Regeneration with platelet-rich fibrin and simvastatin combined with bone xenograft in periapical surgery – A comparative 4-year follow-up case study

Abstract Regenerative combination therapies are increasingly used in periapical surgery to enhance osseous healing. This case study examines the clinical and radiographic outcomes of platelet-rich fibrin (PRF) and simvastatin, both combined with bovine bone xenograft, in the treatment of periapical defects. Two patients with persistent periapical pathology requiring surgical intervention were treated using different regenerative approaches and demonstrated comparable preoperative clinical and radiographic characteristics. Clinical outcomes were assessed using the Universal Pain Assessment Tool. At the same time, radiographic healing was evaluated using cone-beam computed tomography, analyzed according to the modified Penn 3D criteria over a 4-year follow-up period. Both PRF and simvastatin, when combined with a xenograft, demonstrated the ability to promote and guide bone regeneration.