الفهرس 
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Abstract
Regenerative endodontic treatment on immature teeth with apical periodontitis is rapidly becoming a widely approved therapeutic alternative to traditional apexfication
This study was designed as a Randomized controlled clinical trial to evaluate and compare the clinical and radiographic findings of a regenerative procedure using platelet-rich fibrin (PRF) and blood clot in immature necrotic permanent teeth with apical periodontitis 12 months after the procedure as well as experimental study to determine histological findings of the regenerative procedure in immature dogs teeth
The vivo part which was a Randomized controlled clinical trial, 36 teeth were divided into two groups 18 participants in each ,control group treated with a standardized revascularization treatment protocol using blood clot as scaffold and study group used PRF as scaffold and monitored for clinical and radiographic changes for 12 month. Standardized radiographs were collected at regular intervals, and radiographic changes were quantified.
The vitro part was an Experimental study of A total of sixty incompletely formed roots were divided into Ш experimental groups and control groups (negative & positive) according to the treatment protocol in addition to specimen for normal pulp of the dog’s teeth
All data were exported to Excel (Microsoft, Redmond, WA, USA) and saved on a secure server for analysis. The median, minimum and maximum, and standard deviation of percentage change of root length and root width were calculated. Mann Whitney U and Kruskal Wallis tests were used to compare difference in means between the study and control groups. Fisher’s exact test was applied to investigate the effect of potential outcome predictors i.e. pain, swelling and pulp response. Statistical analyses were conducted using the SPSS Statistics 23.0 (IBM SPSS Statistics version 23.0; IBM Corporation, New York, USA). Statistical significance was set at P value < 0.05.
The result of the current study revealed that:
Section 1 vivo
1- Positive response to electric pulp testing was observed in two subject in control group while only one subject in study group showed positive response (the test was done only at the last appointment.
2- Success rate in clinical evaluation criteria post intervention was high with no difference in the number of study versus the control group (86.7% (n=13) of study groups showed absence of pain and soft tissue swelling compared to 80% (n=12) in the control group).
3- Results showed no statistical significant difference in the proportion of pain, soft tissue swelling or the presence of pulp vitality among the study or control group (P value > 0.05).
4- There was an increase in the mean length of the teeth roots in the study group compared to the control group at three, six and twelve months duration.However, the statistical significance was only found for the mean difference at 12 months duration (1.25 ml in the study group versus 0.98ml in the control group, P= 0.001)
5- As for thickness, it was noted that the mean thickness in the study group was higher than the mean thickness in the control group measured at the three time points. The increase in the mean thickness was much observed at 12 months duration (0.88ml in the study group compared to 0.67ml in the control group). Moreover, it was found that there is a statistical significant difference in the mean thickness of the study group compared to the control group at three, six and twelve months duration (p value= 0.006. 0.029, 0.001 respectively)
Section 2 vitro
1- There was an increase in the mean area fraction of blood vessels in the study group compared to the other two groups with a statistical significant difference (P value < 0.001).
2- The number of odontoblasts, it was also found that there was an increase in the mean number of odontoblasts in the study group compared with the other 2 groups with a statistical significant difference (P= 0.003).
3- Concerning the number of inflammatory cells, there was an increase in the number of inflammatory cells in the study group compared to the negative control group. However, the number of inflammatory cells in the study group was less than the number in the control group .All the results showed statistical significant difference in the mean number of the lymphocytes, plasma cells and histiocytes among the three study groups.