VOLUMETRIC AND RADIOGRAPHIC OUTCOMES OF BONE REGENERATION AFTER APICOECTOMY WITH PRF-BASED THERAPIES - A PRELIMINARY STUDY.

Abstract

Background: Successful apicoectomy relies on effective bone healing at the resected root apex. Platelet-rich fibrin (PRF) and bone graft materials have been proposed to enhance regeneration, yet comparative evidence using both two-dimensional (2D) and three-dimensional (3D) imaging remains limited.

Objective: To compare bone regeneration following apicoectomy using PRF, PRF combined with Bio-Oss, and conventional technique, and to evaluate postoperative pain and edema.

Material and methods: Thirty patients undergoing apicoectomy were randomly assigned to three groups (n=10 each): PRF, PRF + Bio-Oss, and control (NaCl 0.9%). Linear defect measurements were obtained from standardized periapical radiographs, while volumetric analysis was conducted using CBCT segmentation software at baseline and 3, 6, and 12 months postoperatively. Regeneration percentage was calculated based on defect reduction. Postoperative pain (VAS 0-10) and edema (0-3 scale) were recorded for 7 days. Data were analyzed using paired t-tests and repeated-measures ANOVA (p<0.05).

Results: All groups showed significant defect reduction (p<0.001). PRF-based treatments achieved greater regeneration than control (2D: F(2,27)=12.41, p<0.001; 3D: F(2,27)=18.93, p<0.001), with the PRF+Bio-Oss group showing the highest percentages (2D: 82.6%±7.2; 3D: 90.4%±4.8). CBCT analysis demonstrated greater sensitivity and effect size than 2D radiography. No significant differences were observed in postoperative pain or edema.

Conclusion: PRF enhances bone regeneration after apicoectomy, especially when combined with Bio-Oss, without increasing postoperative morbidity. CBCT volumetric assessment provides superior evaluation of regenerative outcomes.