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Introduction

Recent studies using novel biomaterial scaffolds that contain host endogenous growth factors represent a departure from traditional clinical approaches and may result in better and more predictable regenerative solutions in medicine and dentistry. As early as 1966, Rule and Winter published a case report regarding continued root formation and apical closure in an immature human premolar tooth using pulp bleeding as a scaffold. Nygaard-Ostby et al, Nevins et al, Iwaya et al, Banchs and Trope, as well as others reported pulp revascularization in teeth with necrotic pulps and immature apices that showed continuous root maturation, dentinal wall thickening and, in some cases, a positive response to vitality tests. In 2011, we reported a case of pulp revascularization using platelet-rich plasma (PRP) in a second maxillary premolar with immature root that had been accidently extracted and then replanted. After removing the necrotic pulp, irrigating it with 5.25% sodium hypochlorite, and medicating it with a triple antibiotic paste for 3 weeks, we prepared PRP from the patient’s blood and injected it into the canal space. Mineral trioxide aggregate (MTA) was placed over the clotted PRP and double-sealed with Cavit (3M) and amalgam. Radiographic examination of this tooth 5.5 months later showed resolution of the periapical lesion, further root development, and continued apical closure. Vitality tests elicited positive responses like those found in the first premolar tooth. The shortcomings of PRP include the need to draw blood from the patient and the complexity of centrifugtion and purification in a clinical setting.

Platelet-rich fibrin (PRF) is an autologous product that contains high concentrations of nonactivated, functional intact platelets within a fibrin matrix that release a relatively constant concentration of growth factors/cytokines over a few days. It is easier to produce but it has to be used immediately after blood drawing and centrifugation. PRF is a potential substitute for PRP in regenerative endodontics and other regenerative procedures involving reconstruction of hard tissues, such as surgical endodontics and adjunctive surgical procedures like root amputation, hemisection, and repair of root perforations.

The main purpose of PRF Applications in Endodontics is to stimulate research in regenerative procedures in endodontics and encourage clinicians to use PRF to improve healing of their patients and save natural dentition. The book has seven chapters and starts with the history of stem cells in regenerative medicine and its possible applications in endodontics, followed by PRF armamentarium and description of how to make PRF, use of PRF in nonsurgical endodontic procedures, its soft tissue applications, hard tissue applications, surgical endodontics, and finally socket preservation. It is assembled by well-known scientists and clinicians who are experts in their fields and interested in the use of innovative materials and techniques to improve human lives.

Mahmoud Torabinejad, DMD, MSD, PhD

References

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7 Rule DC, Winter GB. Root growth and apical repair subsequent to pulpal necrosis in children. Br Dent J 1966;120:586–590.

8 Torabinejad M, Faras H. A clinical and histological report of a tooth with an open apex treated with regenerative endodontics using platelet-rich plasma. J Endod 2011;38:864–868.

9 Torabinejad M, Turman M. Revitalization of tooth with necrotic pulp and open apex by using platelet-rich plasma: A case report. J Endod 2011;37:265–268.