Mittal Neelam, Parashar Vijay
Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India, Phone: +91 9936033339, e-mail:
J Contemp Dent Pract. 2019 Jun 1;20(6):720-726.
The aim of this study is to evaluate and compare the regenerative potential of natural scaffold [platelet-rich fibrin (PRF)] and artificial scaffolds (commercially available collagen, placentrex, and chitosan) in necrotic immature permanent teeth.
Necrotic immature permanent maxillary incisors with or without radiographic evidence of periapical lesion were included. Access opening was done under rubber dam isolation. Canal disinfection was done using minimal instrumentation, copious irrigation, and double antibiotic paste as interappointment medicament for 4 weeks. After 4 weeks, asymptomatic teeth were divided into four groups on the basis of scaffolds used for the revascularization procedure: group I (PRF); group II (collagen); group III (placentrex); group IV (chitosan). The clinical and radiographic evaluations of teeth were done at 3, 6, and 12 months after the procedure and compared with baseline records.
Clinically, patients were completely asymptomatic throughout the study period. Radiographically, all cases showed an improvement in terms of periapical healing, apical closure, root lengthening, and dentinal wall thickening. PRF and collagen gave better results than placentrex and chitosan in terms of periapical healing, apical closure, and dentinal wall thickening.
Revascularization procedure is more effective and conservative over apexification in the management of necrotic immature permanent teeth. This study has shown that PRF and collagen are better scaffolds than placentrex and chitosan for inducing apexogenesis in immature necrotic permanent teeth.
本研究旨在评估和比较天然支架[富血小板纤维蛋白（PRF）]和人工支架（市售胶原蛋白、胎盘提取物和壳聚糖）在坏死未成熟恒牙中的再生潜力。
纳入有或无根尖周病变影像学证据的坏死未成熟恒上颌切牙。在橡皮障隔离下进行开髓。采用最小限度的器械操作、大量冲洗，并使用双重抗生素糊剂作为复诊间药物进行根管消毒，持续4周。4周后，将无症状的牙齿根据用于再血管化程序的支架分为四组：第一组（PRF）；第二组（胶原蛋白）；第三组（胎盘提取物）；第四组（壳聚糖）。在术后3、6和12个月对牙齿进行临床和影像学评估，并与基线记录进行比较。
临床上，患者在整个研究期间完全无症状。影像学上，所有病例在根尖周愈合、根尖闭合、牙根延长和牙本质壁增厚方面均有改善。在根尖周愈合、根尖闭合和牙本质壁增厚方面，PRF和胶原蛋白的效果优于胎盘提取物和壳聚糖。
在坏死未成熟恒牙的治疗中，再血管化程序比根尖诱导成形术更有效且更保守。本研究表明，在诱导未成熟坏死恒牙根尖形成方面，PRF和胶原蛋白是比胎盘提取物和壳聚糖更好的支架。
