Application of I-PRF in bone and periodontal healing after apicoectomy: clinical case
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Abstract
Introduction: endodontic microsurgery is used to treat periapical pathologies when endodontic retreatment fails. In this context, injectable platelet-rich fibrin (I-PRF) is considered a complement to healing due to its ability to gradually release factors that promote bone and periodontal repair. Objective: to report, from a clinical and radiological point of view, a case of apicoectomy following the complementary application of I-PRF. Methodology: a descriptive observational study was conducted, corresponding to a case report, on a 50-year-old female patient treated at the clinic of the Catholic University of Cuenca. A deficient endodontic treatment associated with a metal-porcelain crown with leakage was identified. Apical resection, curettage of the inflammatory tissue, retrograde filling with Biodentine, and application of I-PRF obtained by low-speed centrifugation were performed; subsequently, the flap was repositioned and sutured. Results: the clinical outcome was favorable, with no pain or inflammation. Radiographic controls showed bone regeneration and functional restoration. Conclusion: the complementary use of I-PRF in apical surgery is a minimally invasive option that promotes bone and periodontal healing. Thus, the integration of autologous and bioceramic biomaterials, applied under surgical protocols. General area of study: Dentistry. Specific area of study: Endodontics. Type of article: Clinical case.
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Figueroa Ortiz, B. B., & Rodríguez Reyes, F. G. (2026). Application of I-PRF in bone and periodontal healing after apicoectomy: clinical case. Anatomía Digital, 9(1.2), 83-104. https://doi.org/10.33262/anatomiadigital.v9i1.2.3607
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References
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11. Ricucci D, Siqueira JF, Bate AL, Pitt TR. Histologic investigation of root canal–treated teeth with apical periodontitis: a retrospective study from twenty-four patients. Journal of Endodontics [Internet]. 2009 [cited 2025 Dec 17]; 35(4): 493-502. Available from: https://pubmed.ncbi.nlm.nih.gov/19345793/
12. Sabeti M, Chung YJ, Aghamohammadi N, Khansari A, Pakzad R, Azarpazhooh A. Outcome of contemporary nonsurgical endodontic retreatment: a systematic review of randomized controlled trials and cohort studies. Journal of Endodontics [Internet]. 2024 [cited 2025 Dec 17]; 50(4):414-33. Available from: https://pubmed.ncbi.nlm.nih.gov/38280514/
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14. Torabinejad M, Corr R, Handysides R, Shabahang S. Outcomes of nonsurgical retreatment and endodontic surgery: a systematic review. Journal of Endodontics [Internet]. 2009 [cited 2025 Dec 17]; 35(7):930-937 Available from: http://dx.doi.org/10.1016/j.joen.2009.04.023
15. Fayad MI, Nair M, Levin MD, Benavides E, Rubinstein RA, Barghan S, et al. AAE and AAOMR Joint Position Statement. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology [Internet]. octubre de 2015 [citado 4 de febrero de 2026];120(4):508-12. Disponible en: https://doi.org/10.1016/j.oooo.2015.07.033
16. Ng Y, Gulabivala K. Outcome of non‐surgical re‐treatment. Endodontic Topics [Internet]. 2008 [cited 2025 Dec 17]; 18(1):3-30. Available from: http://dx.doi.org/10.1111/j.1601-1546.2011.00260.x
17. Vieira AR, Pacheco‐Yanes J, Gazzaneo ID, Neves MAS, Siqueira JF, Gonçalves LS. Factors influencing the outcome of nonsurgical root canal treatment and retreatment: A retrospective study. Australian Endodontic Journal [Internet]. 2024 [cited 2025 Sep 30]; 50(1): 245-259. Available from: http://dx.doi.org/10.1111/aej.12828
18. Riis A, Taschieri S, Del Fabbro M, Kvist T. Tooth survival after surgical or nonsurgical endodontic retreatment: long-term follow-up of a randomized clinical trial. Journal of Endodontics [Internet]. 2018 [cited 2025 Dec 17]; 44(10):1480-1486. Available from: http://dx.doi.org/10.1016/j.joen.2018.06.019
19. Mavishna M, Venkatesh KV. Comparative evaluation of retreatability of calcium silicate-based root canal sealers and epoxy resin-based root canal sealers in curved canals-an in-vitro micro-ct analysis. Indian Journal of Dental Research [Internet]. 2021 [cited 2025 Dec 17]; 31(1):79-86. Available from: http://dx.doi.org/10.4103/ijdr.IJDR_328_20
20. Olcay K, Eyüboglu TF, Özcan M. Clinical outcomes of non-surgical multiple-visit root canal retreatment: a retrospective cohort study. Odontology [Internet]. 2019 [cited 2025 Dec 17]; 107(4):536-545. Available from: http://dx.doi.org/10.1007/s10266-019-00426-6
21. Zanza A, Reda R, Testarelli L. Endodontic Orthograde Retreatments: Challenges and Solutions. Clinical, cosmetic and investigational dentistry [Internet]. 2021 [cited 2025 Dec 17]; 15:245–265. Available from: http://dx.doi.org/10.2147/CCIDE.S397835
22. Setzer FC, Kratchman SI. Present status and future directions: Surgical endodontics. International endodontic journal [Internet]. 2022 [cited 2025 Dec 17]; 55(4):1020–1058. Available from: http://dx.doi.org/10.1111/iej.13783
23. Tsesis I, Rosen E, Taschieri S, Telishevsky Y, Ceresoli V, Del Fabbro M. Outcomes of surgical endodontic treatment performed by a modern technique: an updated meta-analysis of the literature. Journal of Endodontics [Internet]. 2013 [cited 2025 Dec 17]; 39(3): 332-339. Available from: http://dx.doi.org/10.1016/j.joen.2012.11.044
24. Kohli MR, Berenji H, Setzer FC, Lee S-M, Karabucak B. Outcome of Endodontic Surgery: A Meta-analysis of the Literature—Part 3: Comparison of Endodontic Microsurgical Techniques with 2 Different Root-end Filling Materials. Journal of Endodontics [Internet]. 2018 [cited 2025 Dec 17]; 44(6): 923-931. Available from: http://dx.doi.org/10.1016/j.joen.2018.02.021
25. Rotstein I, Ingle JI. Ingle’s endodontics 7. Volume 2. En: 50th anniversary edition. 7th ed [Internet]. 2019 [cited 2025 Dec 17]: PMPH USA. Available from: https://pmphusa.com/book/ingles-endodontics-7/
26. Paños-Crespo A, Sánchez-Torres A, Gay-Escoda C. Retrograde filling material in periapical surgery: a systematic review. Medicina oral, patologia oral y cirugia bucal [Internet]. 2021 [cited 2025 Dec 17]; e422–e429. Available from: http://dx.doi.org/10.4317/medoral.24262
27. Sharma R, Tewari S, Sangwan P, Gupta A. Effect of allograft and collagen membrane application on periapical and labial bone regeneration in apicomarginal defects treated with endodontic microsurgery: a randomized controlled trial. Oral surgery, oral medicine, oral pathology and oral radiology [Internet]. 2015 [cited 2025 Dec 17]; 140(1):41-53. Available from: http://dx.doi.org/10.1016/j.oooo.2025.01.005
28. Arpitha M, Tewari S, Sangwan P, Gupta A. Efficacy of mixture of injectable‐platelet‐rich fibrin and type‐1 collagen particles on the closure of through‐and‐through periapical bone defects: a randomized controlled trial. International Endodontic Journal [Internet]. 2023 [cited 2025 Dic. 05];56(10):1197-211. Available from: https://doi.org/10.1111/iej.13954
29. Patel S, Brown J, Semper M, Abella F, Mannocci F. European society of endodontology position statement: use of cone beam computed tomography in endodontics. International Endodontic Journal [Internet]. 2019 [cited 2025 Dec 17]; 52(12): 1675–1678. https://doi.org/10.1111/iej.13187
30. Miron R, Fujioka-Kobayashi M, Hernandez M, Kandalam U, Zhang Y, Ghanaati S, et al. Injectable platelet rich fibrin (I-prf): opportunities in regenerative dentistry? Clinical oral investigations [Internet]. 2017 [cited 2025 Dec 17]; 21(8):2619-2627. Available from: http://dx.doi.org/10.1007/s00784-017-2063-9
31. Zwittnig K, Kirnbauer B, Jakse N, Schlenke P, Mischak I, Ghanaati S, et al. Growth factor release within liquid and solid PRF. Journal of clinical medicine [Internet]. 2022 [cited 2025 Dec 17]; 11(17):5070. Available from: http://dx.doi.org/10.3390/jcm11175070
32. Sinha A, Jain AK, Rao RD, Sivasailam S, Jain R. Effect of platelet-rich fibrin on periapical healing and resolution of clinical symptoms in patients following periapical surgery: A systematic review and meta-analysis. Journal of conservative dentistry and endodontics [Internet]. 2023 [cited 2025 Dec 17]; 26(4):366-376. Available from: http://dx.doi.org/10.4103/jcd.jcd_195_23
33. Angerame D, De Biasi M, Kastrioti I, Franco V, Castaldo A, Maglione M. Application of platelet-rich fibrin in endodontic surgery: a pilot study. Giornale Italiano di Endodonzia [Internet]. 2015 [cited 2025 Dec 17]; 29(2):51-57. Available from: http://dx.doi.org/10.1016/j.gien.2015.08.003
34. Setzer FC, KMR, Shah SB, Karabucak B, Kim S. Outcome of endodontic surgery: a meta-analysis of the literature—part 2: comparison of endodontic microsurgical techniques with and without the use of higher magnification. Journal of Endodontics [Internet]. 2011 [cited 2025 Dec 17]; 38(1):1–10. Available from: http://dx.doi.org/10.1016/j.joen.2011.09.021
35. Rosales Salcedo GV, Molina Barahona RM, Silva Erráez C, Morales Navarro D. Clinical and imaging evaluation of platelet-rich fibrin in post-exodontic bone regeneration. A systematic review. Anatomia Digital [Internet]. 2025 [cited 2025 Dic. 5];8(2.2):27-5. Available from:
https://doi.org/10.33262/anatomiadigital.v8i2.2.3423
36. Rubio Uzho KA, Molina Barahona RM, Cruz Proaño ED, Vásquez Palacios AC. Imagin evaluation of platelet-rich fibrin in post-exodontic bone regeneration. A systematic review. Anatomia Digital [Internet]. 2025 [cited 2025 Dic. 5];8(3.2):6-28. Available from:
https://doi.org/10.33262/anatomiadigital.v8i3.2.3458
37. Soto Zumbana JA, Piedra Andrade RB, Lugo Pinto MA, Rodriguez Reyes FG. Applied regenerative endodontics: periapical surgery and sealing of root drilling with A-PRF and photodynamic therapy. Case Report. Anatomia Digital [Internet]. 2025 [cited 2025 Dec. 05];8(2):89-101. Available from: https://doi.org/10.33262/anatomiadigital.v8i2.3402
2. Rufasto KS, Vigo ER, Lizarbe MV, Salazar MR. Etiología, fisiopatología y tratamiento de la periodontitis apical. Revisión de la literatura. Avances en Odontoestomatología [Internet]. 2023 [citado 2025 Dic 17]; 39(1):9-16. Disponible en: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-12852023000100003
3. Siqueira JF, Rôças IN. Clinical implications and microbiology of bacterial persistence after treatment procedures. Journal of Endodontics [Internet]. 2008 [cited 2025 Dec 17]; 34(11):1291-1301 Available from: https://pubmed.ncbi.nlm.nih.gov/18928835/
4. García-Rubio A, Bujaldón-Daza AL, Rodríguez-Archilla A. Lesiones periapicales. Diagnóstico y tratamiento. Avances en Odontoestomatología [Internet]. 2015 [citado 2025 Dic 17]; 31(1): 31-42. Disponible en: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-12852015000100005
5. Tibúrcio‐Machado CS, Michelon C, Zanatta FB, Gomes MS, Marin JA, Bier CA. The global prevalence of apical periodontitis: a systematic review and meta‐analysis. International endodontic journal [Internet]. 2021 [cited 2025 Dec 17]; 54(5): 712-35. Available from: https://pubmed.ncbi.nlm.nih.gov/33378579/
6. Alhailaa AA, Al-Nazhan SA, Aldosimani MA. Prevalence of apical periodontitis and quality of root canal treatment in an adult Kuwaiti sub-population: a cross-sectional study. Restorative dentistry & endodontics [Internet]. 2024 [cited 2025 Dec 17]; 49(2): e16. Available from: https://pubmed.ncbi.nlm.nih.gov/38841383/
7. Abesi F, Golikani A. Diagnostic performance of cone-beam computed tomography for apical periodontitis: a systematic review and meta-analysis. Polish journal of radiology [Internet]. 2023 [cited 2025 Dec 17]; 88:597-605. Available from: https://pubmed.ncbi.nlm.nih.gov/38362018/
8. Sood N, Maheshwari M, Gothi R, Sood N. Treatment of Large Periapical Cyst Like Lesion: A Noninvasive Approach: A Report of Two Cases. International journal of clinical pediatric dentistry [Internet]. 2015 [cited 2025 Dec 17]; 8(2):133-137. Available from: https://pubmed.ncbi.nlm.nih.gov/26379382/
9. Simon JH, Enciso R, Malfaz JM, Roges R, Bailey-Perry M, Patel A. Differential diagnosis of large periapical lesions using cone-beam computed tomography measurements and biopsy. Journal of Endodontics [Internet]. 2006 [cited 2025 Dec 17]; 32(9):833-837. Available from: https://pubmed.ncbi.nlm.nih.gov/16934625/
10. Miron RJ, Fujioka-Kobayashi M, Bishara M, Zhang Y, Hernandez M, Choukroun J. Platelet-rich fibrin and soft tissue wound healing: A systematic review. Tissue engineering. Part B, Reviews [Internet]. 2017 [cited 2025 Dec 17]; 23(1):83–99. Available from: https://pubmed.ncbi.nlm.nih.gov/27672729/
11. Ricucci D, Siqueira JF, Bate AL, Pitt TR. Histologic investigation of root canal–treated teeth with apical periodontitis: a retrospective study from twenty-four patients. Journal of Endodontics [Internet]. 2009 [cited 2025 Dec 17]; 35(4): 493-502. Available from: https://pubmed.ncbi.nlm.nih.gov/19345793/
12. Sabeti M, Chung YJ, Aghamohammadi N, Khansari A, Pakzad R, Azarpazhooh A. Outcome of contemporary nonsurgical endodontic retreatment: a systematic review of randomized controlled trials and cohort studies. Journal of Endodontics [Internet]. 2024 [cited 2025 Dec 17]; 50(4):414-33. Available from: https://pubmed.ncbi.nlm.nih.gov/38280514/
13. Gorni F, Gagliani M. The outcome of endodontic retreatment: a 2-yr follow-up. Journal of Endodontics [Internet]. 2004 [cited 2025 Sep 30];30(1):1-4. Available from: http://dx.doi.org/10.1097/00004770-200401000-00001
14. Torabinejad M, Corr R, Handysides R, Shabahang S. Outcomes of nonsurgical retreatment and endodontic surgery: a systematic review. Journal of Endodontics [Internet]. 2009 [cited 2025 Dec 17]; 35(7):930-937 Available from: http://dx.doi.org/10.1016/j.joen.2009.04.023
15. Fayad MI, Nair M, Levin MD, Benavides E, Rubinstein RA, Barghan S, et al. AAE and AAOMR Joint Position Statement. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology [Internet]. octubre de 2015 [citado 4 de febrero de 2026];120(4):508-12. Disponible en: https://doi.org/10.1016/j.oooo.2015.07.033
16. Ng Y, Gulabivala K. Outcome of non‐surgical re‐treatment. Endodontic Topics [Internet]. 2008 [cited 2025 Dec 17]; 18(1):3-30. Available from: http://dx.doi.org/10.1111/j.1601-1546.2011.00260.x
17. Vieira AR, Pacheco‐Yanes J, Gazzaneo ID, Neves MAS, Siqueira JF, Gonçalves LS. Factors influencing the outcome of nonsurgical root canal treatment and retreatment: A retrospective study. Australian Endodontic Journal [Internet]. 2024 [cited 2025 Sep 30]; 50(1): 245-259. Available from: http://dx.doi.org/10.1111/aej.12828
18. Riis A, Taschieri S, Del Fabbro M, Kvist T. Tooth survival after surgical or nonsurgical endodontic retreatment: long-term follow-up of a randomized clinical trial. Journal of Endodontics [Internet]. 2018 [cited 2025 Dec 17]; 44(10):1480-1486. Available from: http://dx.doi.org/10.1016/j.joen.2018.06.019
19. Mavishna M, Venkatesh KV. Comparative evaluation of retreatability of calcium silicate-based root canal sealers and epoxy resin-based root canal sealers in curved canals-an in-vitro micro-ct analysis. Indian Journal of Dental Research [Internet]. 2021 [cited 2025 Dec 17]; 31(1):79-86. Available from: http://dx.doi.org/10.4103/ijdr.IJDR_328_20
20. Olcay K, Eyüboglu TF, Özcan M. Clinical outcomes of non-surgical multiple-visit root canal retreatment: a retrospective cohort study. Odontology [Internet]. 2019 [cited 2025 Dec 17]; 107(4):536-545. Available from: http://dx.doi.org/10.1007/s10266-019-00426-6
21. Zanza A, Reda R, Testarelli L. Endodontic Orthograde Retreatments: Challenges and Solutions. Clinical, cosmetic and investigational dentistry [Internet]. 2021 [cited 2025 Dec 17]; 15:245–265. Available from: http://dx.doi.org/10.2147/CCIDE.S397835
22. Setzer FC, Kratchman SI. Present status and future directions: Surgical endodontics. International endodontic journal [Internet]. 2022 [cited 2025 Dec 17]; 55(4):1020–1058. Available from: http://dx.doi.org/10.1111/iej.13783
23. Tsesis I, Rosen E, Taschieri S, Telishevsky Y, Ceresoli V, Del Fabbro M. Outcomes of surgical endodontic treatment performed by a modern technique: an updated meta-analysis of the literature. Journal of Endodontics [Internet]. 2013 [cited 2025 Dec 17]; 39(3): 332-339. Available from: http://dx.doi.org/10.1016/j.joen.2012.11.044
24. Kohli MR, Berenji H, Setzer FC, Lee S-M, Karabucak B. Outcome of Endodontic Surgery: A Meta-analysis of the Literature—Part 3: Comparison of Endodontic Microsurgical Techniques with 2 Different Root-end Filling Materials. Journal of Endodontics [Internet]. 2018 [cited 2025 Dec 17]; 44(6): 923-931. Available from: http://dx.doi.org/10.1016/j.joen.2018.02.021
25. Rotstein I, Ingle JI. Ingle’s endodontics 7. Volume 2. En: 50th anniversary edition. 7th ed [Internet]. 2019 [cited 2025 Dec 17]: PMPH USA. Available from: https://pmphusa.com/book/ingles-endodontics-7/
26. Paños-Crespo A, Sánchez-Torres A, Gay-Escoda C. Retrograde filling material in periapical surgery: a systematic review. Medicina oral, patologia oral y cirugia bucal [Internet]. 2021 [cited 2025 Dec 17]; e422–e429. Available from: http://dx.doi.org/10.4317/medoral.24262
27. Sharma R, Tewari S, Sangwan P, Gupta A. Effect of allograft and collagen membrane application on periapical and labial bone regeneration in apicomarginal defects treated with endodontic microsurgery: a randomized controlled trial. Oral surgery, oral medicine, oral pathology and oral radiology [Internet]. 2015 [cited 2025 Dec 17]; 140(1):41-53. Available from: http://dx.doi.org/10.1016/j.oooo.2025.01.005
28. Arpitha M, Tewari S, Sangwan P, Gupta A. Efficacy of mixture of injectable‐platelet‐rich fibrin and type‐1 collagen particles on the closure of through‐and‐through periapical bone defects: a randomized controlled trial. International Endodontic Journal [Internet]. 2023 [cited 2025 Dic. 05];56(10):1197-211. Available from: https://doi.org/10.1111/iej.13954
29. Patel S, Brown J, Semper M, Abella F, Mannocci F. European society of endodontology position statement: use of cone beam computed tomography in endodontics. International Endodontic Journal [Internet]. 2019 [cited 2025 Dec 17]; 52(12): 1675–1678. https://doi.org/10.1111/iej.13187
30. Miron R, Fujioka-Kobayashi M, Hernandez M, Kandalam U, Zhang Y, Ghanaati S, et al. Injectable platelet rich fibrin (I-prf): opportunities in regenerative dentistry? Clinical oral investigations [Internet]. 2017 [cited 2025 Dec 17]; 21(8):2619-2627. Available from: http://dx.doi.org/10.1007/s00784-017-2063-9
31. Zwittnig K, Kirnbauer B, Jakse N, Schlenke P, Mischak I, Ghanaati S, et al. Growth factor release within liquid and solid PRF. Journal of clinical medicine [Internet]. 2022 [cited 2025 Dec 17]; 11(17):5070. Available from: http://dx.doi.org/10.3390/jcm11175070
32. Sinha A, Jain AK, Rao RD, Sivasailam S, Jain R. Effect of platelet-rich fibrin on periapical healing and resolution of clinical symptoms in patients following periapical surgery: A systematic review and meta-analysis. Journal of conservative dentistry and endodontics [Internet]. 2023 [cited 2025 Dec 17]; 26(4):366-376. Available from: http://dx.doi.org/10.4103/jcd.jcd_195_23
33. Angerame D, De Biasi M, Kastrioti I, Franco V, Castaldo A, Maglione M. Application of platelet-rich fibrin in endodontic surgery: a pilot study. Giornale Italiano di Endodonzia [Internet]. 2015 [cited 2025 Dec 17]; 29(2):51-57. Available from: http://dx.doi.org/10.1016/j.gien.2015.08.003
34. Setzer FC, KMR, Shah SB, Karabucak B, Kim S. Outcome of endodontic surgery: a meta-analysis of the literature—part 2: comparison of endodontic microsurgical techniques with and without the use of higher magnification. Journal of Endodontics [Internet]. 2011 [cited 2025 Dec 17]; 38(1):1–10. Available from: http://dx.doi.org/10.1016/j.joen.2011.09.021
35. Rosales Salcedo GV, Molina Barahona RM, Silva Erráez C, Morales Navarro D. Clinical and imaging evaluation of platelet-rich fibrin in post-exodontic bone regeneration. A systematic review. Anatomia Digital [Internet]. 2025 [cited 2025 Dic. 5];8(2.2):27-5. Available from:
https://doi.org/10.33262/anatomiadigital.v8i2.2.3423
36. Rubio Uzho KA, Molina Barahona RM, Cruz Proaño ED, Vásquez Palacios AC. Imagin evaluation of platelet-rich fibrin in post-exodontic bone regeneration. A systematic review. Anatomia Digital [Internet]. 2025 [cited 2025 Dic. 5];8(3.2):6-28. Available from:
https://doi.org/10.33262/anatomiadigital.v8i3.2.3458
37. Soto Zumbana JA, Piedra Andrade RB, Lugo Pinto MA, Rodriguez Reyes FG. Applied regenerative endodontics: periapical surgery and sealing of root drilling with A-PRF and photodynamic therapy. Case Report. Anatomia Digital [Internet]. 2025 [cited 2025 Dec. 05];8(2):89-101. Available from: https://doi.org/10.33262/anatomiadigital.v8i2.3402