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| Title |
Autologous Platelet Concentrate Does Not Yield Greater Root Development After Regenerative Endodontic Treatment |
| Clinical Question |
Does autologous platelet concentrate yield greater root development than blood clot after regenerative endodontic treatment? |
| Clinical Bottom Line |
Regenerative procedures done using autologous platelet concentrates (APCs) as scaffolds contribute to root development similar to that seen with the traditionally used blood clot. This information will facilitate the clinician’s decision on which method to use, especially when there are problems with bleeding during the regenerative endodontic treatment (RET). However, further long-term clinical studies are required as the level of evidence on longer follow ups is weak. |
| Best Evidence |
(you may view more info by clicking on the PubMed ID link) |
| PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
| #1) 30935618 | Ulusoy / 2019 | 67 healthy children with 88 immature necrotic incisors | Randomized Controlled Trial | | Key results | Children aged 8–11 years were included. After the root canal disinfection step, the teeth were randomly assigned to one of the following groups (n = 22/group) according to the scaffold used: platelet rich plasma (PRP), platelet rich fibrin (PRF), platelet pellet (PP), and blood clot (BC). The platelet concentrates were introduced into the root canal without prior induction of apical bleeding in the PRP, PRF, and PP groups. A combined clinical and radiographic scoring system was used to assess treatment outcomes with respect to changes in root dimensions using linear measurements of root length and width. The average follow up time was 28.25 +/- 1.2 months. Findings from this study demonstrate similar increase in root length and width among all groups. | | #2) 25459571 | Bezgin / 2015 | 20 necrotic single rooted teeth with immature roots | Randomized Controlled Trial | | Key results | The teeth were randomly assigned to either PRP or BC. After disinfecting the root canal space with triple antibiotic paste (1:1:1 ciprofloxacin, metronidazole, and cefaclor), a tissue scaffold was created by using either PRP or BC and covered with white mineral trioxide aggregate. Clinical and radiographic follow-up examinations were performed every 3 months during an 18-month period. Differences in root area were calculated from preoperative and postoperative radiographs. The PRP group exhibited 9.86% increase in root area, compared with 12.6% increase in the BC group. The difference in success rates between the groups was not statistically significant (P > .05). This study found a PRP scaffold to be effective when used in RET of necrotic immature teeth; however, treatment outcomes did not vary significantly between PRP and conventional BC scaffold. | | #3) 28765825 | Shivashankar / 2017 | 60 patients with a necrotic immature permanent tooth | Randomized Controlled Trial | | Key results | Immature necrotic permanent teeth of patients (aged 9–28 years) were divided into three groups (n=20) according to the treatment protocol: PRF as scaffolding material, revascularization with conventional induced bleeding technique, and PRP as the biomaterial. After 12 months, there was no significant difference among the three groups with respect to root lengthening and lateral wall thickness. The shortcoming of the PRP and PRF methods is that they require drawing of blood from the patient and promptly preparing the PRF or PRP using specialized equipment as compared to the induced bleeding technique, which is less cumbersome. | |
| Evidence Search |
("platelet-rich plasma"[MeSH Terms] OR ("platelet-rich"[All Fields] AND "plasma"[All Fields]) OR "platelet-rich plasma"[All Fields] OR ("platelet"[All Fields] AND "rich"[All Fields] AND "plasma"[All Fields]) OR "platelet rich plasma"[All Fields]) AND ("regenerative endodontics"[MeSH Terms] OR ("regenerative"[All Fields] AND "endodontics"[All Fields]) OR "regenerative endodontics"[All Fields]) |
Comments on
The Evidence |
Validity: Both internal and external validity are high due to inclusion of independent randomized control trials. Subjects in all the studies were randomized. All studies used a standardized and highly reproducible method to assess the outcome: Radiographic Root Assessment measurement to provide a valid assessment of the amount of root maturogenesis. In the study by Bezgin and Shivashankar, a 12- to 18-month follow up period may not allow sufficient time to observe root maturogenesis. Thus further long-term follow up is required to assess successful outcome. The results should be interpreted with caution because these studies may only provide direct evidence for repair or regeneration if the tooth is extracted and investigated at the histologic level. The histological changes in the root canal are not addressed in any of the studies, which can precisely state the nature of tissues formed in response to various revascularization techniques.
Perspective: Autologous platelet concentrates can be used in regenerative endodontic treatment. However, further long-term clinical studies are required as the level of evidence is weak. The analysis will facilitate the clinician’s decision on which method to use, especially when there are problems with bleeding during the regenerative endodontic treatment.
|
| Applicability |
The current PICO question included independently performed randomized controlled trials with heterogenous populations demonstrating the applicability of this treatment option in children. Both sexes can benefit from this procedure and single root canals appear to be good candidates for this procedure. Overall, the applicability of this treatment modality is good. However, more long-term clinical studies are needed. |
| Specialty/Discipline |
(Endodontics) (General Dentistry) (Pediatric Dentistry) |
| Keywords |
Regenerative endodontics, root development, autologous platelet concentrate, PRP, PRF
|
| ID# |
3407 |
| Date of submission: |
12/04/2019 |
| E-mail |
patelp12@uthscsa.edu |
| Author |
Panchali Patel, DDS |
| Co-author(s) |
Ahmad Rayyan, DDS |
| Co-author(s) e-mail |
rayyan@livemail.uthscsa.edu |
| Faculty mentor/Co-author |
Nikita Ruparel, DDS, MS, PhD |
| Faculty mentor/Co-author e-mail |
Ruparel@uthscsa.edu |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
|
Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
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