Advanced Platelet-Rich Fibrin (A-PRF) as an Adjunct in Enucleation and Apicectomy of Root-Filled Teeth: A Case Series

Abstract

Introduction: Enucleation and apicectomy are common surgical approaches for managing persistent periapical pathologies associated with root-filled teeth. Advanced platelet-rich fibrin (A-PRF), an enhanced version of PRF prepared using modified centrifugation protocols, has gained attention for its ability to release growth factors over an extended period, promoting superior bone and soft tissue healing. Purpose(s): This study evaluated the effectiveness of A-PRF as an adjunct to enhance bone regeneration following enucleation and apicectomy in three clinical cases of persistent periapical pathology associated with root-filled teeth. Method(s): Three patients with persistent periapical lesions refractory to non-surgical treatment underwent enucleation and apicectomy. A-PRF membranes were prepared using the patients' blood, centrifuged at lower speeds and for a longer duration to optimize growth factor retention. A-PRF was placed into the bony defect following lesion removal. Standard post-operative care was provided, and bone healing was assessed through radiographic reviews at six months. Result(s): Radiographic evaluation at six months revealed significant bony infill in all three cases. The surgical sites showed progressive trabecular bone regeneration with no signs of infection or symptomatic relapse. A-PRF contributed to enhanced healing, evidenced by the restoration of bone density and structural integrity. Conclusion(s): A-PRF demonstrates potential as a valuable adjunct for promoting bone regeneration following enucleation and apicectomy of root-filled teeth. Its ability to support sustained growth factor release and enhance healing outcomes warrants further investigation in larger clinical studies.Copyright © 2025