Effect of platelet rich fibrin barier and bioceramic sealer in endodontic treatment immature teeth with periapical lesions
This case report demonstrates that combining a platelet-rich fibrin (PRF) apical barrier with a bioceramic sealer for endodontic treatment of immature permanent teeth with periapical lesions results in favorable clinical and radiographic outcomes, including complete lesion healing within six months.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Imagine your teeth are like skyscrapers. When a building is finished, it has a solid foundation and a strong, closed roof. But sometimes, a building gets damaged before it's fully built—maybe a storm hits, or a pipe bursts inside the walls. In the world of dentistry, this happens when a young tooth gets a cavity or a hit from a fall. The "roof" (the tip of the root) stays wide open, and the "scaffolding" (the nerve inside) dies. This leaves a hole at the bottom of the tooth where bacteria can sneak in and start a fire in the bone around it, called a periapical lesion.
For a long time, fixing these "unfinished skyscrapers" was tricky. Dentists had to use strong cement to plug the hole, but without a natural floor to stop it, the cement could leak out, or the thin walls of the tooth could crack under pressure. It was like trying to pour concrete into a bucket with a hole in the bottom. Recently, scientists have been testing two special tools to fix this: a "bioceramic sealer," which is a super-smart, self-healing cement that loves bone, and "Platelet-Rich Fibrin" (PRF), which is like a magical, healing sponge made from the patient's own blood. This study asks a simple question: If we use the healing sponge to build a temporary floor at the bottom of the tooth, and then fill the rest with the smart cement, will the fire go out and the building get strong again?
The Experiment: Building a Floor with Blood and Cement
In this study, a team of dentists in Ho Chi Minh City, Vietnam, decided to test this exact combination. They looked at 15 teeth belonging to 14 patients, all of whom were between 7 and 14 years old. These were "immature" teeth, meaning their roots were still growing and had wide-open tips, and they all had infections (lesions) at the bottom.
The treatment plan was a bit like a construction project. First, the dentists cleaned out the infected "scaffolding" inside the tooth. Then, they took a small sample of blood from the patient, spun it in a machine to separate out the healing parts (the PRF), and cut it into tiny pieces. They pushed these pieces down to the very bottom of the tooth root to act as a "floor" or barrier. This was crucial because it stopped the filling material from falling out of the open tip. Once this "blood floor" was in place, they filled the rest of the tooth with a special bioceramic sealer (Bio-C® Sealer) and warm gutta-percha (a rubber-like filling material).
What Happened Next?
The results were surprisingly quick and positive. The researchers checked on the patients at 1, 2, 3, and 6 months after the procedure.
- The Pain: Right after the treatment, most patients felt fine. By the one-week mark, everyone reported zero pain. There was no swelling, no pus, and no tenderness when they tapped on the teeth. By the one-month follow-up, every single tooth (15 out of 15) was completely symptom-free.
- The X-Rays: This is where the magic really showed up. Before treatment, the average size of the infection hole in the bone was about 37.6 square millimeters.
- After 1 month, the average hole had shrunk to 17.0 mm².
- After 2 months, it was down to 4.4 mm².
- After 3 months, it was barely visible at 1.0 mm².
- By 6 months, the X-rays showed that all 15 lesions had completely disappeared. The bone had healed back to normal.
In 9 of the 15 teeth (60%), the dentists even saw a new, hard layer of tissue forming at the very tip of the root, effectively "capping" the open end naturally. This is a huge deal because it means the tooth might continue to grow stronger, rather than staying weak and fragile.
Why This Matters (and What It Doesn't Say)
The authors suggest that using the patient's own blood (PRF) as a barrier, combined with the super-sealing bioceramic cement, is a winning strategy for these tricky, open-rooted teeth. It seems to heal the infection faster than some older methods, which often took years to show results. The "blood floor" seems to act as a scaffold that guides the body's own cells to rebuild the bone, while the cement keeps everything sealed tight.
However, the paper is careful not to call this a "perfect, forever solution" just yet. The study only followed the patients for six months, so we don't know for sure if the teeth will stay this healthy for decades. Also, the group was small (only 15 teeth), and they didn't have a control group to compare against (like a group that got treated with a different method). The researchers admit that future studies with more people and 3D scans (like CBCT) would be needed to confirm these findings and see exactly how the roots are developing over the long haul.
But for now, the story is a hopeful one: for young patients with broken, unfinished teeth, a mix of their own blood and high-tech cement might just be the key to saving their smile and letting their teeth finish growing strong.
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