Comparison of double antibiotic chitosan hydrogel scaffold with platelet‑rich fibrin in regeneration in immature necrotic permanent teeth – Randomized controlled trial

Abstract

Background: Fibrin, a natural hydrogel, can act as scaffold for tissue regeneration. Antibiotic‑loading of hydrogels can create an infection‑free environment for stem cell proliferation and maturation. Aim: To compare regenerative endodontic potential of three groups (antibiotic‑loaded hydrogel, chitosan‑loaded hydrogel, and double antibiotic‑loaded chitosan hydrogel) in immature necrotic permanent teeth with platelet rich fibrin (PRF). Materials and Methods: Fifty‑six immature necrotic teeth with periapical lesions were included in simple randomized parallel‑controlled superiority trial. Patients aged 10–35 years were assigned into four groups based on scaffolds used: Group 1 (PRF), Group 2 (double antibiotic‑loaded [metronidazole and ciprofloxacin] chitosan hydrogel), Group 3 (double antibiotic‑loaded hydrogel), and Group 4 (chitosan‑loaded hydrogel). One patient per group was lost to follow‑up. Regenerative outcomes (change in apex size, root length, radicular dentin thickness, and periapical healing) were assessed at 12 months, through double‑blinding and compared postprocedure using cone‑beam computed tomography. Statistical Analysis: Based on normality distribution, change in apex size (ANOVA test) while root length, radicular dentin thickness (Kruskal–Wallis test), and periapical healing (paired t‑test) were used. Results: Group 2 showed superior regenerative outcomes (P = 0.001) compared to groups 1, 4 after 12 months, and no significant difference with Group 3. Conclusion: Double antibiotic‑loaded chitosan produced significantly superior outcomes compared to PRF in promoting apexogenesis in immature permanent teeth with necrosed pulp. © 2024 Journal of Conservative Dentistry and Endodontics.