Prpić V, et al. J Adv Prosthodont. 2020 Dec;12(6):376-382. https://doi.org/10.4047/jap.2020.12.6.376

Regenerative endodontic approaches for immature necrotic permanent teeth must balance biological efficacy, clinical practicality and long-term aesthetic outcomes. This study evaluates a novel regenerative protocol using autologous advanced platelet-rich fibrin plus (A-PRF+) scaffold sealed exclusively with glass ionomer cement (GIC) and compares it to conventional calcium hydroxide apexification used as the control. Twenty-eight patients were prospectively enrolled and followed for 12 months alongside a retrospectively selected historical control group. Outcomes were evaluated through standardised blinded clinical, radiographic and vitality assessments. The A-PRF+ protocol demonstrated significantly faster periapical healing, superior root lengthening, increased dentinal wall thickness and apical closure (p < 0.0001), with excellent aesthetic outcomes and no reported tooth discolouration. Pulpal blood flow measured by laser Doppler flowmetry indicated vitality restoration in 93% of cases. Preliminary linear regression identified treatment duration as a significant predictor of apical closure (p < 0.0001), with possible enhancement by additional patient-specific variables. These findings validate the A-PRF+ protocol as a highly effective, aesthetically favourable and predictable regenerative strategy, establishing a new benchmark for the management of immature necrotic teeth and laying the foundation for personalised predictive endodontic care. Future studies should include multicentre randomised controlled trials to confirm long-term clinical sustainability and generalisability.

Glass ionomer cements (GICs) are bioactive restorative materials valued for their sustained ion release and remineralisation capacity. However, their long-term interactions with sound enamel and dentine remain underexplored. This 12-month in vitro study aimed to evaluate microstructural and compositional changes in sound dental tissues adjacent to four GICs—Ketac Universal, Fuji IX and Equia Forte Fil (conventional GICs) and the advanced Glass Carbomer (incorporating hydroxyapatite nanoparticles)—using field-emission scanning electron microscopy (FE-SEM) and energy-dispersive X-ray spectroscopy (EDS). Glass Carbomer uniquely formed hydroxyapatite nanoparticles and mineralised regions indicative of active biomineralisation—features not observed with conventional GICs. It also demonstrated greater fluoride uptake into dentine and higher silicon incorporation in both enamel and dentine. Conventional GICs exhibited filler particle dissolution and mineral deposition within the matrix over time; among them, Equia Forte released the most fluoride while Fuji IX released the most strontium. Notably, ion uptake was consistently higher in dentine than in enamel for all materials. These findings indicate that Glass Carbomer possesses superior bioactivity and mineralising potential which may contribute to the reinforcement of sound dental tissues and the prevention of demineralisation. However, further in vivo studies are required to confirm these effects under physiological conditions.

Traumatised immature permanent teeth with pulp necrosis pose a clinical challenge due to incomplete root development and limited treatment options. This retrospective observational study evaluated the clinical and radiographic outcomes of regenerative endodontic treatment (RET) incorporating an additional calcium hydroxide-based step for blood clot stabilisation compared with apexification in traumatised immature teeth. A total of 49 teeth treated between 2015 and 2025 were analysed. Clinical and radiographic parameters were recorded at baseline and reassessed at 6- and 12-month follow-up, including root length, dentinal wall thickness, apical diameter, periapical status, and apical closure. RET was associated with significantly greater increases in dentinal wall thickness (p = 0.002), root length (p = 0.010), and reductions in apical diameter (p < 0.001) over time compared with apexification. Apical closure was observed significantly more frequently in the RET group (p < 0.001). Periapical healing improved in both groups, while overall clinical outcomes appeared broadly similar. Within the limitations of this retrospective observational study, RET incorporating an additional calcium hydroxide-based step for blood clot stabilisation appears to be a clinically applicable approach for promoting root development in traumatised immature teeth. Further prospective and controlled studies are required to confirm these findings and to better define the role of this adjunctive step.