Comparative histological evaluation of two PRF formulations (PRF High and PRF Medium) on quality of life and healing outcome of apicomarginal defects: A randomized clinical trial |
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| Affiliation: | 1. Department of Conservative Dentistry and Endodontics, Post Graduate Institute of Dental Sciences Rohtak (Haryana), India;2. Department of Oral Pathology and Microbiology, Post Graduate Institute of Dental Sciences Rohtak (Haryana), India;3. Department of Oral Medicine and Radiology, Post Graduate Institute of Dental Sciences Rohtak (Haryana), India;1. Dept of Oral and Maxillofacial Surgery, Indo-Bhutan Friendship Hospital, Thimphu, 11001, Bhutan;2. Dept of Oral and Maxillofacial Surgery, Command Military Dental Centre (Western Command), Chandimandir, India;3. Dept of Anesthesiology, Military Hospital, Jalandhar Cantt, Punjab, India;4. Department of Preventive & Social Medicine, Armed Forces Medical College, Pune, Maharashtra, India;1. Univ. Angers, CHU Angers, Department of Oral and Maxillofacial Surgery, 49000, Angers, France;2. Univ. Bordeaux, CHU Bordeaux, Inserm, Department of Oral and Maxillofacial Surgery, U 1026 – Bioengineering of Tissues, F-33000, Bordeaux, France;3. Maxillo-Facial Surgery Department, Amiens-Picardie University Hospital, 80000, Amiens, France;4. Department OMFS, Department Imaging and Pathology, Faculty of Medicine, Leuven University Hospitals, Leuven, Belgium;5. Department of Pathology, Lille University Hospital, Lille, France;6. Inserm, CNRS, UMR9020, U1277 - CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies, University of Lille, Lille University Hospital, F-59000, Lille, France;7. Univ. Lille, CHU Lille, Inserm, Department of Oral and Maxillofacial Surgery, U 1008 - Controlled Drug Delivery Systems and Biomaterials, F-59000, Lille, France;8. ENT and Head and Neck Department, Lille, 59037, Cedex, France;9. University Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, Lille, F-59000, France;10. Univ. Bordeaux, CHU Bordeaux, Department of Oral and Maxillofacial Surgery, F-33000, Bordeaux, France;11. Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Herestraat 49, Leuven, Belgium;1. Hospital Sírio Libanês, São Paulo, Brazil;2. Instituto Vita, São Paulo, Brazil;1. Department of Oral and Cranio-maxillofacial Surgery, Ninth People''s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China;2. National Center of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, PR China;3. Department of Stomatology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China;4. Department of ENT and Oral Maxillofacial Surgery, Shanghai Children Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China |
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| Abstract: | The objective of this randomized clinical trial was to investigate the effects of two PRF formulations (PRF High and PRF Medium) on quality of life and healing outcome (2D and 3D) of apicomarginal defects.Patients presenting with endodontic lesions and concomitant periodontal communication were randomly allocated to PRF High and PRF Medium groups. The treatment protocol in each group included a periapical surgical procedure with placement of PRF clot and membrane in the bony defect and on the denuded root surface, respectively. Quality of life was assessed for 1 week after surgery following a modified version of the patient's perception questionnaire. Postoperative pain was assessed using a visual analog scale. Clinical and radiographic evaluations were performed using Rud and Molven 2D criteria and Modified PENN 3D criteria. Buccal bone formation was assessed using sagittal and corresponding axial sections in CBCT. Histological analysis was performed using hematoxylin and eosin (H and E) staining and attaching primary antibodies to tissue sections.In total, 40 patients were enrolled in the trial (N = 20 per group). PRF Medium group patients reported significantly less swelling on the 1st (p = 0.036), 2nd (p = 0.034), and 3rd (p = 0.023) days, and average pain on the 2nd (p = 0.031), 3rd (p = 0.03), and 4th (p = 0.04) days postoperatively. The difference in success rate for periapical healing was non-significant between the PRF Medium group (89.5%) and PRF High group (90%), in both 2D and 3D imaging (p = 0.957). The formation of buccal bone was observed in five cases (26.3%) and four cases (20%) in the PRF Medium and PRF High groups, respectively, with a non-significant difference (p = 0.575). PRF Medium clots had a loose fibrin structure with a significantly higher number of neutrophils (473.79 ± 82.89 per mm2) than PRF High clots, which had a dense structure and fewer neutrophils (253.15 ± 63.86 per mm2) (p = 0.001). Autologous platelet concentrates (APCs) promoted satisfactory periapical healing, with no significant difference between the groups.Within the limitations of the study, it seems that PRF Medium should be preferred over PRF High when the patients’ quality of life is the priority. |
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| Keywords: | Consort randomized clinical trial Apicomarginal defect Platelet-rich fibrin high (PRF High) Platelet-rich fibrin medium (PRF Medium) Relative centrifugal force (RCF) Quality of life Middle East and India |
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