Revascularizing ability of platelet-rich fibrin in permanent necrotic immature teeth: A systematic review and meta-analysis.

Abstract

<h4>Aim</h4>To evaluate the efficacy of revascularizing ability of platelet rich fibrin (PRF) compared to other scaffolds in permanent necrotic immature teeth.<h4>Methods</h4>Review was adhered to Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) guidelines. A database search was conducted for studies comparing PRF to other scaffolds in inducing revascularization of permanent necrotic immature teeth. Quality assessment was performed using the Cochrane risk of bias 2 tool through Review Manager (RevMan) software version 5.3. Standardized mean difference (SMD) and odds ratio (OR) was used as summary statistic measure employing random effect model (<i>P</i> < 0.05).<h4>Results</h4>Nine studies were taken for qualitative synthesis and five studies for meta analysis. PRF was compared to other scaffolds such as advanced PRF, blood clots, calcium hydroxide, mineral trioxide aggregate, platelet rich plasma and artificial scaffolds (collagen, placentrex, and chitosan) and reported outcomes as decrease in clinical signs (pain, swelling, and abscess), periapical healing, dentine wall thickness, increase in root length, increase in root width and decrease in apical foramen diameter. Meta analysis showed that PRF had greater periapical healing (OR = 1.11 [0.29-4.34]) and dentine wall thickening (OR = 3.68 [0.48-28.08]). Moreover, PRF showed greater increase in root length (SMD = 0.08 [-0.54-0.70]), increase in root width (SMD = 3.32 [-0.26-6.89]) and reduction in apical foramen diameter (SMD = 0.17 [-0.67-1.01]).<h4>Conclusion</h4>Included studies showed a positive trend on the benefits of PRF. Regenerative endodontic procedures with PRF has shown high success rate in terms of periapical healing, dentine wall thickening and improved apical closure and can be concluded as a biologic and an economical adjunct exhibiting better results.