Outcome evaluation of regenerative endodontic therapy using injectable-platelet-rich fibrin and platelet-rich fibrin in nonvital immature permanent teeth: A prospective observational study

Abstract

Background: Pulp necrosis in an immature permanent tooth disrupts root development, often treated with calcium hydroxide or Mineral Trioxide Aggregate (MTA) apexification, however, these approaches do not improve structural integrity of teeth. Regenerative endodontic therapy (RET) promotes root maturation, with blood clot and platelet-rich fibrin (PRF) commonly used as a scaffold. Injectable PRF (i-PRF) may offer enhanced biological properties. Aim: This study aimed to compare clinical and radiographic outcomes of RET using i-PRF and PRF in nonvital immature permanent teeth. Settings and Design: Department of Conservative Dentistry and Endodontics, Department of Paediatric Dentistry, Government Dental College, Thiruvananthapuram. Prospective Observational Study. Materials and Methods: Thirty-eight patients undergoing RET were allocated into two groups: Group I (i-PRF, n = 19) and Group II (PRF, n = 19). Clinical outcomes were assessed at 3, 6, and 12 months. Radiographic evaluation was performed at 6 and 12 months, including assessment of periapical healing using periapical index (PAI) scores, root development (length and dentinal wall thickness) measured using ImageJ, and apical responses evaluated according to the criteria described by Chen et al. Statistical analysis was performed with the level of significance set at P < 0.05. Results: Group I demonstrated a higher success rate (100%) and significantly greater reduction in PAI scores (P < 0.05) than Group II (89.47%). Both groups exhibited increases in root length and dentinal wall thickness without significant intergroup differences. Type 3 apical response was the predominant outcome, indicating ongoing root maturation with incomplete apical closure. No changes in coronal discoloration or vitality responses were observed at the 12-month follow-up. Conclusion: i-PRF demonstrated superior periapical healing and overall treatment outcomes compared to PRF, whereas both groups showed comparable effects on root development. These findings suggest that i-PRF may represent a promising biological scaffold for regenerative endodontic treatment of immature permanent teeth.