Regenerative Potential Of Platelet Rich Fibrin With MTA In Non- Vital Immature Apex: A Case Report

Treatment of a non vital tooth with necrotic pulp and immature apex is a great challenge to the clinician. In obturation for gutta-percha condensation, there should be an apical barrier to avoid extrusion of cements and gutta-percha into the apical area leading to periapical trauma. Apexification is a method which is used for treatment of such tooth with open apex. It is defined as “a method to induce a calcified barrier in a root with an open apex or the continued apical development of an incomplete root in teeth with necrotic pulp”. Recently, synthetic apical barriers with a variety of materials have been proposed as alternatives to the traditional apexification treatment method with calcium hydroxide. These include tricalcium phosphate, freeze dried bone, freezedried dentin, collagen calcium phosphate, proplast, polytetrafluor-ethylene and carbon felt-like porous material. Antibacterial pastes like metronidazole, ciprofloxacin, and cefactor have effectively encouraged apexification. Deliberate over-instrumentation of the periapical area to produce a blood clot that will induce apical closure has also been described. MTA has been suggested to create an apical plug at the rootend and helps to prevent the extrusion of the filling materials.[12],[13] There was a paradigm shift in the treatment protocol of such teeth from apexification to regenerative procedures and as such several cases have been reported of use of platelet rich fibrin as apical matrix. [14, 15] This case report presents the management of an immature tooth (with an open apex) with an apical barrier placement by PRF membrane and MTA as an internal matrix with an Abstract: Non-vital teeth with immature open apices with or without associated periapical pathology defy routine endodontic management. Formation of a calcified barrier at the root end using calcium hydroxide was favored treatment for such cases in the past. With the introduction of MTA, single visit Apexification using MTA has gained acceptance. Platelet Rich Fibrin is an autologous fibrin matrix containing a large quantity of platelet and leukocyte cytokines, which enhance healing by release of growth factors. This case report represents successful management of a case of an immature anterior tooth with PRF used as a scaffold and source of growth factor for the formation of a biologic seal while a physical barrier was achieved with MTA.