Revascularization of an immature tooth with a necrotic pulp using platelet-rich fibrin: a case report

To discuss the clinical and radiological outcome of a revascularization procedure in an immature tooth with a necrotic pulp using platelet-rich fibrin (PRF), a second-generation platelet concentrate.

A 7-year-old male reported with pain in the maxillary anterior region as a result of the injury to his immature right maxillary central incisor tooth. After preparation of the access cavity, the necrotic pulp was removed and the canal irrigated using 5.25% sodium hypochlorite solution. The canal was then dried and packed with triantibiotic paste for 3 weeks. After removal of the antibiotic paste, a 5 mL sample of whole venous blood was drawn from the patient's forearm to prepare PRF. The freshly prepared PRF was condensed in the canal until the cementoenamel junction. Three millimetres of white MTA was placed directly over the PRF clot. Three days later, the tooth was restored using a permanent restoration. At 7-, 12- and 15-month recall, the tooth was asymptomatic with no sensitivity to percussion or palpation. At 12- and 15-month follow-up, the tooth responded positively to cold and an electric pulp test, and similarly to adjacent lateral incisor and canine teeth. Radiographic examination demonstrated continued thickening of root canal walls, root lengthening and apical closure.

Platelet-rich fibrin might serve as a potentially ideal scaffold in revascularization of immature permanent teeth with necrotic pulps as it is rich in growth factors, enhances cellular proliferation and differentiation, and acts as a matrix for tissue ingrowth.