Periapical Osseous Healing Following Non-Surgical Endodontic Retreatment: A Cone-Beam CT–Based Comparative Evaluation of Nano-Hydroxyapatite With and Without Platelet-Rich Fibrin

Abstract

Background: Successful periapical healing after non-surgical endodontic retreatment is critical for long-term tooth survival. Nano-hydroxyapatite (nHA) is widely used as a bone graft material, and its regenerative potential may be enhanced by platelet-rich fibrin (PRF), an autologous source of growth factors. Cone-beam computed tomography (CBCT) allows precise volumetric assessment of periapical bone healing.

Objective: To compare periapical osseous healing following non-surgical endodontic retreatment using nHA alone versus nHA combined with PRF, assessed via CBCT.

Methods: A randomized controlled study was conducted on patients requiring non-surgical endodontic retreatment for periapical lesions. Participants were allocated into two groups: Group A received nHA alone, and Group B received nHA combined with PRF. CBCT scans were obtained preoperatively and at 3, 6, and 12 months postoperatively to evaluate volumetric changes in periapical lesions. Healing outcomes were analyzed using appropriate statistical methods.

Results: Both groups demonstrated significant periapical bone regeneration over time. However, Group B (nHA + PRF) showed accelerated and greater volumetric reduction of periapical lesions compared to Group A (nHA alone), indicating enhanced osteogenic healing.

Conclusion: The adjunctive use of PRF with nHA in non-surgical endodontic retreatment significantly improves periapical osseous healing. CBCT-based volumetric evaluation provides a reliable method to assess bone regeneration. Incorporating PRF with nHA may offer a promising strategy for optimizing endodontic retreatment outcomes.