarations

Status:

Version 1