The Use of Plasma Rich in Growth Factors With Guided Tissue Regeneration in Surgical Endodontics—A Retrospective Cohort Study

AIM: To examine the influence of plasma rich in growth factors (PRGF) with or without guided tissue regeneration (GTR) techniques on soft tissue healing dynamics, postoperative sequelae and treatment outcome in endodontic surgery. METHODOLOGY: In this retrospective study, the clinical records (n = 161) of adult patients treated by an endodontic specialist between January 2018 and December 2024 across three cohorts were reviewed. Cohort 1 compared Group A (no PRGF/GTR; n = 24) with Group B (PRGF only; n = 30); Cohort 2 compared Group C (Bio-Gide membrane; n = 28) with Group D (PRGF + Bio-Gide; n = 26); and Cohort 3 compared Group E (Bio-Gide + Bio-Oss graft; n = 27) with Group F (PRGF + Bio-Gide + Bio-Oss; n = 26). Sub-group analysis was performed for large lesions (> 5 mm) in Cohort 3. Soft tissue healing quality, clinical attachment loss and treatment outcome, based on clinical and radiographic healing, were assessed during suture removal and at 12 and 24 months follow-ups. Additionally, postoperative signs and symptoms, analgesics need, further intervention, adverse effects and quality of life were also evaluated. Statistical analysis was performed with Pearson's chi-square or Fisher's exact tests (significance threshold, α = 0.05). RESULTS: In Cohort 1, PRGF significantly improved soft tissue healing at suture removal (p = 0.013; Group B: 100.0% v. Group A: 79.2%). In Cohort 2, combining PRGF with Bio-Gide significantly reduced the analgesic need, adverse effects and impact on quality of life at suture removal (p < 0.001), and preserved clinical attachment at 12 months (p < 0.001) and 24 months (p = 0.012). For Cohort 3 and large lesions, PRGF had no significant association with any clinical or radiographic outcomes at any stage (p > 0.050). CONCLUSIONS: The benefits of PRGF in endodontic surgery were dependent on the GTR used. When used alone early soft tissue healing was improved, and when combined with a collagen membrane, short-term adverse effects and impact on quality of life were reduced, while maintaining clinical attachment levels. When performed to an optimal technical standard, the advantages of using PRGF and GTR were limited.