Evaluation of Survival of Mature Second Premolar with Periapical Lesion Following Different Regenerative Treatment Protocols: A Randomized Controlled Trial

Introduction: The aim of the present study was to compare the survival, periapical healing and regaining sensibility of necrotic mature second premolars with periapical lesion following treatment with two different regenerative protocols, Platelet Rich Plasma(PRP) versus Platelet Rich Fibrin(PRF) pulp regeneration. Both regenerative endodontic procedures were used for regeneration of pulp tissue in the root canal. Methods: Twenty eight patients with mature, single canalled, necrotic, and asymptomatic second premolar with radiographic evidence of periapical lesion were included. At the first visit, the tooth was anesthetized, isolated and an access cavity was performed. Mechanical preparation of root canals was performed using the standardized technique reaching apical canal preparation to K-file size #40-60. Antibiotic paste was injected in canal, and the cavity was temporarily sealed. Two weeks later, regenerative procedures were performed by applying PRP (group 1) and PRF (group 2) in root canal and pulp chamber space. Collagen plug was placed directly over platelet concentrates followed by biodentin. Survival was defined as retention of the tooth in the arch at 12 months recall. Cone beam computed tomography assessments were done through recording of bone healing of periapical lesion and density of pulp chamber space at 12 months recall. The electric pulp test was used to record at 3,6,9 and 12 months follow-up. Results: There was no statistically significant difference in survival of teeth and healing of periapical lesions between the two groups at 12 months recall. Readings of sensibility revealed statistically significant difference (P < .0001) between baseline and the 12-months follow-up,with no statistically significant difference between the two groups. Conclusions: PRP and PRF combined with revascularization protocol were successful treatment modalities for survival of mature necrotic teeth and healing of periapical lesion. Platelet concentrates protocol is successful in regaining sensibility of necrotic teeth.