TREATMENT OF IMMATURE PERMANENT TEETH WITH OPEN APEX USING PLATELET RICH FIBRIN AS A SCAFFOLD: A REGENERATIVE ENDODONTIC PROCEDURE

Aim: The main goal of the present clinical study was to check the efficacy of platelet rich fibrin (PRF) as a scaffold in promoting regeneration in the immature permanent tooth with open apex.

Materials and Methods: Regenerative endodontic procedure was performed in two immature permanent teeth. After access opening and establishing the patency of the canal, rubber dam isolation was done. In the first visit 20 ml of 3%, NaOCl irrigation was done and final irrigation was done with 17% Ethylene diamine tetra acetic acid (EDTA) (20). In the second case, 20 ml of 2% Chlorhexidine (CHX) was used additionally as it was a secondary infection case. Following the irrigation, canals were dried with paper points and a layer of bonding agent was applied to the internal wall of canal followed by insertion of triple antibiotic paste consisting of Ciprofloxacin, metronidazole and minocycline, in a paste-like consistency obtained after mixing the Triple antibiotic paste (TAP) in a saline in concentration of 1 gm/ml. Canals were sealed with glass ionomer cement and the patient was discharged. In the second visit (after 24 days), TAP was removed by irrigation with 20ml of 3% NaOCl and final irrigation with 17% EDTA. Canals were dried with paper points and Platelet-rich fibrin (PRF), prepared by Choukroun method was inserted in the canal with the help of pluggers followed by placement of 4mm of Mineral Trioxide Aggregate (MTA) below CEJ. The orifice was restored with light-cured composite resin restoration.

Results: Follow up radiograph revealed increase in root dentin thickness and root length with the closure of apex in case 1 whereas an increase in root dentin thickness and closure of apex with no lengthening was seen in case 2. In both, the cases reduction in the size of periapical radiolucency was seen.

Conclusion: On the basis of follow up radiographs and clinical evaluation, PRF proved to be a successful scaffold for the regenerative endodontic procedure.