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Table of Contents
CASE REPORT
Year : 2020  |  Volume : 7  |  Issue : 1  |  Page : 14-16

Platelet-rich fibrin in the management of periapical lesions: A case series


1 Assistant Professor, Department of Periodontology, Subbaiah Institute of Dental Sciences, Shivamoga, Karnataka, India
2 Reader, Department of Periodontology, Subbaiah Institute of Dental Sciences, Shivamoga, Karnataka, India
3 Professor and Head, Department of Periodontology, Subbaiah Institute of Dental Sciences, Shivamoga, Karnataka, India
4 Assistant Professor, Department of Conservative Dentistry and Endodontics, Subbaiah Institute of Dental Sciences, Shivamoga, Karnataka, India
5 Senior Resident, Department of Periodontology, Maulana Azad Institute of Dental Sciences, New Delhi, India
6 Assistant Professor, Department of Oral Medicine and Radiology, Subbaiah Institute of Dental Sciences, Shivamoga, Karnataka, India

Date of Submission19-Dec-2019
Date of Acceptance22-Dec-2019
Date of Web Publication22-Dec-2019

Correspondence Address:
Bharathi
Department of Periodontology, Subbaiah Institute of Dental Sciences, Shivamoga, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INPC.INPC_62_19

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  Abstract 


Platelet rich Fibrin is a rich concentrate of various growth factors which exhibit properties such as cell migration, cell attachment ,cell proliferation, and cell differentiation .These properties allow for the enhancement of the regenerative process and hence the use of the PRF has been increasing in the field of Dentistry.In this case report we have described the use of two cases of periapical leions wherein the PRF has been used along with bone grafts as a regenerative material.

Keywords: Periapical lesions, platelet-rich fibrin, regeneration


How to cite this article:
Bharathi, Manasa H D, Manjunath S G, Anand V, Datta A, Shanthala D. Platelet-rich fibrin in the management of periapical lesions: A case series. Int J Prev Clin Dent Res 2020;7:14-6

How to cite this URL:
Bharathi, Manasa H D, Manjunath S G, Anand V, Datta A, Shanthala D. Platelet-rich fibrin in the management of periapical lesions: A case series. Int J Prev Clin Dent Res [serial online] 2020 [cited 2020 Apr 8];7:14-6. Available from: http://www.ijpcdr.org/text.asp?2020/7/1/14/275692




  Introduction Top


Periapical lesions usually occur due to pulpal disease or extensive periodontal damage. Diagnosis is made during routine dental radiographic examination or following acute pain in a tooth. Periapical lesions are most commonly occurring pathological lesions of the alveolar bone. They may also be seen in the same instances unrelated to pulpal inflammation and present as neoplasms.

The periapical lesions can be classified as periapical abscess, periapical granuloma, and peri-radicular cysts. Evidence suggest that the periapical lesions increase in size, the proportion of radicular cysts increases, and some large lesions have been shown to be granulomas. A definitive cystic lesion diagnosis can be made only on histological examination.

The usual mode of treatment of periapical lesions are:

  • Conservative nonsurgical procedures (root canal treatment)
  • Surgical intervention (only after nonsurgical techniques have failed).


Usually, the periapical lesions heal satisfactorily after nonsurgical endodontic intervention. According to a study conducted by Mazumbar et al., treatment of 24.5% of cases was impossible without surgical therapy.[1]

Platelets play a vital role in the wound-healing process. They are formed in the bone marrow from megakaryocytes. Typically, they are discoidal and have nuclear structures. The cytoplasm in them contains many granules, out of which the alpha granules contain many proteins which are platelet specific or nonplatelet specific. Platelet-rich fibrin (PRF) preparation generates fibrin network which allows for cell migration and proliferation and induces tissue repair and regeneration.


  Case Reports Top


In this case series, we have discussed two cases with periapical lesions which were effectively managed using PRF and bone grafts.

Case 1

A female patient aged about 28 years reported to Subbaiah Institute of Dental Sciences, Shivamoga, Karnataka, India, with pain in the right mandibular premolar region. Clinical examination showed no carious lesion and probing pocket depth around 44 and 45 is 3 mm. Intraoral periapical radiograph in relation to 44 and 45 showed vertical bone loss around 43 and 44. After clinical and radiographic evaluation, a diagnosis was made as primary endodontic and secondary periodontal lesion and a combined endo perio approach was decided upon for treatment. After root canal treatment, periapical surgery was carried out. Submarginal incision was made to preserve the intact epithelial attachment. Apicectomy was carried out after the debridement of lesion. Mineral trioxide paste was used for retrograde restoration, following which PRF was placed in the cystic lesion and flaps were sutured. The patient was evaluated after 1 week and uneventful healing was noted. Intraoral periapical radiograph made 4 months postoperatively showed reduction in radiolucency around the periapical areas of the involved teeth indicating bone fill in the lesion [Figure 1], [Figure 2].
Figure 1: Preoperative radiograph

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Figure 2: Platelet-rich fibrin placed in the defect

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Case 2

A male patient aged about 35 years reported to Subbaiah Institute of Dental Sciences, Shivamoga, Karnataka, India, with pain in the upper front tooth region. After clinical and radiographic evaluation, a diagnosis of primary endodontic and secondary periodontic lesions was arrived at and a combined endo perio approach was decided upon for treatment. After root canal treatment, periodontal surgery was carried out. Apicectomy was done after debridement of the lesion. Following the apicectomy, PRF and collagen membrane were placed in the cystic lesion and flaps were sutured. Healing was uneventful [Figure 3], [Figure 4].
Figure 3: Preoperative occlusal radiograph

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Figure 4: After platelet-rich fibrin placement

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  Discussion Top


Endo-perio lesions can develop through an endodontic lesion or through periodontal destruction.[2] In either cases, irrespective of the etiopathogenesis, the prognosis of an affected tooth can be improved by increasing the bony support, which can be achieved by bone grafting and guided tissue regeneration.[3],[4] Regeneration of the lost periodontal tissue is the main aim of surgical periodontal therapy.

The PRF has regenerative potential which can lead to regeneration when placed in intrabony defects, furcation areas, and cystic cavities. It was first developed by Choukroun et al. in France in 2001.[5] PRF belongs to a new generation of platelet concentrates which contain all constituents of a blood sample favorable for healing and immunity.[6]

The PRF matrix enmeshes glycosaminoglycans (heparin and hyaluronic acid) from blood and platelets, which helps in cell migration in healing process.[5] In addition, platelet cytokines play a fundamental role in initial healing mechanisms owing to the capacity to stimulate cell migration and proliferation and induce fibrin matrix remodeling as well as secretion of cicatricial collagen matrix.[7] It also facilities healing by controlling inflammatory response. PRF contains high concentration of growth factors as its main component, which are contained in the platelets necessary for wound healing. It also acts as a fibrin bandage, serving as a matrix to accelerate the healing of wound. Among the various growth factors contained in PRF, platelet-derived growth factor, vascular endothelial factor, and fibroblast growth factor are believed to play a major role in bone metabolism and potential regulation of cell proliferation. All these properties make it a novel biomaterial for periodontal regenerative therapy. Furthermore, the use of PRF eliminates the cost issues and provides affordable treatment.

According to the results of a study conducted by Chao et al., clinical application of PRF as a sole grafting material is effective as a mode of regenerative therapy for periodontal intrabony defects.[8] The results of a study carried out by Pratibha et al. also demonstrate a substantial bone fill within 12 months after the use of PRF alone as a grafting material. These evidences point toward the beneficial effect of the use of PRF as a mode of regeneration in the case of endo-perio lesions.[6]


  Conclusion Top


From the presented cases, it can be concluded that PRF is efficacious clinically and radiographically in the treatment of intrabony defects caused by periapical pathology. PRF is an autologous preparation and is found to be clinically effective and economically feasible than any other regenerative material presently available. Long-term controlled clinical trials are required to evaluate the final treatment outcome.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mazumbar P, Bhunia S. Treatment of periapical lesion with platelet rich fibrin. Indian Med Gazette 2013;28:33.  Back to cited text no. 1
    
2.
Singh P. Endo-perio dilemma: A brief review. Dent Res J (Isfahan) 2011;8:39-47.  Back to cited text no. 2
    
3.
Zubery Y, Kozlovsky A. Two approaches to the treatment of true combined periodontal-endodontal lesions. J Endod 1993;19:414-6.  Back to cited text no. 3
    
4.
Tseng CC, Harn WM, Chen YH, Huang CC, Yuan K, Huang PH. A new approach to the treatment of true-combined endodontic-periodontic lesions by the guided tissue regeneration technique. J Endod 1996;22:693-6.  Back to cited text no. 4
    
5.
Choukroun J, Adda F, Schoefffler C, Vervelle A,. An opportunity in perio-implantology :the PRF(french). Implantodontie 2001;42:55-62.  Back to cited text no. 5
    
6.
Shashikumar P, Nisha S. Autologous platelet concentrates as a potential regenerative biomaterial in treatment of endoperio lesion. Indian J Oral Health Res 2016;2:106-9.  Back to cited text no. 6
  [Full text]  
7.
Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, et al. Platelet-rich fibrin (PRF): A second-generation platelet concentrate. Part II: Platelet-related biologic features. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101:e45-50.  Back to cited text no. 7
    
8.
Chao Y, Kuo-Chin W, Jiing-Huei Z. Clinical application of platelet rich fibrin a sole grafting material in periodontal intrabony defects. J Dent Sci 2011;6:181-8.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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