PRF and CGF Scaffolds Tested Against Blood Clot for Regrowing Dead Tooth Roots
A 12-month RCT compares three scaffold types and two EDTA concentrations for regenerating necrotic immature permanent teeth.
Summary
When a young person's permanent tooth dies before the root fully forms, dentists face a unique challenge: can the root still grow? This clinical trial tested three different biological scaffolds — a standard blood clot, platelet-rich fibrin (PRF), and concentrated growth factor (CGF) — combined with either 5% or 17% EDTA irrigation solutions across 30 teeth over 12 months. Using cone-beam CT imaging, researchers tracked root lengthening, changes in apical diameter, hard tissue formation, and whether surrounding bone lesions resolved. Clinical outcomes like pain and swelling were also monitored. The study aimed to identify whether advanced growth-factor-rich scaffolds and EDTA concentration choices meaningfully improve tooth regeneration, potentially offering young patients a path to preserving natural teeth that would otherwise require extraction.
Detailed Summary
Losing a permanent tooth before the root fully develops creates a serious long-term problem, particularly for children and adolescents. Without a complete root, the tooth is structurally fragile and cannot anchor properly in the jaw. Regenerative endodontics — using biological scaffolds to stimulate continued root development in teeth with dead pulps — has emerged as a promising alternative to extraction, but the optimal materials and protocols remain debated.
This completed randomized clinical trial from Kahramanmaras Sutcu Imam University in Turkey enrolled 30 immature permanent teeth with necrotic pulps and randomly assigned them to one of six treatment arms. Three scaffold types were tested: a traditional blood clot, platelet-rich fibrin (PRF), and concentrated growth factor (CGF). Each was paired with either 5% or 17% EDTA as the final irrigating rinse before scaffold placement. Patients were followed for 12 months with both clinical assessments and cone-beam computed tomography (CBCT) imaging.
CBCT measurements captured changes in root length, apical diameter, volume of periapical lesions, and hard tissue bridge formation — key indicators of whether true regeneration or mere repair was occurring. Clinical parameters included pain, swelling, sinus tract resolution, percussion sensitivity, and pulp sensitivity responses.
The study was designed to determine whether growth-factor-enriched scaffolds like PRF and CGF meaningfully outperform the standard blood clot approach, and whether EDTA concentration alters outcomes. These are clinically significant questions because PRF and CGF require additional centrifuge preparation steps, adding cost and complexity to treatment.
Limitations include the small sample size of 30 teeth across six groups, meaning roughly five teeth per arm — insufficient for robust subgroup conclusions. The 12-month follow-up may also be too short to capture the full trajectory of root maturation. Importantly, this summary is based solely on the trial abstract, as full results are not yet publicly available.
Key Findings
- Six treatment groups compared three scaffolds (blood clot, PRF, CGF) with two EDTA concentrations (5% vs 17%) over 12 months.
- CBCT imaging tracked root length increase, apical diameter, hard tissue formation, and periapical lesion volume as primary outcomes.
- Both clinical and radiographic endpoints were assessed, providing a comprehensive view of regenerative success.
- Study tested whether advanced growth-factor scaffolds justify added complexity over standard blood clot protocols.
- All 30 enrolled teeth with necrotic pulps and open apices were followed to trial completion, indicating low dropout.
Methodology
Randomized clinical trial with 30 immature necrotic permanent teeth assigned to six groups in a 2x3 factorial design (3 scaffolds × 2 EDTA concentrations). Primary imaging endpoint was CBCT-measured root development at 12 months. Clinical assessments included pain, swelling, sinus tract, percussion sensitivity, and pulp testing.
Study Limitations
The sample size of approximately 5 teeth per treatment arm is very small, limiting statistical power and generalizability of subgroup comparisons. The 12-month observation window may be insufficient to fully characterize root maturation trajectories. Critically, this summary is based on the trial abstract only, as full results data are not publicly accessible.
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