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Endodontics

Authors: Dr. Annil Dhingra

INTRODUCTION

The primary goal of dental treatment is the maintenance of the natural dentition in health and for optimum comfort , function and esthetic. Periapical infections should be initially treated with conventional endodontic therapy. This improves result in 85% of the cases. However failed root canal treatment calls for surgical intervention . In clinical conditions, periapical surgery remains the last option when either root canal treatment fails or is not possible. After surgical procedure healing usually occurs by repair or regeneration. Regeneration has been defined as the reproduction or reconstitution of a lost or injured part to restore the architecture and function of the periodontium. It is possible to achieve bone regeneration by using autografts and biomaterials as both have presented high rates of success. Regenerative surgery including the use of barrier membrane, graft material, can support the formation of tissue and allow regenerative rehabilitation and also functional reconstruction.

Platelet rich fibrin (PRF) introduced by Choukroun et al(2001) is a second generation platelet concentrate. Periapical tissue’s regeneration and healing is enhanced by concentrate enriched with platelet and growth factor. Post-surgically, blood clots initiate the healing andregeneration of hard and soft tissues. Platelet rich fibrin (PRF) is coming up as a biological revolution in dental field. Using platelet-rich fibrin, or PRF, is a way to accelerate and enhance the body’s natural wound-healing mechanisms. Platelets primarily are involved in wound healing through clot formation and the release of growth factors that initiate and support wound healing.3Growth factors are the biologically active substances that are involved in tissue-repair mechanism such as chemotaxis, cell proliferation, angiogenesis, extracellular matrix deposition, and remodelling. PRF contains and releases (through degranulation) at least seven different growth factors (cytokines) that stimulate bone and soft tissue healing. An easy, cost-effective way to obtain high concentrations of growth factors for tissue healing and regeneration is autologous platelet storage via PRF.


The PRF production protocol attempts to accumulate platelets and released cytokines in a fibrin clot. New technology permits to safely harvest and produce a sufficient quantity of platelets from only 8-10 ml of blood drawn from patients in dental office. Surgical sites enhanced with PRF have been shown to heal at rates two to three times that of normal surgical sites.

Patient chief complaint of occasional pain in the upper front tooth

On intraoral examination, central incisor was slight discolored with slight mobility and no swelling or pus exudation. There was history of dental procedure used and risks and benefits. Before the surgery, patient’s complete hemogram was done and all the parameters were found within normal limits. Intraoral antisepsis was performed using 2% chlorhexidine gluconate and extra oral antisepsis using 1% povidine iodine solution.

Administration of local anesthesia, one horizontal and two vertical incisions were placed at marginal gingiva followed by reflection of full mucoperiostealflap . Meticulous debridement was done and obturation was done using lateral compaction technique.

PRF was prepared in accordance with the protocol developed by Choukrounet al. Intravenous blood was obtained by venipuncturing the antecubital vein and was collected in a 10 ml sterile tube followed by immediate centrifugation at 3,000 rpm for 10 minutes. Once centrifugation was completely done, PRF was easily separated from red corpuscles base (preserving a small RBC layer) using sterile tweezers and then transferred into a test tube. PRF was used and augmented into the intra bony defect upon the surrounding bone level. The flap was repositioned and sutures were given using 3-0 non-absorbable black silk suture .