Effect of Concentrated Growth Factors on Healing of Apicomarginal Defects: a Prospective Study

Study Overview
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Brief Summary
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The persistent and chronic apical periodontitis has caused great difficulties for clinical physicians. Ensuring rapid and successful healing of the extensively damaged periapical region is a pressing issue that needs to be addressed. The treatment options include traditional apical surgery, simultaneous placement of bone powder and membrane after apical surgery, and simultaneous placement of sticky bone (bone powder mixed with concentrated growth factors gel) and membrane. However, high-quality evidence regarding these various treatment options is scarce. The purpose of this study is to compare the advantages and disadvantages of each treatment option, in order to guide clinical physicians in the application of apical surgery.

Detailed Description
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This prospective study will recruit 72 patients with chronic periapical periodontitis in their anterior teeth or premolars, all of which have received comprehensive root canal treatment. The patients will be randomly divided into four groups: Group A, which will undergo only apical surgery (including apicoectomy, inflammation debridement, and retrofilling of the root apex); Group B, which will undergo apical surgery plus bone powder; Group C, which will undergo apical surgery plus CGF (concentrated growth factors); and Group D, which will undergo apical surgery plus bone powder and CGF gel. Each group will consist of 18 patients, and all surgeries will be performed by the same experienced doctor. The participants will receive a 1-year follow-up with the assistance of a professional doctor, including questionnaire data and daily records of pain and swelling at 2, 6, and 12 hours and 7 days after the intervention. Cone-beam computed tomography (CBCT) images will also be taken before the surgery, immediately after the surgery, and at 2, 3, 4, 6, and 12 months post-surgery.

Official Title
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Effect of Concentrated Growth Factors on Healing of Apicomarginal Defects: a Prospective Study

Conditions
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Concentrated Growth Factor, Bone Substitute

Intervention / Treatment
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* Other: concentrated growth factor
* Other: bone substitute
* Combination Product: concentrated growth factor + bone substitute


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18 years old or above. Tooth with significant symptoms or with root apex bone tissue destruction that cannot be treated by non-surgical methods. The affected tooth is either an anterior tooth or a premolar. The size of the lesion during preoperative cone beam computed tomography (CBCT) coronal acquisition is at least 6 mm but not more than 12 mm. The affected tooth has undergone successful root canal treatment. CBCT shows intact lingual side bone plate in the apical region, with only buccal alveolar bone defect present. Good oral hygiene and compliance with medical instructions. Exclusion Criteria: Severe periodontal destruction, with over 1/3 of the root length absorbed by alveolar bone. CBCT shows root fracture or root canal perforation. After root apex surgery, crown-root ratio ≤1:1. Presence of surgical contraindications, systemic and local factors that affect wound healing. Pregnant women and females planning to conceive within the next two years.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: only apical surgery group<br>which will undergo only apical surgery (including apicoectomy, inflammation debridement, and retrofilling of the root apex) | |
| Experimental: bone substitute group<br>which will undergo apical surgery plus bone substitute | Other: bone substitute<br>* Implanting bone substitute into the area of root apical bone defect<br>|
| Experimental: concentrated growth factors group<br>which will undergo apical surgery plus CGF (concentrated growth factors) | Other: concentrated growth factor<br>* Implanting concentrated growth factor into the area of root apical bone defect<br>|
| Experimental: bone substitute and CGF group<br>which will undergo apical surgery plus bone substitute and CGF gel | Combination Product: concentrated growth factor + bone substitute<br>* Implanting concentrated growth factor + bone substitute into the area of root apical bone defect<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Root apex healing status | Measurements of postoperative apical bone healing were obtained using cone-beam computed tomography (CBCT) in horizontal, coronal, and sagittal planes, respectively. Unit: mm | up to 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| pain status | Record the pain condition of patients postoperatively at 2, 6, and 12 hours, as well as daily for 7 days after the surgery through questionnaire surveys. The pain scale is as follows: 0: No pain; (mild): Discomfort or pain that is felt but does not require medication; (moderate): Pain that is uncomfortable but tolerable, and can be effectively relieved with pain medication; (severe): Pain that is difficult to bear. | 7 days | 
| postoperative swelling | Record the postoperative swelling of patients postoperatively at 2, 6, and 12 hours, as well as daily for 7 days after the surgery through questionnaire surveys. Postoperative swelling score will be rated on the following scale: 0: No swelling; Mild swelling at the surgical site; Moderate swelling outside the surgical area; Severe swelling outside the treatment area. | 7 days |