PRF in Regenerative Endodontic Procedures: Applications, Mechanism, and Clinical Effectiveness

1. What is PRF? The Role of PRF in Regenerative Endodontics

PRF (Platelet-Rich Fibrin) is a form of autologous platelet-rich plasma, created from the patient's own blood without the need for anticoagulants or artificial additives. The PRF structure contains platelets, leukocytes (white blood cells), and numerous biological growth factors held within a three-dimensional fibrin matrix.

In the field of (Regenerative Endodontic Procedures (REPs), PRF serves as a biological scaffold that supports the regeneration of pulp-dentine tissue. At the same time, it releases growth factors that help activate stem cells, stimulate the formation of new blood vessels (revascularization), and facilitate tissue repair in the periapical region.

Furthermore, PRF also helps:

• Improve circulation and nutrition in the damaged tissue area.
• Accelerate the healing process and limit periapical inflammation.
• Promote the regeneration of hard and soft tissues, aiding in the restoration of the tooth's physiological structure.

2. Mechanism of Action of PRF in Regenerative Endodontics

Clinical and experimental studies show that PRF exerts its efficacy through several important biological mechanisms:

2.1. Providing Growth Factors

PRF contains numerous biological factors such as PDGF, TGF-$\beta$, VEGF, IGF, EGF..., which stimulate the proliferation, migration, and differentiation of stem cells – particularly odontoblast-like cells, fibroblasts, and vascular endothelial cells.

2.2. Three-Dimensional Fibrin Structure Acts as a Scaffold for Cells

The 3D fibrin network allows cells to adhere, migrate, and exchange nutrients efficiently, creating a favorable environment for tissue reorganization within the root canal.

2.3. Sustained Release of Biological Factors

Unlike PRP, PRF releases growth factors gradually over several days, which helps maintain a longer-lasting effect of stimulating tissue regeneration.

2.4. Role of Leukocytes and Cytokines

The leukocytes in PRF help control inflammation and fight infection, while also secreting cytokines that stimulate the repair response in damaged tissue.

2.5. Enhanced Hard Tissue and Vascular

Differentiation Advanced PRF variants like A-PRF or i-PRF have the ability to stimulate bone formation, dentinogenesis, and neovascularization (new blood vessel formation), supporting the recovery process after treatment.

3. So sánh các loại PRF trong nội nha tái sinh

4. Ứng dụng lâm sàng của PRF trong điều trị nội nha tái sinh

5. Evaluating the Cost-Effectiveness of Applying PRF in Regenerative Endodontic Procedures (REPs)

5.1. Costs and Technical Requirements

• Requires investment in a centrifuge, blood collection tubes, and a PRF kit.
• Increases the procedure time for the steps of blood drawing, centrifugation, and PRF placement.
• Strict technical training is required for blood processing and sterility.

Though the initial cost is higher, PRF delivers long-term value by improving treatment outcomes and reducing recurrence.

5.2. Superior Benefits

• Natural pulp-dentine tissue regeneration, instead of just "artificial apex closure."
• Increases the thickness of the root canal walls, reducing the risk of tooth fracture.
• Promotes root lengthening in immature open-apex teeth, improving biological longevity.
• Reduces the size of periapical lesions faster.
• Decreases the failure rate and the need for retreatment.

5.3. Practical Challenges

• Results may be inconsistent across different facilities/clinics.
• Lack of unified procedural standards for each type of PRF.
• Some patients are hesitant about blood drawing, reducing treatment acceptance.

6. Herident – Application of PRF in Regenerative Endodontic Procedures

At Herident Dental Clinic, the PRF technique in regenerative endodontics has been practically applied in numerous cases treating teeth with pulp necrosis, open apices, or complex periapical lesions.

Some notable results at Herident:

• Young patients with open-apex incisors: After performing REPs combined with A-PRF, X-ray images after 6 months showed a clear thickening of the root walls, the apex gradually closing, and no remaining periapical lesions.
• Cases of large periapical cysts: The use of i-PRF coordinated with MTA helped the periapical bone regenerate quickly, reduced inflammation, and restored healthy bone tissue after only a few months of follow-up.
• Apicoectomy surgeries: Herident utilizes a PRF membrane to cover the root apex area, which helps reduce post-operative swelling and pain, and accelerates soft tissue healing.

By applying PRF under a rigorous sterile protocol and being performed directly by a team of specialty-trained resident doctors, Herident provides safe, biological, and sustainable treatment efficacy for patients.

7. Conclusion

PRF is becoming a significant advancement in regenerative endodontic procedures, helping to restore the physiological function of the tooth rather than just providing mechanical intervention.
With investment in modern equipment and a team of specialized doctors, Herident Dental Clinic is one of the pioneering units successfully applying PRF in regenerative endodontics in Vietnam, contributing to the preservation of natural teeth and the improvement of patients' quality of life.