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

Abstract

Objectives: Clinical and radiographic evaluation of the regeneration of bilateral necrotic upper permanent central incisors with open apex using blood clot (BC) and platelet-rich fibrin (PRF) scaffolds. Trial design: Split-mouth double-blind parallel arm randomized controlled clinical trial. Materials and methods: Randomization and blinding: The study started with 15 patients with bilateral necrotic upper permanent central incisors with open apex. Computer-generated tables were used to allocate treatments. The two maxillary central incisors were randomly assigned to either the control (BC scaffold) or the examined (PRF scaffold) groups. Participants: Thirteen patients aged 8–14 years fulfilled the study requirements. Follow-up was performed for 3, 6, 9, and 12 months. Standardized radiographs were collected each 3 months, and difference in measurements was calculated using Image J software. Primary outcomes measured were sinus/fistula formation, pain complaint, mobility grade, and swelling presence/absence. Radiographic: Root length elongation and increase in root thickness. Secondary outcomes were sensibility test and crown color change. Radiographic: Change in bone density and apical diameter. Radiographs that were standardized used during the follow-up time, and occurred changes were calculated using Image J software. Results: One patient was lost during follow-up; therefore, 24 treated teeth were analyzed, they showed 100% success rate. Platelet-rich fibrin teeth displayed a statistically significant growth in radiographic root length and width, increased periapical bone density, and a reduction in apical diameter when compared with BC. At the end of the follow-up period, all treated teeth were negative to sensibility test. Blood clot displayed greater crown discoloration in comparison to PRF group. Conclusion: For teeth with open apex and necrotic pulp, revascularization using PRF is an appropriate substitute to BC.