Apexification of the mineral trioxide aggregate in nonvital immature anterior teeth with and without platelet-rich plasma: A preliminary clinical study

Abstract

Introduction: Treatment of permanent teeth with weak root dentin, exposed apex, necrotic pulp, periapical disease, and stunted root growth present a significant challenge to the practicing conservative dentistry. Necrotic immature permanent teeth with open apices are arduous to seal by thermo-plasticized or lateral condensation methods. Apexification methods have traditionally used a variety of materials including calcium hydroxide, biodentine, and mineral trioxide aggregate (MTA). Calcium hydroxide apexification takes a long time to develop an apical barrier and contains large pores, resulting in inadequate sealing ability and a bad outcome. MTA is a biomimetic and bio-inductive substance that has been employed to construct a single-step apical barrier in immature open apices with and without periapical pathology. Endodontic in this 21st century uses regenerative procedures in a nonvital, immature tooth with wide-open apices but it is also a very lengthy procedure and poor patient compliance due to slow biologic healing and long-term follow-up of the patients. Platelet-rich plasma (PRP) contains various growth factors such as platelet-derived growth factors and transforming growth factors and has been proposed as a potentially ideal scaffold for accelerated wound healing. Aims and Objectives: To evaluate and compare the clinical and radiographic outcome of MTA apexification with and without PRP in periapical healing kinetics in nonvital, immature teeth. Materials and Methods: An analysis was performed on patient with immature teeth, open-apex, maxillary front nonvital that were randomly divided into two groups of eighteen patients (eighteen roots permanent upper anterior) each: Group I in which MTA apexification was performed without PRP and Group II consisting of 18 roots where MTA apexification were carried out on a collagen sponge supplemented with PRP. Results: The cases were followed up at 6 months and 12 months after treatment, both clinically and radiographically, by two independent assessors. Periapical healing (PAH) was good in 6–18 roots, and in Group I-11 roots showed excellent healing. In Group II-17 roots showed excellent results. Case number 18 and case number 9 were lost to follow-up due to migration to groups I and II, respectively. Apical closure was 100% in Group II and 77% in Group I. Conclusions: Single-step MTA apexification with PRP is a conservative and effective method for inducing PAH and is time-saving in managing nonvital, immature teeth with an open apex.