Efficacy of mixture of injectable-platelet-rich fibrin and type-1 collagen particles on the closure of through-and-through periapical bone defects: A randomized controlled trial

Effect of allograft and collagen membrane application on periapical and labial bone regeneration in apicomarginal defects treated with endodontic microsurgery: a randomized controlled trial

OBJECTIVE

To evaluate effectiveness of guided tissue regeneration (GTR) using an allograft and collagen membrane versus non-GTR for apicomarginal defects using endodontic microsurgery at 1-year follow-up.

STUDY DESIGN

Thirty healthy adult patients with apicomarginal defects requiring periradicular surgery were randomly assigned to either study group (n = 15) or control group (n = 15). Study group received allograft and bioresorbable collagen membrane, while control group underwent surgery without GTR. Both groups were treated using endodontic microsurgery by same operator, following standardized protocol. Clinical and radiographic evaluations were conducted at baseline and after 12 months. Periapical healing was assessed using Rud and Molven's criteria on periapical radiographs and modified PENN 3D criteria for cone-beam computed tomography (CBCT) scans. Labial bone height was also measured with CBCT. Statistical analyses included descriptive statistics, Mann-Whitney, Wilcoxon rank-sum tests, and Fisher's exact test, with significance set at P < .05.

RESULTS

Clinical outcomes were favorable in both groups. 2D periapical healing assessment showed 100% success in study group versus 86.6% in control group (P = .143). 3D periapical healing success rate was 80% in both groups. Labial alveolar bone regeneration was significantly higher in study group (17.64 ± 19.76%) compared to control group (4.74 ± 13.14%) (P = .023).

CONCLUSION

At 1-year follow-up, study findings indicated that use of allograft and collagen membrane in GTR significantly improves labial alveolar bone regeneration in apicomarginal defects treated with endodontic microsurgery.

Healing Outcomes of Through-And-Through Bone Defects in Periapical Surgery: A Systematic Review and Meta-Analysis

Through-and-through (TAT) cortical plate defects present a challenge in periapical surgery, influencing treatment outcomes. This study investigates whether guided regenerative procedures (GRPs) enhance cortical plate healing and overall success compared to non-GRP treatments in TAT lesions. A systematic search was conducted across PubMed, CINAHL Plus, Wiley Cochrane Library, and Dental and Oral Science. Studies assessing endodontically treated teeth with TAT lesions via Cone Beam Computed Tomography were included. The risk of bias was assessed using Cochrane Risk of Bias 2.0 tool and Newcastle-Ottawa Scale. Five studies met inclusion criteria, with four included in meta-analysis. No significant differences were observed in cortical plate healing (OR: 0.52, 95% CI: 0.12-2.39; p = 0.40) or treatment success (OR: 0.35, 95% CI: 0.09-1.39; p = 0.14) between GRPs and non-GRPs. Findings suggest that GRPs do not significantly improve healing in TAT lesions, highlighting the need for further studies with larger sample sizes.

Endodontic surgery and platelet concentrates: A comprehensive review

While autologous platelet concentrates (APCs) have gained traction as promising regenerative materials in recent years, their impact on wound healing and tissue regeneration in periapical hard tissue defects remains controversial. Endodontic microsurgery (EMS) has embraced the potential of platelet concentrates, particularly L-PRF (Leucocyte-Platelet-Rich Fibrin) and PRP (Platelet-Rich Plasma), as regenerative tools. These concentrates, rich in growth factors and other bioactive molecules, are thought to enhance healing and treatment outcomes for various endodontic conditions. However, their effectiveness remains a subject of investigation. Despite encouraging 3-D cone beam computed tomography (CBCT) based evidence for PRP's effectiveness in complex lesions and apico-marginal defects, inconsistencies in its performance across preparation and application protocols raise questions about its superiority over existing options. More research is crucial to understand its full potential as a reliable regenerative tool in endodontics. L-PRF and its derivatives are particularly effective in treating apical-marginal defects. It enhances clinical attachment levels and reduces probing pocket depths, likely due to its slow and coordinated release of various growth factors. L-PRF has been shown to also improve patients' quality of life by reducing postoperative swelling and pain. However, more research is needed to standardize its preparation methods and confirm its long-term benefits. This paper aims to provide a comprehensive review of the current knowledge and recent advances in endodontic surgery and the use of platelet concentrates, focusing on their roles in managing periapical lesions and endo-perio lesions.

Impact of regenerative procedure on the healing process following surgical root canal treatment: A systematic review and meta-analysis

INTRODUCTION

Different Guided Tissue Regeneration (GTR) procedures, such as membranes, bone substitute materials, and Autologous Platelet Concentrates (APCs), have been applied after surgical root canal treatment (SRCT), which produce different outcomes. This study aimed to evaluate the impact of regenerative procedures on the healing process following SRCT.

METHODS

A comprehensive search of PubMed, Embase, Scopus, Cochrane, and the Web of Science found Randomized Controlled Trials (RCTs) published until February 25, 2024. Manual searches were also conducted. Our main outcome was SRCT success or failure after GTR procedures. The Risk Ratio (RR) and failure rate meta-analysis used a fixed effects model with a 95% confidence interval (CI). Subgroup analyses were conducted based on the use of different GTR procedures for varying lesion types in SRCT.

RESULTS

Out of 1,605 records, 16 studies with 690 lesions were included. Overall, GTR procedures significantly improved healing after SRCT in both 2D (RR: 0.50; 95% CI, 0.34-0.73; P < 0.001) and 3D evaluation methods (RR: 0.36; 95% CI, 0.15-0.90; P < 0.001) with no significant difference between the two methods.

CONCLUSION

GTR significantly improved SRCT healing regardless of the evaluation method used. Combining collagen membranes with bovine bone-derived hydroxyapatite significantly enhanced the healing process. Additionally, GTR procedures significantly improve healing in through-and-through lesions.

Two- and three-dimensional healing assessment after endodontic microsurgery in through-and-through periapical lesions: 5-year follow-up from a randomized controlled trial

AIM

To evaluate clinical and radiographic outcome of endodontic microsurgery in through-and-through periapical lesions at 1-year and 5-year follow-up with adjunct use of platelet-rich plasma (PRP).

METHODOLOGY

Thirty-two patients with large through-and-through periapical lesions were randomized in platelet-rich plasma (PRP) group and control group. Two-dimensional (2D) healing was evaluated with Molven's criteria and three-dimensional (3D) healing with modified PENN 3D criteria. Healing at resection plane (R), apical area (A), buccal cortex (BC), palatal cortex (PC) and overall bone healing (B) was assessed using CBCT scans. The volume of lesion was measured using ITK-Snap software. The analysis included comparison of 1- to 5-year intragroup (Friedman test/McNemar test) and intergroup scoring (Chi-square/ Mann-Whitney test). Logistic regression analysis was performed to determine the effect of various factors on healing at 5 years.

RESULTS

Out of 32 patients/59 teeth evaluated after 1-year of endodontic microsurgery, 24 patients/44 teeth reported at 5 - year follow-up. Healing assessment with modified PENN 3D criteria revealed improvement in overall success rate of 66.7% at 1 year to 83.3% at 5 years, with no deterioration in any healing category. PRP group exhibited significantly better 3D healing than control group; both at 1 year (84.6% vs. 45.5%) and 5 years (100% vs. 63.6%). A significantly higher number of completely healed teeth were observed in PRP group than the control group at 5 years with respect to R, BC and B parameters. A volume reduction of 88% (91.4% PRP, 84% control) was depicted at 1 year and 94% (97.1% PRP, 91.1% control) at 5 years. None of the recorded factors including age, gender, size of lesion, preoperative swelling and sinus, histology of lesion, use of PRP, tooth location, preoperative buccal bone had significant effect on 3D healing at 5 years.

CONCLUSIONS

This 5-year study suggested improvement in 3D radiographic healing of large through-and-through periapical lesions from 1 to 5 years with no deterioration in any healing parameter in both control and PRP groups. The additional use of PRP led to significantly better healing in such lesions. RACB index using CBCT allows better estimation of healing at resected, apical and cortical plane over modified PENN 3D or Molven's criteria.

Type 1 collagen: Synthesis, structure and key functions in bone mineralization

Collagen is a highly abundant protein in the extracellular matrix of humans and mammals, and it plays a critical role in maintaining the body's structural integrity. Type I collagen is the most prevalent collagen type and is essential for the structural integrity of various tissues. It is present in nearly all connective tissues and is the main constituent of the interstitial matrix. Mutations that affect collagen fiber formation, structure, and function can result in various bone pathologies, underscoring the significance of collagen in sustaining healthy bone tissue. Studies on type 1 collagen have revealed that mutations in its encoding gene can lead to diverse bone diseases, such as osteogenesis imperfecta, a disorder characterized by fragile bones that are susceptible to fractures. Knowledge of collagen's molecular structure, synthesis, assembly, and breakdown is vital for comprehending embryonic and foetal development and several aspects of human physiology. In this review, we summarize the structure, molecular biology of type 1 collagen, its biomineralization and pathologies affecting bone.