Regenerative endodontics: a promising tool to promote periapical healing and root maturation of necrotic immature permanent molars with apical periodontitis using platelet-rich fibrin (PRF)

Purpose: Currently, mineral trioxide aggregate (MTA) apexification is recommended as the preferred treatment for permanent anterior immature necrotic teeth. Apexification treatment does not enable further development and maturation of the teeth, resulting in short roots with thin root canal walls, that often are prone to cervical fractures. This study presents the regenerative endodontic procedure (REP) as an alternative treatment for immature necrotic molars with apical periodontitis or a chronic apical abscess. REP enables periapical healing as well as root lengthening and widening of the dentinal root canal walls. Case series results: Six immature first molars teeth (five mandibular, one maxillary) with apical periodontitis or chronic apical abscess were treated with REP. Patients underwent periodic follow-up visits every 3 months the first year and twice a year thereafter. The final clinical examination revealed no symptoms, no gingival pockets, and no sensitivity to percussion. Cold sensitivity tests were negative. Radiographs revealed full periapical healing in all the treated molars, remarkable root lengthening, and dentinal wall thickening. Conclusion: REP with PRF is feasible and may have some advantages over MTA apexification since it facilitates root elongation, dentinal thickening of the root canals walls, and narrowing of the apical foramen.