Conventional root canal treatment eliminates infection in necrotic permanent teeth but does not restore the dentin–pulp complex. The clinical predictability of regenerative endodontic treatment in mature teeth remains uncertain. This study evaluated the clinical and radiographic outcomes of an injectable platelet-rich fibrin (i-PRF)-supported regenerative protocol in mature necrotic teeth. This retrospective two-center cohort study included mature permanent teeth presenting with pulp necrosis, closed apices, and periapical lesions with a periapical index (PAI) score ≥ 3 treated between 2022 and 2025 using a standardized i-PRF–supported regenerative endodontic treatment protocol. Periapical healing was assessed using PAI scores, with cone-beam computed tomography (CBCT) images serving as supplementary three-dimensional illustrations. Postoperative pain was recorded using the Visual Analog Scale (VAS). Statistical analysis was performed using the Wilcoxon signed-rank test, Friedman test with Dunn post hoc analysis, logistic regression, and receiver operating characteristic (ROC) curve analysis. A total of 27 teeth were included, with a mean follow-up of 22.5 months. Clinical success was achieved in 24 teeth (88.9%). Mean PAI scores decreased significantly from 4.3 ± 0.78 preoperatively to 1.07 ± 1.57 at follow-up (p < 0.001). CBCT images showed radiographic evidence of three-dimensional periapical healing. Postoperative pain was minimal, with median scores reaching zero within 72 h and no need for analgesic medication. No significant predictors of treatment failure were identified. Within the limitations of this two-center retrospective study, i-PRF–supported regenerative endodontic treatment in mature necrotic teeth demonstrated favorable clinical outcomes, periapical healing, and low postoperative pain, suggesting its potential as a biologically based management approach.
Çeki̇ç et al. (Mon,) studied this question.