Document Type : Systematic Review
Authors
1 Postgraduate Student, Dept. of Pediatric Dentistry, Dental School of Shahid Beheshti University of Medical Sciences, Tehran Iran.
2 Stem Cell Research Canter, Tissue Engineering and Regenerative Medicine Institute, Tehran Central Branch, Islamic Azad University, Tehran, Iran.
3 Head of the Hospital Dentistry and Sedation Unit, Dept. of Pediatric Dentistry, Past-President of IADR-Iranian Division, Dental School Shahid Beheshti Medical University, Tehran, Iran.
Abstract
Statement of the Problem: Treatment of immature necrotic teeth is a problematic situation. Conventional root canal therapy is challenging and leaves a weak, fragile and undeveloped tooth for lifetime.
Purpose: This review was aimed to assess the outcome of available randomized clinical tr-ials (RCTs) on the efficacy of platelet concentrates (PC) in dentine-pulp complex regeneration.
Materials and Method: An electronic search was conducted on MEDLINE, EMBASE, Cochrane, and Google scholar databases. A further manual search was performed on the list of related articles in order to ensure inclusion of potentially missed articles in earlier electronic search. Those proved RCTs matched with the standard criteria were included following an initial assessment of abstracts and the text independently by the reviewers.
Results: From the total 602 harvested articles, only 13 met the criteria and were evaluated with 11 having parallel design and 2 split mouth. Only one study featured low risk of bias, while three had moderate risk and the rest were at high risk of bias. Six studies had used platelet rich plasma (PRP), 4 employed platelet rich fibrin (PRF), one utilized injectable platelet rich fibrin (I-PRF), and three used both PRF and PRP for their experimental groups while blood clot (BC) was used as the control group for all. The success rate was reported at 87.3% judged by the absence of pathologic signs and symptoms.
Conclusion: Dentin wall thickening, root lengthening and apex closure were higher in PC groups, however, these differences were not statistically significant in reported studies. It can be concluded that PCs promote the pulp tissue revitalization and continuation of root development. However, a consensus on its potency for true pulp regeneration is yet to be reached.
Keywords
- Mittal N, Parashar V. Regenerative evaluation of immature roots using PRF and artificial scaffolds in necrotic permanent teeth: a clinical study. J Contemp Dent Pract. 2019; 20: 720-726.
- Jayadevan V, Gehlot PM, Manjunath V, Madhunapantula SV, Lakshmikanth JS. A comparative evaluation of Advanced Platelet-Rich Fibrin (A-PRF) and Platelet-Rich Fibrin (PRF) as a Scaffold in Regenerative Endodontic Treatment of Traumatized Immature Non-vital permanent anterior teeth: A Prospective clinical study. J Clin Exp Dent. 2021; 13: e463-e472.
- Huang GTJ, Al‐Habib M, Gauthier P. Challenges of stem cell‐based pulp and dentin regeneration: a clinical perspective. Endod Topics. 2013; 28: 51-60.
- Pulyodan MK, Mohan SP, Valsan D, Divakar N, Moyin S, Thayyil S. Regenerative endodontics: A paradigm shift in clinical endodontics. J Pharm Bioallied Sci. 2020; 12 (Suppl 1): S20-S26.
- Smith AJ, Smith JG, Shelton RM, Cooper PR. Harnessing the natural regenerative potential of the dental pulp. Dent Clin North Am. 2012; 56: 589-601.
- Alsousou J, Ali A, Willett K, Harrison P. The role of platelet-rich plasma in tissue regeneration. Platelets. 2013; 24: 173-182.
- Anuroopa P, Patil P, Kumar RV, Kripal K. Role and efficacy of L-PRFmatrix in the regeneration of periodontal defect: a new perspective. J Clin Diagn Res. 2014; 8: ZD03-ZD05.
- Atala A. Tissue engineering and regenerative medicine: concepts for clinical application. Rejuvenation Res. 2004; 7: 15-31.
- Ehrenfest DMD, Rasmusson L, Albrektsson T. Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte-and platelet-rich fibrin (LPRF). Trends Biotechnol. 2009; 27: 158-167.
- Su CY, Kuo YP, Tseng YH, Su CH, Burnouf T. In vitro release of growth factors from platelet-rich fibrin (PRF): a proposal to optimize the clinical applications of PRF. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 108: 56-61.
- ElSheshtawy AS, Nazzal H, El*Shahawy OI, El*Baz AA, Ismail SM, Kang J, et al. The effect of platelet-rich plasma as a scaffold in regeneration/revitalization endodontics of immature permanent teeth assessed using 2-dimensional radiographs and cone beam computed tomography: a randomized controlled trial. Int Endod J. 2020; 53: 905-921.
- Shirbhate U, Bajaj P. Third-generation platelet concentrates in periodontal regeneration: gaining ground in the field of regeneration. Cureus. 2022; 14: e28072.
- Dohan*Ehrenfest DM, Bielecki T, Mishra A, Borzini P, Inchingolo F, Sammartino G, et al. In search of a consensus terminology in the field of platelet concentrates for surgical use: platelet-rich plasma (PRP), platelet-rich fibrin (PRF), fibrin gel polymerization and leukocytes. Curr Pharm Biotechnol. 2012; 13: 1131-1137.
- Nagaveni NB, Kumari KN, Poornima P, Reddy VVS. Management of an endo-perio lesion in an immature tooth using autologous platelet-rich fibrin: a case report. J Indian Soc Pedod Prev Dent. 2015; 33: 69-73.
- Jennings LK. Mechanisms of platelet activation: need for new strategies to protect against platelet-mediated atherothrombosis. Thromb Haemost. 2009; 102: 248-257.
- Zhu X, Zhang C, Huang GT, Cheung GS, Dissanayaka WL, Zhu W. Transplantation of dental pulp stem cells and platelet-rich plasma for pulp regeneration. J Endod. 2012; 38: 1604-1609.
- Choukroun J, Diss A, Simonpieri A, Girard MO, Schoeffler C, Dohan SL, et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part IV: clinical effects on tissue healing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 101: e56-e60.
- Choukroun J, Diss A, Simonpieri A, Girard MO, Schoeffler C, 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: 299-303.
- Farshidfar N, Jafarpour D, Firoozi P, Sahmeddini S, Hamedani S, de*Souza RF, et al. The application of injectable platelet-rich fibrin in regenerative dentistry: A systematic scoping review of in vitro and in vivo studies. Jpn Dent Sci Rev. 2022; 58: 89-123.
- Dianat O, Mashhadi Abas F, Paymanpour P, Eghbal MJ, Haddadpour S, Bahrololumi N. Endodontic repair in immature dogs' teeth with apical periodontitis: blood clot vs plasma rich in growth factors scaffold. Dent Traumatol. 2017; 33: 84-90.
- Wang QL, Yang PP, Ge LH, Liu H. Preliminary evaluation of platelet rich fibrin-mediated tissue repair in immature canine pulpless teeth. Chin J Dent Res. 2016; 19: 49-54.
- Borie E, Olivi DG, Orsi LA, Garlet K, Weber B, Beltran V, et al. Platelet-rich fibrin application in dentistry: a literature review. Int J Clin Exp Med. 2015; 8: 7922-7929.
- He X, Wei W, Chen WX. Three-dimensional structure of platelet-rich fibrin gel and its effect on proliferation of human dental pulp cells in vitro. Shanghai Kou Qiang Yi Xue. 2015; 24: 263-268.
- Petrovic V, Pejcic N, Cakic S. The influence of different therapeutic modalities and platelet rich plasma on apexogenesis: a preliminary study in monkeys. Adv Clin Exp Med. 2013; 22: 469-479.
- Yang KC, Wang CH, Chang HH, Chan WP, Chi CH, Kuo TF. Fibrin glue mixed with platelet-rich fibrin as a scaffold seeded with dental bud cells for tooth regeneration. J Tissue Eng Regen Med. 2012; 6: 777-785.
- Lata P, Chhabra A, Jindal V, Kaur D, Thakur A. In vivo clinical evaluation of regenerative endodontics in immature necrotic permanent teeth with open apex. Dent J Adv Stud. 2015; 3: 26–33.
- Metlerska J, Fagogeni I, Nowicka A. Efficacy of autologous platelet concentrates in regenerative endodontic treatment: a systematic review of human studies. J Endod. 2019; 45: 20-30.
- Jadhav G, Shah N, Logani A. Revascularization with and without platelet-rich plasma in nonvital, immature, anterior teeth: a pilot clinical study. J Endod. 2012; 38:1581-87.
- Bezgin T, Yilmaz AD, Celik BN, Kolsuz ME, Sonmez H. Efficacy of platelet-rich plasma as a scaffold in regenerative endodontic treatment. J Endod. 2015; 41: 36-44.
- Narang I, Mittal N, Mishra N. A comparative evaluation of the blood clot, platelet-rich plasma, and platelet-rich fibrin in regeneration of necrotic immature permanent teeth: a clinical study. Contemp Clin Dent. 2015; 6: 63-68.
- Sharma S, Mittal N. A comparative evaluation of natural and artificial scaffolds in regenerative endodontics: a clinical study. Saudi Endod J. 2016; 6:9-15.
- Alagl A, Bedi S, Hassan K, AlHumaid J. Use of platelet-rich plasma for regeneration in non-vital immature permanent teeth: Clinical and cone-beam computed tomography evaluation. J Int Med Res. 2017; 45: 583-593.
- Shivashankar VY, Johns DA, Maroli RK, Sekar M, Chandrasekaran R, Karthikeyan S, et al. Comparison of the effect of PRP, PRF and induced bleeding in the revascularization of teeth with necrotic pulp and open apex: a triple blind randomized clinical trial. J Clin Diagn Res. 2017; 11: ZC34-ZC39.
- Ragab RA, El Lattif AEA, El Dokky N. Comparative study between revitalization of Necrotic Immature Permanent anterior teeth with and without platelet rich fibrin: a randomized controlled trial. J Clin Pediatr Dent. 2019; 43: 78-85.
- Rizk HM, Al-Deen MSS, Emam AA. Regenerative endodontic treatment of bilateral necrotic immature permanent maxillary central incisors with platelet-rich plasma versus blood clot: a split mouth double-blinded randomized controlled trial. Int J Clin Pediatr Dent. 2019; 12: 332-339.
- Rizk HM, Salah Al-Deen MSS, Emam AA. Pulp revascularization/ revitalization of bilateral upper necrotic immature permanent central incisors with blood clot vs platelet-rich fibrin scaffolds: a split-mouth double-blind randomized controlled Trial. Int J Clin Pediatr Dent. 2020; 13: 337-343.
- Ulusoy AT, Turedi I, Cimen M, Cehreli ZC. Evaluation of blood clot, platelet-rich plasma, platelet-rich fibrin and platelet pellet as scaffolds in regenerative endodontic treatment: a prospective randomized trial. J Endod. 2019; 45: 560-566.
- Nara A, Palekar A, Satnoorkar VMDS, Allappanavar K, Chandrasekhar T. Comparative evaluation of the efficacy of injectable-PRF and blood clot in maturogenesis of non -vital immature permanent teeth: a clinical study. Annals of RSCB. 2021; 25: 11507-11516.
- Shivashankar VY, Johns DA, Vidyanath S, Kumar MR. Platelet rich fibrin in the revitalization of tooth with necrotic pulp and open apex. J Conserv Dent. 2012; 15: 395-398.
- Garrod M, Chau DY. An overview of tissue engineering as an alternative for toxicity assessment. J Pharm Sci. 2016; 19: 31-71.
- Chang YC, Zhao JH. Effects of platelet-rich fibrin on human periodontal ligament fibroblasts and application for periodontal infrabony defects. Aust Dent J. 2011; 56: 365-371.
- Johns DA, Shivashankar VY, Krishnamma S, Johns M. Use of photoactivated disinfection and platelet-rich fibrin in regenerative Endodontics. J Conserv Dent. 2014; 17: 487-490.
- Keswani D, Pandey RK. Revascularization of an immature tooth with a necrotic pulp using platelet-rich fibrin: a case report. Int Endod J. 2013; 46: 1096-1104.
- Bains R, Bains VK, Loomba K, Verma K, Nasir A. Management of pulpal floor perforation and grade II Furcation involvement using mineral trioxide aggregate and platelet rich fibrin: A clinical report. Contemp Clin Dent. 2012; 3(Suppl 2): S223-s227.
- Keswani D, Pandey RK, Ansari A, Gupta S. Comparative evaluation of platelet-rich fibrin and mineral trioxide aggregate as pulpotomy agents in permanent teeth with incomplete root development: a randomized controlled trial. J Endod. 2014; 40: 599-605.
- Torabinejad M, Faras H. A clinical and histological report of a tooth with an open apex treated with regenerative endodontics using platelet-rich plasma. J Endod. 2012; 38: 864-868.
- Martin G, Ricucci D, Gibbs JL, Lin LM. Histological findings of revascularized/revitalized immature permanent molar with apical periodontitis using platelet-rich plasma. J Endod. 2013; 39: 138-144.
- Lolato A, Bucchi C, Taschieri S, Kabbaney AE, Fabbro MD. Platelet concentrates for revitalization of immature necrotic teeth: a systematic review of the clinical studies. Platelets. 2016; 27:383-392.
- Del*Fabbro M, Lolato A, Bucchi C, Taschieri S, Weinstein RL. Autologous Platelet Concentrates for Pulp and Dentin Regeneration: A Literature Review of Animal Studies. J Endod. 2016; 42:250-257.
)