Surgery · Medical Literature
VOLUMETRIC AND RADIOGRAPHIC OUTCOMES OF BONE REGENERATION AFTER APICOECTOMY WITH PRF-BASED THERAPIES - A PRELIMINARY STUDY.
Abstract
Successful apicoectomy relies on effective bone healing at the resected root apex. Platelet-rich fibrin (PRF) and bone graft materials have been proposed to enhance regeneration, yet comparative evidence using both two-dimensional (2D) and three-dimensional (3D) imaging remains limited. To compare bone regeneration following apicoectomy using PRF, PRF combined with Bio-Oss, and conventional technique, and to evaluate postoperative pain and edema. Thirty patients undergoing apicoectomy were randomly assigned to three groups (n=10 each): PRF, PRF + Bio-Oss, and control (NaCl 0.9%). Linear defect measurements were obtained from standardized periapical radiographs, while volumetric analysis was conducted using CBCT segmentation software at baseline and 3, 6, and 12 months postoperatively. Regeneration percentage was calculated based on defect reduction. Postoperative pain (VAS 0-10) and edema (0-3 scale) were recorded for 7 days. Data were analyzed using paired t-tests and repeated-measures ANOVA (p<0.05). All groups showed significant defect reduction (p<0.001). PRF-based treatments achieved greater regeneration than control (2D: F(2,27)=12.41, p<0.001; 3D: F(2,27)=18.93, p<0.001), with the PRF+Bio-Oss group showing the highest percentages (2D: 82.6%±7.2; 3D: 90.4%±4.8). CBCT analysis demonstrated greater sensitivity and effect size than 2D radiography. No significant differences were observed in postoperative pain or edema. PRF enhances bone regeneration after apicoectomy, especially when combined with Bio-Oss, without increasing postoperative morbidity. CBCT volumetric assessment provides superior evaluation of regenerative outcomes.
Clinical relevance
In patients undergoing apicoectomy, does the use of platelet-rich fibrin (PRF) alone or PRF combined with Bio-Oss result in superior volumetric and radiographic bone regeneration, and reduced postoperative pain and edema, compared to conventional saline-based technique at 12 months? __SNAPSHOT__ {"studyDesign":"Preliminary randomized controlled trial (three-arm parallel-group RCT)","setting":"Not reported (single institution implied; country not specified in abstract)","sampleSize":"n=30 (PRF: n=10; PRF + Bio-Oss: n=10; Control/NaCl 0.9%: n=10)","population":"Adult patients undergoing apicoectomy for periapical pathology; additional inclusion/exclusion criteria not reported in abstract","intervention":"PRF alone (Group 1) or PRF combined with Bio-Oss bovine xenograft (Group 2) placed at the apicoectomy site","comparator":"Conventional apicoectomy with NaCl 0.9% (saline) irrigation/packing as control","primaryOutcome":"Bone defect regeneration percentage assessed by 2D periapical radiography (linear measurement) and 3D CBCT volumetric segmentation at baseline and 3, 6, and 12 months postoperatively; secondary outcomes: postoperative pain (VAS 0–10) and edema (0–3 scale) over 7 days","followUp":"12 months postoperatively (with interim assessments at 3 and 6 months)","fundingSource":"Not reported"}
Key findings
All three groups demonstrated statistically significant defect reduction from baseline (p<0.001). PRF-based treatments (PRF alone and PRF + Bio-Oss) achieved greater bone regeneration than the saline control group, reaching statistical significance by both 2D radiographic analysis [F(2,27)=12.41, p<0.001] and 3D CBCT volumetric analysis [F(2,27)=18.93, p<0.001]. The abstract is truncated and does not report: (a) absolute or relative magnitudes of regeneration (%) per group, (b) confidence intervals for any outcome, (c) direct comparison between PRF alone versus PRF + Bio-Oss (i.e., whether combining Bio-Oss confers additive benefit over PRF alone), (d) quantitative pain or edema values per group, or (e) whether intergroup differences in pain/edema reached statistical significance. NNT cannot be calculated from the available data. No adverse events are reported in the abstract. All effect sizes and group-level means are 'not reported' due to abstract truncation.
Practice implications
The study suggests that adjunctive PRF-based therapies may enhance periapical bone regeneration following apicoectomy compared to conventional technique, as reflected by both 2D and 3D imaging metrics at 12 months. However, several critical limitations prevent translation to practice at this time. First, this is a preliminary study with only n=10 per arm — markedly underpowered for detecting clinically meaningful subgroup differences or rare adverse events. Second, the abstract is truncated, preventing assessment of the magnitude of benefit (absolute regeneration percentages), the PRF-alone versus PRF+Bio-Oss comparison, and patient-reported outcome data. Third, generalizability is unknown because patient demographics, tooth type, defect size, operator experience, and root-end filling material are not described. Fourth, CBCT volumetric segmentation, while rigorous, introduces inter-operator variability that is not addressed. Fifth, 12 months may be insufficient to assess long-term osseous consolidation and tooth survival. These findings apply specifically to patients undergoing apicoectomy with periapical defects, but the precise patient profile eligible for this approach cannot be determined from the abstract alone. Patients with large bony defects, compromised healing capacity (e.g., diabetes, immunosuppression, smoking), or those outside the studied setting are not adequately represented. Only the abstract was available for analysis; the full data tables, methodology details, and statistical reporting have not been reviewed. __LIMITATIONS__ Very small sample size (n=10 per arm); severely underpowered for reliable subgroup comparisons and clinically relevant effect size estimation,Labeled as a 'preliminary study,' indicating results are exploratory and hypothesis-generating rather than confirmatory,Abstract truncated — quantitative outcome data per group, confidence intervals, pairwise comparisons (PRF vs. PRF+Bio-Oss), and pain/edema results are not available for evaluation,Funding source not reported; potential for undisclosed conflicts of interest cannot be excluded,No description of randomization concealment, allocation sequence, or blinding strategy — risk of performance and detection bias is unknown,CBCT volumetric segmentation methodology (software, operator blinding, inter-rater reliability) not described in abstract,Surrogate endpoints (radiographic defect reduction) do not directly establish clinical outcomes such as tooth survival, patient quality of life, or retreatment rates,Setting and patient population characteristics (defect size, tooth type, systemic health) not reported, limiting generalizability,Twelve-month follow-up may be insufficient to evaluate mature bone consolidation and long-term osseous stability,Statistical significance demonstrated (p<0.001), but clinical importance cannot be assessed without knowledge of absolute regeneration magnitudes or minimal clinically important difference thresholds __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ This preliminary three-arm RCT (n=30) reports statistically significant advantages in periapical bone regeneration for PRF-based adjuncts over conventional technique at 12 months by both 2D and 3D imaging, but the very small sample size, truncated abstract, absence of quantitative effect sizes, and preliminary study designation preclude any practice change. Clinicians should await adequately powered, fully reported RCTs with long-term tooth survival data before routinely adopting PRF or PRF+Bio-Oss as standard adjuncts to apicoectomy.