Introduction and Aim: Larger periapical lesions are a challenging surgical procedure due to the greater amount of resorbed bone. L-PRF, a concept of naturally guided tissue regeneration, contains a dense fibrin network which releases various growth factors, cytokines and proteins. L-PRF improves the initial stages of healing, reducing the inflammatory process and risk of infection. Although L-PRF is popular among other dental fields, its regenerative potential in the apical region still seems to be unclear, therefore the aim of this review was to interpret the currently available literature and ascertain its effectiveness.
Method: Search was carried out in PUBMED’s and EBSCO’s databases, between 2010 and 2020, combinations of keywords were used to find appropriate clinical and in vitro studies. Only articles in English were considered and human studies were not limited to RCTs.
Results: In the 24 selected studies, L-PRF demonstrated to induce the proliferation of fibroblasts and stem cells, accelerate hemostasis, suppress osteoclastogenesis, increase osteoblastic expression and release growth factors, cytokines and proteins. In the apical region, complete regeneration was achieved in all studies and, a reduction of post-surgical pain, inflammation and administration of analgesics was also demonstrated. The centrifugation protocol and materials used demonstrated an influence over the viability of L-PRF.
Conclusions: L-PRF in endodontic microsurgery achieved total apical regeneration in all studies. Nevertheless, more research, preferably with a implemmented standardized protocol, is required.
Clinical Implications: L-PRF potentially accelerates hemostasis and tissue regeneration in the apical region, decreases inflammation, risk of infection and post-surgical pain.