New research from Istanbul Medipol University compares two key surgical techniques for treating large periapical lesions, offering insight on their effectiveness. The study highlights the roles of apicoectomy and apical curettage, particularly when enhanced with leukocyte- and platelet-rich fibrin (L-PRF).
Apical periodontitis, often arising after inadequate endodontic treatments, can lead to recurring issues requiring additional surgical intervention. Traditionally, apicoectomy has been the go-to procedure, involving the removal of the infected tissue and part of the tooth root. On the other hand, apical curettage is less invasive, focusing on tissue removal without cutting the root tip. While both approaches show promise, the study demonstrates new efficacy markers by incorporating L-PRF, which is known for its healing properties due to growth factor release.
The research team conducted the trial with 64 adult participants, divided equally among four groups: retrograde obturation (RG), orthograde obturation (OG), RG with L-PRF, and OG with L-PRF. Each participant underwent root canal retreatment, followed by either apicoectomy or apical curettage during the second session, both with and without the application of L-PRF to the surgical site.
Initial findings reveal significant advantages associated with the L-PRF application. At the one-week postoperative mark, the group receiving the combined RG and L-PRF treatment exhibited less tenderness to percussion—indicating reduced pain levels—compared to the RG group without L-PRF. This group showed not only improved immediate comfort but also superior periapical lesion area healing rates at various follow-ups, achieving over 90% healing by the nine-month mark.
"Our results demonstrate the effectiveness of combining L-PRF with traditional surgical methods for enhancing recovery and reducing postoperative discomfort," wrote the authors of the article. "This approach could redefine the procedure protocols for managing complex periapical lesions, leading to more favorable outcomes for patients.\"
The study’s structured methodology saw participants monitored over twelve months with multiple clinical and radiographic assessments to evaluate pain levels, swelling, mobility, tenderness, and changes measured via the periapical index (PAI). The conclusion drawn from the data is clear—while both surgical methods have their respective benefits, the synergistic effect of L-PRF elevates the healing process significantly.
The role of L-PRF, which consists of concentrated platelets and leukocytes, plays a pivotal role by contributing growth factors conducive to tissue regeneration, enhancing both soft and hard tissue recovery around infected dental sites. The addition of this biomaterial appears beneficial for patients with challenging conditions such as large lesions, which often demand surgical solutions.
This research provides valuable insight not only for surgical practice but also reinforces the growing trend of using biomaterials to aid healing. The surgeons involved emphasized the need for more large-scale studies to validate and understand the full extent of these findings. Given the promising results of this study, L-PRF may eventually be considered best practice when treating dental infections interlinked with apical periodontitis.
Moving forward, dental professionals could leverage the advantages of L-PRF alongside traditional surgical methods, leading to improved patient experiences and outcomes. These innovations not only help resolve existing dental issues more effectively but could also contribute to longer-lasting dental health.