| Objective: Injectable-platelet-rich fibrin(i-PRF)is a platelet concentrate rich in growth factors,which has good biocompatibility.It can be used as a scaffold material for tissue regeneration.Pulp regeneration is a new method for the treatment of nonvital immature young permanent teeth in recent years.But it was occurred that failure to induce bleeding or sufficient bleeding when preforming pulp regeneration.Therefore,we used i-PRF as a new scaffold and evaluated the treatment outcome.Methods: In this experiment,24 patients(aged 8-17 years)were recruited in the Department of Endodontics of stomatology Lanzhou University from September 2017 to March 2019.A total of 20 teeth were collected;all of them were nonvital immature permanent teeth with a single root showed by X-ray.Pulp regeneration was performed for all the patients.Meantime,another 10 teeth in the Department of Pediatric Dentistry(children of the same age)got apexification were selected as experimental controls.The follow-up time was 9-16 months.The rate of tooth survival,clinical symptom elimination and resolution of apical radiolucency were compared between the two groups.Besides,the increase ratio of root length,root wall thickness and the decrease ratio of the apical diameter were further analyzed.To minimize potential differences in angulations between the preoperative and recall images,they were corrected by using TurboReg software.To evaluate the treatment outcome of i-PRF,18 premolars with dens evaginatus of the above pulp regeneration group were selected for the study.12 of them used i-PRF and 6 used blood clots as scaffold materials.The follow-up time was 9-16 months.The treatment outcome were evaluated by three-level goals of pulp regeneration prescribed by American Association of Endodontics.(Primary goal: The elimination of symptoms and the evidence of bony healing;Secondary goal: Further root development;Tertiary goal: Positive response to vitality testing.).The rate of achieved the primary goal were compared between the two groups.Besides,the percentage change of root length,root wall thickness,apical diameter,root area,canal area were further analyzed.To minimize potential differences in angulations between the preoperative and recall images,they were corrected by using TurboReg software.Results:1.In terms of treatment outcome of pulp regeneration and apexification,there was no missing teeth during follow-up,so the teeth survival rate was 100%(35/35).The rate of clinical symptom elimination(no pain,soft tissue swelling or sinus tract)for the two methods were respectively 96%(24/25)、100%(10/10).The percentage of apical radiolucency resolution was 84%(21/25)and 90%(9/10),and there was no significant difference of them.However,the treatment outcome of pulp regeneration was better than apexification in promoting root development.The increase ratio of dentin wall thickness was respectively(21.93±7.18)% and(-6.52±3.04)%(p<0.05).The percentage changes in root length increase was(12.66±3.45)% and(4.56±3.73)%,and the ratio of apical foramen size decrease was(61.79±9.44)% and(72.99±13.81)%(p>0.05).2.When i-PRF was used as an new scaffold for immature permanent teeth with pulp necrosis treated by pulp regeneration,a total of 11 teeth obtained the primary goal,the proportion was 92%(11/12).The 11 teeth also achieved the secondary goal.The percentage of root length increase was(10.68±4.36)%,the root thickness was(20.56±9.85)% and the apical foramen size decrease was(59.09±14.28)%,the rate of root area increase was(15.88±6.84)%,the decrease of canal area was(10.32±9.23)%.In total,5 teeth were with positive response to electric pulp test,which met the tertiary goal.To sum up,i-PRF was used as a new scaffold for pulp regeneration can achieve a comparable outcome to blood clot.Conclusion: When performing pulp regeneration for young permanent teeth with pulp necrosis and it is failure to induce bleeding or to achieve adequate blood volume,clinicians can consider to use i-PRF as a scaffold material and continue finishing the treatment plan. |
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