Abstract
BACKGROUND: Fibrin, a natural hydrogel, can act as scaffold for tissue regeneration. Antibiotic-loading of hydrogels can create an infection-free environment for stem cell proliferation and maturation. AIM: To compare regenerative endodontic potential of three groups (antibiotic-loaded hydrogel, chitosan-loaded hydrogel, and double antibiotic-loaded chitosan hydrogel) in immature necrotic permanent teeth with platelet rich fibrin (PRF). MATERIALS AND METHODS: Fifty-six immature necrotic teeth with periapical lesions were included in simple randomized parallel-controlled superiority trial. Patients aged 10-35 years were assigned into four groups based on scaffolds used: Group 1 (PRF), Group 2 (double antibiotic-loaded [metronidazole and ciprofloxacin] chitosan hydrogel), Group 3 (double antibiotic-loaded hydrogel), and Group 4 (chitosan-loaded hydrogel). One patient per group was lost to follow-up. Regenerative outcomes (change in apex size, root length, radicular dentin thickness, and periapical healing) were assessed at 12 months, through double-blinding and compared postprocedure using cone-beam computed tomography. STATISTICAL ANALYSIS: Based on normality distribution, change in apex size (ANOVA test) while root length, radicular dentin thickness (Kruskal-Wallis test), and periapical healing (paired t-test) were used. RESULTS: Group 2 showed superior regenerative outcomes (P = 0.001) compared to groups 1, 4 after 12 months, and no significant difference with Group 3. CONCLUSION: Double antibiotic-loaded chitosan produced significantly superior outcomes compared to PRF in promoting apexogenesis in immature permanent teeth with necrosed pulp.