A comparative evaluation of natural and artificial scaffolds in regenerative endodontics: A clinical study

Aim: To evaluate and compare the regenerative potential of natural autologous scaffolds (blood clot and platelet rich fibrin [PRF]) with artificial scaffolds (commercially available collagen and poly-lactic-co-glycolic acid [PLGA] polymer) in inducing apexogenesis in necrotic immature permanent teeth. Materials and Methods: Necrotic immature permanent maxillary incisors with or without radiographic evidence of periapical lesion were included. Access opening was done under rubber dam isolation. Canal disinfection was done using minimal instrumentation, copious irrigation, and triple antibiotic paste as interappointment medicament for 4 weeks. After 4 weeks, asymptomatic teeth were divided into four groups on the basis of scaffolds used for revascularization procedure: Group I (blood clot); Group II (PRF); Group III (collagen); Group IV (PLGA). The clinical and radiographic evaluations of teeth were done at 6 and 12 months after the procedure and compared with baseline records. Result: Clinically, patients were completely asymptomatic throughout the study period. Radiographically, all cases showed improvement in terms of periapical healing, apical closure, root lengthening, and dentinal wall thickening. PRF and collagen gave better results than blood clot and PLGA in terms of periapical healing, apical closure, and dentinal wall thickening. Conclusion: Revascularization procedure is more effective and conservative over apexification in the management of necrotic immature permanent teeth. This study has shown that PRF and collagen are better scaffolds than blood clot and PLGA for inducing apexogenesis in immature necrotic permanent teeth.