Will L-PRF Be the Future of Endodontic Microsurgery? A Series of Case Reports.

[OBJECTIVES] This case series aimed to evaluate the healing potential of apical tissues with large periapical radiolucencies (> 10 mm) after apical microsurgery with L-PRF. The secondary objectives were to evaluate L-PRF's benefits and adverse effects as well as to aid in the development of a clinical protocol.

[MATERIALS AND METHODS] This case series was conducted in accordance with the Preferred Reporting Items for Case Reports in Endodontics (PRICE) 2020 guidelines. Thirteen patients with persistent endodontic infections, unresponsive to nonsurgical root canal treatment/retreatment, were treated at the Restorative and Oral Surgery Departments with endodontic microsurgery. L-PRF preparation followed Choukroun et al. (2001) and the L-PRF 2018 guidelines under the supervision of an experienced consultant. Postoperative follow-up included a phone call at 24 h to assess pain, swelling, and daily functions. Sutures were removed at 7 days, and a 6-month clinical and radiographic review was conducted. The clinical assessment included patient-reported symptoms and extraoral and intraoral examinations. Periapical radiographs were assessed for periapical healing based on Rud et al.'s (1972) radiographic criteria. Radiographs were reviewed by one clinician under standardized conditions.

[RESULTS] Histopathological analyses identified 76.9% (n = 10) radicular cysts and 23.0% (n = 3) periapical granulomas from the 13 cases. At the 6-month review, 76.9% (n = 10) showed incomplete healing, 15.4% (n = 2) demonstrated complete healing, and 7.7% (n = 1) had incomplete healing at 4 months. All patients remained asymptomatic with no reported complaints. Radiographic assessments showed a significant reduction in the size of periapical radiolucency in all cases. At 24 h, 69.2% (n = 9) reported no pain, while mild pain was noted in 15.4% (n = 2). Swelling was observed in 69.2% (n = 9) and absent in 15.4% (n = 2), with missing records for 15.4% (n = 2).

[CONCLUSION] L-PRF appears beneficial in endodontic microsurgery. However, larger, low-bias studies with extended follow-up periods are needed for definitive conclusions on its application.