Application of Advanced Platelet-Rich Fibrin Plus (A-PRF+) in Revascularisation of Necrotic Immature Permanent Teeth

NCT ID: NCT07092488

Last Updated: 2025-07-30

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

COMPLETED

Clinical Phase

NA

Total Enrollment

28 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-03-19

Study Completion Date

2021-06-18

Brief Summary

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The goal of this clinical trial is to evaluate the effectiveness of an advanced platelet-rich fibrin plus (A-PRF+) revascularization procedure to promote healing and root development in necrotic immature permanent single-rooted teeth in children and adolescents aged 8 to 18 years.

The main questions it aims to answer are:

* Does the A-PRF+ protocol improve root length, dentinal wall thickness, and apical closure compared to traditional calcium hydroxide apexification treatment?
* Does A-PRF+ promote restoration of pulp vitality and reduce clinical symptoms such as pain, inflammation, or tooth discoloration? Results from the A-PRF+ treatment group will be compared with those from a historical control group receiving traditional calcium hydroxide apexification to evaluate relative effectiveness.

Participants will:

* Receive treatment following the A-PRF+ protocol, which includes disinfecting the tooth canal, applying an autologous platelet-rich fibrin scaffold, and sealing with glass ionomer cement;
* Undergo clinical and radiographic follow-up visits at 1, 3, 6, 9, and 12 months;
* Have pulp vitality tested with cold, electric, and laser Doppler flowmetry methods;
* Be monitored for clinical symptoms, healing progress, and restoration performance.

This study will help determine whether A-PRF+ is a safe and effective alternative to conventional apexification for regenerating necrotic immature teeth in young patients.

Detailed Description

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This study is a prospective interventional clinical trial evaluating an advanced platelet-rich fibrin plus (A-PRF+) revascularization protocol compared to a historical control group treated with traditional calcium hydroxide apexification for necrotic immature permanent single-rooted teeth in children and adolescents aged 8 to 18 years.

The main goal is to assess the regenerative effectiveness of the A-PRF+ protocol in promoting root development, including root lengthening, dentinal wall thickening, and apical closure, compared to conventional apexification. Secondary objectives include evaluating pulp vitality restoration and monitoring clinical outcomes such as symptom resolution, tooth survival, and adverse effects like tooth discoloration.

Participants in the experimental group were prospectively enrolled and received treatment involving minimal mechanical instrumentation, canal disinfection with sodium hypochlorite, intracanal calcium hydroxide medicament, followed by triple antibiotic paste. At the final appointment, autologous A-PRF+ was prepared from peripheral blood and applied as an intracanal scaffold extending into the coronal cavity, sealed permanently with glass ionomer cement.

The control group consists of patients previously treated at the same institution with calcium hydroxide apexification. Their clinical and radiographic records were retrospectively reviewed for comparison. Apexification was not performed as part of this study.

Clinical and radiographic follow-ups were conducted at 1, 3, 6, 9, and 12 months, including pulp vitality testing with cold, electric, and laser Doppler flowmetry methods, along with standardized periapical radiographs to measure root length, dentinal wall thickness, and apical diameter. Restoration quality was assessed using modified USPHS criteria.

This study aims to determine if the A-PRF+ protocol provides a safe and effective regenerative alternative to traditional apexification for treating necrotic immature teeth, potentially enhancing long-term tooth preservation in pediatric patients.

Conditions

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Necrotic Immature Permanent Teeth Regenerative Endodontic Treatment Pulp Regeneration Root Maturation Periapical Lesions

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

This is a prospective, single-group interventional study evaluating the regenerative effectiveness of an advanced platelet-rich fibrin plus (A-PRF+) revascularization protocol in necrotic immature permanent single-rooted teeth. Participants receive the A-PRF+ treatment without randomization or concurrent control groups. The control comparison is conducted retrospectively using historical patient records treated with calcium hydroxide apexification.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

While this is an open-label trial with no masking of participants, care providers, investigators, or outcome assessors, radiographic images were randomly coded and evaluated by blinded independent examiners to reduce measurement bias and improve objectivity. Additionally, the control group consisted of randomly selected historical patient records to enhance the validity of comparisons. Follow-up assessments were conducted by independent clinicians who were not involved in the initial treatments, further minimizing examiner bias.

Study Groups

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Advanced Platelet-Rich Fibrin Plus (A-PRF+) Revascularization Group

Participants receive the advanced platelet-rich fibrin plus (A-PRF+) revascularization protocol. This involves minimal mechanical instrumentation, canal disinfection with sodium hypochlorite, intracanal medicaments including calcium hydroxide and triple antibiotic paste, followed by placement of autologous A-PRF+ scaffold extending into the coronal cavity. The cavity is then permanently sealed with glass ionomer cement.

Group Type EXPERIMENTAL

Advanced Platelet-Rich Fibrin Plus (A-PRF+) Revascularization Procedure

Intervention Type PROCEDURE

The intervention consists of the advanced platelet-rich fibrin plus (A-PRF+) revascularization protocol. It includes minimal mechanical instrumentation of the root canal, disinfection using sodium hypochlorite irrigation, and intracanal medicaments-initially calcium hydroxide followed by triple antibiotic paste. Peripheral venous blood was drawn from each participant into anticoagulant-free sterile tubes. The blood was immediately centrifuged at 1300 rpm for 8 minutes to obtain the A-PRF+ clot, which was then used as the scaffold material, extending through the root canal into the coronal cavity. The cavity was permanently sealed with glass ionomer cement. This protocol aims to promote regenerative healing and continued root development in necrotic immature permanent teeth.

Interventions

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Advanced Platelet-Rich Fibrin Plus (A-PRF+) Revascularization Procedure

The intervention consists of the advanced platelet-rich fibrin plus (A-PRF+) revascularization protocol. It includes minimal mechanical instrumentation of the root canal, disinfection using sodium hypochlorite irrigation, and intracanal medicaments-initially calcium hydroxide followed by triple antibiotic paste. Peripheral venous blood was drawn from each participant into anticoagulant-free sterile tubes. The blood was immediately centrifuged at 1300 rpm for 8 minutes to obtain the A-PRF+ clot, which was then used as the scaffold material, extending through the root canal into the coronal cavity. The cavity was permanently sealed with glass ionomer cement. This protocol aims to promote regenerative healing and continued root development in necrotic immature permanent teeth.

Intervention Type PROCEDURE

Other Intervention Names

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Advanced platelet-rich fibrin A-PRF+ revascularization Platelet-rich fibrin scaffold Regenerative endodontic procedure with PRF

Eligibility Criteria

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Inclusion Criteria

* Patients aged 8 to 18 years presenting with immature permanent single-rooted teeth with necrotic pulp caused by caries or dental trauma
* Preserved tooth crown
* Negative response to cold and electric pulp tests
* Radiographic evidence of incomplete root development (Cvek stages I-IV)
* Apical diameter greater than 0.5 mm

Exclusion Criteria

* Presence of systemic illness or allergies to treatment components
* Complicated crown or root fractures
* Evidence of ankylosis or root resorption
* Ongoing orthodontic treatment
* Inability to comply with follow-up appointments (e.g., needle phobia or poor cooperation)
* Subsequent trauma to the treated tooth during the study period
* Missed recall appointments
Minimum Eligible Age

8 Years

Maximum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Zagreb

OTHER

Sponsor Role lead

Responsible Party

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Dubravka Turjanski, Dr. Dent. Med.

Dr. Dent. Med.

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Department of Pediatric and Preventive Dentistry, University Hospital Centre Zagreb

Zagreb, Croatia, Croatia

Site Status

Countries

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Croatia

Other Identifiers

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PRF-CT-01

Identifier Type: -

Identifier Source: org_study_id

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