Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Stomatol. Dec 18, 2019; 7(3): 28-38
Published online Dec 18, 2019. doi: 10.5321/wjs.v7.i3.28
Autologous platelet-rich-fibrin-induced revascularization sequelae: Two case reports
Ahmed M Eltawila, Rania El Backly
Ahmed M Eltawila, Department of Materials Science, Institute of Graduate Studies and Research, Alexandria University, Alexandria 21526, Egypt
Ahmed M Eltawila, Rania El Backly, Tissue Engineering Laboratories, Faculty of Dentistry, Alexandria University, Alexandria 21411, Egypt
Rania El Backly, Endodontics Division, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria 21411, Egypt
Author contributions: Eltawila AM performed the clinical procedures, analyzed data and wrote the manuscript; El Backly R designed the study, supervised the clinical procedures, interpreted data and revised the manuscript; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from patients before clinical procedure, and for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read and prepared the manuscript according to the CARE Checklist (2016). The list is attached.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Rania El Backly, BDS, MSc, PhD, Lecturer, Endodontics Division, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Champollion Street, Alexandria 21411, Egypt. ranianoaman@gmail.com
Telephone: +2-3-4868066 Fax: +2-3-4868066
Received: June 28, 2019
Peer-review started: June 29, 2019
First decision: August 2, 2019
Revised: October 2, 2019
Accepted: November 26, 2019
Article in press: November 26, 2019
Published online: December 18, 2019
Abstract
BACKGROUND

A key requirement for biomimetic regeneration of tissues is a 3D scaffold. The gold standard scaffold for revascularization is the blood clot, however, an adequate blood clot cannot always be achieved in narrow canals or mature roots. Hereby, we document the effects of platelet-rich fibrin (PRF) for the regenerative endodontic treatment (RET) of two immature permanent teeth with necrotic pulps for up to 48 mo.

CASES SUMMARY

The first patient was a 22-year-old female with history of trauma in tooth #9 with a sinus tract and a large periapical lesion. The second was a 9-year-old male presenting with a badly decayed tooth #14. Both cases were treated with RET and PRF prepared from the patients’ blood. PRF and its extract were used as a scaffold for RET. Patients were followed-up to 9 and 48 mo (4 years), respectively. Both patients, were asymptomatic after treatment. At the 9-mo-follow-up of case #1, there was radiographic evidence of periapical bone healing, however, the root apex was still open. In case #2, the roots exhibited apical closure and normal periapical bone architecture at 12-mo follow-up, while no root lengthening was observed. After 48 mo, case #2 showed extensive intracanal calcification in all root canals that complicated conventional root canal treatment.

CONCLUSION

RET with PRF and its extract could be used in revascularization of immature permanent teeth. However, proper case selection to comply with long-term follow-up is necessary and adverse events such as calcification and canal obliteration should be planned for.

Keywords: Revascularization, Platelet-rich fibrin, Dental pulp, Regenerative endodontics, Tooth, Case report

Core tip: This report investigated the effects of platelet-rich fibrin (PRF) for the regenerative endodontic treatment (RET). The first patient had a history of trauma in tooth #9 with a sinus tract and a large periapical lesion. The second patient presented with a badly decayed tooth #14. Both cases were treated with platelet-rich fibrin (PRF) as scaffold for RET. Patients were followed up to 9 and 48 mo, respectively. There was radiographic evidence of periapical bone healing in both cases. The second patient showed root maturation after 12 mo and extensive intracanal calcification at 48 mo.