Impact of Platelet-rich Plasma in the Healing of Through-and- through Periapical Lesions Using 2-dimensional and 3-dimensional Evaluation: A Randomized Controlled Trial

Introduction: The purpose of this randomized controlled trial was to evaluate the role of platelet-rich plasma (PRP) in the healing of through-and-through periapical lesions using both 2-dimensional periapical radiographs and 3-dimensional (3D) cone-beam computed tomographic imaging. Methods: Thirty-four patients after confirmation of a through-and-through periapical lesion were enrolled and randomly assigned to either the control or PRP group. Periapical surgery was performed, and grafting of the bone defect with PRP was done in the PRP group before suturing. Follow-up was scheduled at 12 months for clinical and radiographic analysis based on Molven's criteria; modified Penn 3D criteria; and resected plane, apical area, and cortical plate indexes. The absolute area and volume of the lesions were measured preoperatively and at follow-up using CoreIDRAW X7 (64-bit) (Corel Corporation, Ottawa, Canada) and ITK Snap software (free software under the GNU General Public License developed by the National Institutes of Health, the US National Institute of Biomedical Imaging and BioEngineering, the US National Library of Medicine, the Universities of Pennsylvania and North Carolina, and an independent developer group), respectively. Results: Thirty-two patients were available at follow-up. A success rate of 93.7% was observed for both the control and PRP groups on 2-dimensional evaluation, whereas the PRP group exhibited a significantly higher success rate (87.5%) than the control (50%) on 3D assessment. A significantly higher percentage reduction in the lesion volume was documented in the PRP group (92.30 +/- 4.72) than the control group (83.04 +/- 12.82). Resected plane, apical area, and cortical plate indexes revealed a significantly higher scoring at the resected plane and cortical plate parameter in the PRP group. Overall analysis documented the faster reestablishment of the palatal cortical plate than the buccal cortical plate in through-andthrough lesions. Conclusions: These results suggest that PRP improves the healing outcome in through-and-through lesions. CBCT imaging provides better healing assessment after periapical surgery over periapical radiographs in such lesions.