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      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

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          ABSTRACT

          Aim

          Clinical and radiographic assessment of the regenerative potential of bilateral immature permanent maxillary central incisors with necrotic pulps using blood clot (BC) and platelet-rich plasma (PRP) scaffolds.

          Trial design

          This is a split mouth double-blinded parallel randomized controlled clinical trial.

          Subjects and methods

          Randomization and blinding: the study started with 15 patients with bilateral maxillary immature permanent central incisors with necrotic pulp. The two upper bilateral central incisors were randomly assigned to either the control (BC scaffold) group I or examined (PRP scaffold) group II. Participant: 13 patients aged 8–14 years fulfilled the study requirements. A follow-up was done for 3, 6, 9, and 12 months. Standardized radiographs were collected during the follow-up period, and radiographic changes were measured using Image J software. Primary outcome measured were clinical: pain, mobility, swelling, and sinus/fistula. Radiographic outcome included increased root length and increase in root thickness. Secondary outcomes were clinical: discoloration and sensibility test. Radiographic outcome included an increase in bone density measurements and a decrease in apical diameter. Standardized radiographs were collected during the follow-up period, and radiographic changes were measured using Image J software.

          Results

          All 26 treated teeth survived during the 12-month follow-up period with 100% success rate. PRP-treated teeth showed a statistically significant increase in radiographic root length, width, periapical bone density, and a decrease in apical diameter when compared with BC. At the end of 12 months, all treated teeth did not respond to the sensibility test. BC displayed a significantly higher amount of crown discoloration compared to the PRP group.

          Conclusion

          For necrotic immature teeth, regenerative endodontic treatment using PRP is a desirable alternative to BC and shows excellent 12-months prognosis.

          How to cite this article

          Rizk HM, AL-Deen MSS, et al. 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(4):332–339.

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          Platelet-rich plasma: Growth factor enhancement for bone grafts.

          R Marx, E R Carlson, R M Eichstaedt … (1998)
          Platelet-rich plasma is an autologous source of platelet-derived growth factor and transforming growth factor beta that is obtained by sequestering and concentrating platelets by gradient density centrifugation. This technique produced a concentration of human platelets of 338% and identified platelet-derived growth factor and transforming growth factor beta within them. Monoclonal antibody assessment of cancellous cellular marrow grafts demonstrated cells that were capable of responding to the growth factors by bearing cell membrane receptors. The additional amounts of these growth factors obtained by adding platelet-rich plasma to grafts evidenced a radiographic maturation rate 1.62 to 2.16 times that of grafts without platelet-rich plasma. As assessed by histomorphometry, there was also a greater bone density in grafts in which platelet-rich plasma was added (74.0% +/- 11%) than in grafts in which platelet-rich plasma was not added (55.1% +/- 8%; p = 0.005).
          Article 0 comments Cited 327 times – based on 0 reviews     Review now
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            Long-term calcium hydroxide as a root canal dressing may increase risk of root fracture.

            B Farik, E C Munksgaard, J Andreasen (2002)
            It has been proposed (Cvek 1992) that immature teeth are weakened by filling of the root canals with calcium hydroxide dressing and gutta-percha. The aim of the present study was to test the hypothesis that dentin in contact with calcium hydroxide would show a reduction in fracture strength after a certain period of time. Immature mandibular incisors from sheep were extracted and divided into two experimental groups. Group 1: the pulps were extirpated via the apical foramen. The root canals were then filled with calcium hydroxide (Calasept) and sealed with IRM(R) cement, and the teeth were then stored in saline at room temperature for 0.5, 1, 2, 3, 6, 9, or 12 months. Group 2: the pulps were extirpated and the root canals were filled with saline and sealed with IRM(R) cement. The teeth were then stored in saline for 2 months. Intact teeth served as controls and were tested immediately after extraction. All teeth were tested for fracture strength in an Instron testing machine at the indicated observation periods. The results showed a markedly decrease in fracture strength with increasing storage time for group 1 (calcium hydroxide dressing). The results indicate that the fracture strength of calcium hydroxide-filled immature teeth will be halved in about a year due to the root filling. The finding may explain the frequent reported fractures of immature teeth filled with calcium hydroxide for extended periods.
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              Evaluation of the delivery of mesenchymal stem cells into the root canal space of necrotic immature teeth after clinical regenerative endodontic procedure.

              Margaret K. Hargreaves, Christopher T Lovelace, Ronald M A Henry … (2011)
              Immature teeth with open apices treated with conventional nonsurgical root canal treatment often have a poor prognosis as a result of the increased risk of fracture and susceptibility to recontamination. Regenerative endodontics represents a new treatment modality that focuses on reestablishment of pulp vitality and continued root development. This clinical procedure relies on the intracanal delivery of a blood clot (scaffold), growth factors (possibly from platelets and dentin), and stem cells. However, to date, the clinical presence of stem cells in the canal space after this procedure has not been demonstrated. The purpose of this clinical study was to evaluate whether regenerative endodontic procedures are able to deliver stem cells into the canal space of immature teeth in young patients and to identify the possible tissue origin for these cells. After informed consent, the first appointment consisted of NaOCl irrigation and treatment with a triple antibiotic paste. One month later, the root canal space was irrigated with sterile saline, and bleeding was evoked with collection of samples on paper points. Real-time reverse-transcription polymerase chain reaction and immunocytochemistry were conducted to compare the gene transcripts and proteins found in the root canal sample with levels found in the systemic circulation. Molecular analyses of blood collected from the canal system indicated the significant accumulation of transcripts for the stem cell markers CD73 and CD105 (up to 600-fold), compared with levels found in the systemic blood. Furthermore, this effect was selective because there was no change in expression of the differentiation markers ALK-P, DSPP, ZBTB16, and CD14. Histologic analyses demonstrated that the delivered cells expressed both CD105 and STRO-1, markers for a subpopulation of mesenchymal stem cells. Collectively, these findings demonstrate that the evoked-bleeding step in regenerative procedures triggers the significant accumulation of undifferentiated stem cells into the canal space where these cells might contribute to the regeneration of pulpal tissues seen after antibiotic paste therapy of the immature tooth with pulpal necrosis. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int J Clin Pediatr Dent
                Journal ID (iso-abbrev): Int J Clin Pediatr Dent
                Journal ID (publisher-id): IJCPD
                Title: International Journal of Clinical Pediatric Dentistry
                Publisher: Jaypee Brothers Medical Publishers
                ISSN (Print): 0974-7052
                ISSN (Electronic): 0975-1904
                Publication date (Print): Jul-Aug 2019
                Volume: 12
                Issue: 4
                Pages: 332-339
                Affiliations
                [1–3 ]Preventive and Dental Public Health Department, Faculty of Dentistry, Suez Canal University, Egypt
                Author notes
                Hazim Mohamed Rizk, Preventive and Dental Public Health Department, Faculty of Dentistry, Suez Canal University, Egypt, Phone: +201001109668, e-mail: hazimrizk@ 123456hotmail.com
                Article
                DOI: 10.5005/jp-journals-10005-1656
                PMC ID: 6898871
                PubMed ID: 31866720
                SO-VID: a9349c80-ed10-4e4c-8c36-a8bc41758388
                Copyright © Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.
                License:

                © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Categories
                Subject: Research Article

                Keywords: blood clot,immature permanent necrotic maxillary bilateral central incisors,platelet-rich plasma,regenerative endodontic treatment
                Data availability:
                Keywords: blood clot, immature permanent necrotic maxillary bilateral central incisors, platelet-rich plasma, regenerative endodontic treatment

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