Comparative evaluation of clinical and radiographic outcomes of three different scaffolds in regenerative endodontic treatment - A randomized clinical trial.

BACKGROUND: Regenerative endodontic procedures (REPs) have emerged as a biologically based treatment modality for immature nonvital permanent teeth, promoting continued root maturation and periapical healing. Platelet-rich fibrin (PRF), concentrated growth factor (CGF), and collagen hydroxyapatite-based scaffolds such as SynOss Putty have been used as scaffolds during regenerative therapy; however, comparative evidence regarding their effectiveness remains limited. AIM: To evaluate and compare the clinical and radiographic outcomes of PRF, CGF, and SynOss Putty as scaffolds in regenerative endodontic treatment of immature nonvital permanent teeth. MATERIALS AND METHODS: Fifteen immature nonvital permanent teeth in children aged 7-17 years were randomly allocated into three groups ( n = 5 each): PRF, CGF, and SynOss Putty. REPs were performed according to the American Association of Endodontists guidelines. Clinical and radiographic evaluations were carried out at 1, 3, 6, and 12 months. Outcome measures included pain, swelling, tenderness to percussion, mobility, periapical healing, root elongation, dentinal wall thickening, and root apex approximation. STATISTICAL ANALYSIS: Data were analyzed using IBM SPSS Statistics software. Descriptive statistics and Chi-square/Fisher's exact tests were applied, with P < 0.05 considered statistically significant. RESULTS: All groups demonstrated resolution of signs and symptoms during the follow-up period. At 12 months, the PRF group showed significantly greater reduction in periapical pathology and superior root elongation compared with CGF and SynOss Putty ( P = 0.048). PRF also demonstrated greater dentinal wall thickening and root apex approximation. CGF exhibited moderate regenerative potential, whereas SynOss Putty showed comparatively variable radiographic outcomes. CONCLUSION: All three scaffolds were clinically successful; however, PRF demonstrated superior radiographic healing and root development.