Endodontic Microsurgery

NCT ID: NCT06776289

Last Updated: 2026-01-16

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

PHASE4

Total Enrollment

20 participants

Study Classification

INTERVENTIONAL

Study Start Date

2026-03-31

Study Completion Date

2026-12-30

Brief Summary

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Current literature on platelet rich fibrin (PRF) use in apicoectomies, also known as endodontic microsurgery, is sparse. PRF use in oral surgery or periodontal surgery has been more thoroughly researched. Whether it is able to reduce post-op pain or if it improves success rate in endodontic microsurgery is not well known. It is also not well known if it will be able to increase the rate of healing. This study will evaluate the success of endodontic microsurgery with and without PRF.

Detailed Description

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Periradicular surgery is an endodontic procedure comprising of surgical access to the periapical area to perform direct periradicular curettage, root-end resection, root-end preparation and filling. In situations where the outcome of primary root canal treatment is not sufficient, nonsurgical retreatment is considered the option of choice. Surgical endodontic treatment is usually employed to manage apical periodontitis when the orthograde approach (root canal treatment or retreatment) to the apical root anatomy (and infection) is irretrievably obstructed.

However, If the existing root canal anatomy cannot be successfully explored and instrumented with the radiographic presence of apical periodontitis, nonsurgical retreatment has been reported to be as low as low as 40%. In addition, a variety of tooth-related factors may necessitate surgical retreatment, including complicated root canal anatomy, the pathophysiology of the apical pathosis, extreme root curvatures, severe root canal alterations caused during treatment, non-removable root filling materials, existing posts at great risk for retreatment, and root fractures as well as perforations, resorptions, or root fractures. Furthermore, a surgical approach may be indicated when the periradicular tissues require direct visualization, debridement, excision, biopsy or management due to biomechanical failures.

Yan et al. found that the use of concentrated growth factors may influence the outcome of endodontic microsurgery. A systematic review by Mehta found that the use of platelet aggregates, such as PRF gave a favorable effect on the healing of apico-marginal defects, the research suggests that more studies are needed on the healing outcomes of endodontic microsurgery with PRF.

PRF has been widely used in regenerative dentistry, periodontics, and oral surgery with varying degrees of success. It is made through centrifugation of peripheral blood with the resulting centrifuged product is a solid fibrin clot sandwiched between the supernatant and blood cells. The matrix of the solid fibrin clot is a matrix consisting of platelets, leukocytes, a variety of growth factors, and cytokines as well as high biocompatibility due to its autologous source.

In this study patients will receive endodontic microsurgery with one group having the osteotomy filled with PRF prior to closure and another group having surgery completed without the use of PRF. Healing will be evaluated through a series of follow up exams, limited field of view cone beam computed tomography, and periapical radiographs. Additionally, patients will be asked to completed a visual analog scale post surgery for 7 days to track the patients pain response.

Conditions

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Apical Periodontitis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Participants will be placed in group A or group B. Group A will have endodontic microsurgery without the use of PRF and group B will have endodontic microsurgery with the use of PRF.
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
Oral Radiologist assessing healing will not be aware if the patient had received PRF.

Study Groups

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Microsurgery with Platelet Rich Fibrin

Patents will have a blood draw completed so that PRF can be made. Endodontic microsurgery will then be completed. Prior to closing the flap, PRF will be placed in the osteotomy.

Group Type EXPERIMENTAL

Platelet rich fibrin

Intervention Type BIOLOGICAL

Platelet rich fibrin will be used to fill an osteotomy after endodontic microsurgery is completed.

Microsurgery Alone

Endodontic microsurgery will be completed without PRF. The osteotomy will remain empty as per standard procedure.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Platelet rich fibrin

Platelet rich fibrin will be used to fill an osteotomy after endodontic microsurgery is completed.

Intervention Type BIOLOGICAL

Eligibility Criteria

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Inclusion Criteria

* Maxillary or Mandibular Anterior teeth and premolars #4-13 and #20-29 with a history of failing RCT and a periapical radiolucency will be accepted

Exclusion Criteria

* Patients with vertical root fractures
* Patients with non-restorable teeth
* Patients with class 3 mobility
* Pregnant
* Smoker
* Systematic disease contraindicating surgery
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Mark Schachman

OTHER

Sponsor Role lead

Responsible Party

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Mark Schachman

Post Graduate Program Director in Endodontics

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Mark Schachman, DMD

Role: PRINCIPAL_INVESTIGATOR

Locations

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University of Kentucky College of Dentistry Endodontics Division

Lexington, Kentucky, United States

Site Status

Countries

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United States

Central Contacts

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Dawn Dawson, RDH, CCRC

Role: CONTACT

8593235409

Michael Skanchy, DMD

Role: CONTACT

859-562-2232

Facility Contacts

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Mark Schachman, DMD

Role: primary

8593238575

Dawn Dawson, RDH, CCRC

Role: backup

8593235409

References

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Miron RJ, Moraschini V, Fujioka-Kobayashi M, Zhang Y, Kawase T, Cosgarea R, Jepsen S, Bishara M, Canullo L, Shirakata Y, Gruber R, Ferenc D, Calasans-Maia MD, Wang HL, Sculean A. Use of platelet-rich fibrin for the treatment of periodontal intrabony defects: a systematic review and meta-analysis. Clin Oral Investig. 2021 May;25(5):2461-2478. doi: 10.1007/s00784-021-03825-8. Epub 2021 Feb 20.

Reference Type BACKGROUND
PMID: 33609186 (View on PubMed)

Fan Y, Perez K, Dym H. Clinical Uses of Platelet-Rich Fibrin in Oral and Maxillofacial Surgery. Dent Clin North Am. 2020 Apr;64(2):291-303. doi: 10.1016/j.cden.2019.12.012. Epub 2020 Feb 3.

Reference Type BACKGROUND
PMID: 32111269 (View on PubMed)

Mehta N, Gupta A, Aggarwal V, Abraham D, Singh A. Effect of autologous platelet aggregates on the healing outcome of periapical surgery for the management of apicomarginal defects: A systematic review. Saudi Endodontic Journal. 2020 Sep 1;10(3):187- DOI:10.4103/sej.sej_146_19

Reference Type BACKGROUND

Yan L, Lin J, Yang L, He S, Tan X, Huang D. Clinical Effect Evaluation of Concentrated Growth Factor in Endodontic Microsurgery: A Cross-Sectional Study. J Endod. 2023 Jul;49(7):836-845. doi: 10.1016/j.joen.2023.05.005. Epub 2023 May 12.

Reference Type BACKGROUND
PMID: 37182792 (View on PubMed)

Tsesis I, Rosen E, Tamse A, Taschieri S, Del Fabbro M. Effect of guided tissue regeneration on the outcome of surgical endodontic treatment: a systematic review and meta-analysis. J Endod. 2011 Aug;37(8):1039-45. doi: 10.1016/j.joen.2011.05.016.

Reference Type BACKGROUND
PMID: 21763891 (View on PubMed)

Pinto D, Marques A, Pereira JF, Palma PJ, Santos JM. Long-Term Prognosis of Endodontic Microsurgery-A Systematic Review and Meta-Analysis. Medicina (Kaunas). 2020 Sep 3;56(9):447. doi: 10.3390/medicina56090447.

Reference Type BACKGROUND
PMID: 32899437 (View on PubMed)

Torabinejad M, Corr R, Handysides R, Shabahang S. Outcomes of nonsurgical retreatment and endodontic surgery: a systematic review. J Endod. 2009 Jul;35(7):930-7. doi: 10.1016/j.joen.2009.04.023.

Reference Type BACKGROUND
PMID: 19567310 (View on PubMed)

Rud J, Andreasen JO, Jensen JE. Radiographic criteria for the assessment of healing after endodontic surgery. Int J Oral Surg. 1972;1(4):195-214. doi: 10.1016/s0300-9785(72)80013-9. No abstract available.

Reference Type BACKGROUND
PMID: 4199168 (View on PubMed)

Gorni FG, Gagliani MM. The outcome of endodontic retreatment: a 2-yr follow-up. J Endod. 2004 Jan;30(1):1-4. doi: 10.1097/00004770-200401000-00001.

Reference Type BACKGROUND
PMID: 14760899 (View on PubMed)

Maddalone M, Gagliani M. Periapical endodontic surgery: a 3-year follow-up study. Int Endod J. 2003 Mar;36(3):193-8. doi: 10.1046/j.1365-2591.2003.00642.x.

Reference Type BACKGROUND
PMID: 12657145 (View on PubMed)

Setzer FC, Kratchman SI. Present status and future directions: Surgical endodontics. Int Endod J. 2022 Oct;55 Suppl 4:1020-1058. doi: 10.1111/iej.13783. Epub 2022 Jul 4.

Reference Type BACKGROUND
PMID: 35670053 (View on PubMed)

Other Identifiers

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95694

Identifier Type: -

Identifier Source: org_study_id

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