Nonsurgical Management of a Failed Revascularization Case Using the Trio of Platelet-Rich Fibrin, Mineral Trioxide Aggregate, and Direct Anatomic Post

A BSTRACT Managing an immature tooth with periapical pathology following a failed revascularization is a significant challenge. This case presents an innovative approach, using a platelet-rich fibrin (PRF) membrane as an apical matrix barrier. This novel technique not only holds promise in stabilizing mineral trioxide aggregate (MTA) in the root-end apexification procedure but also opens up new possibilities in endodontic procedures. The present case report depicts the management of a failed revascularization case. PRF membrane was used as an apical matrix barrier to stabilize MTA in the root-end apexification procedure. The old MTA, present on the canal walls, was removed using H files, irrigated using saline, and finally rinsed with 3% NaOCl and saline with passive ultrasonic irrigation. The calcium hydroxide paste was placed in the canal for disinfection, and the orifice was sealed using a temporary restoration. PRF was inserted into the canal and pushed beyond the apex, followed by a 5-mm apical plug with MTA in the subsequent appointments. After 24 h, the root canal was reinforced using a direct anatomic fiber post. A 6-month follow-up revealed a significantly reduced periapical radiolucency and a well-functioning tooth with decreased mobility, demonstrating the successful management of this challenging case and the effectiveness of the treatment approach. As shown in this case, the one-step apexification using a PRF apical matrix barrier and MTA plug is a highly predictable treatment. This predictability offers a promising alternative to long-term revascularization failures, providing reassurance and confidence in its efficacy.