Two-dimensional and three-dimensional evaluation of bone regeneration using platelet-rich fibrin versus bone putty in large periapical lesions after endodontic surgery: A randomized clinical trial

Aim: The aim of this study was to perform a two-dimensional (2D) and three-dimensional (3D) comparative evaluation of bone regeneration using autologous platelet-rich fibrin (PRF) versus calcium phosphosilicate-based bone putty in large periapical lesions before and after endodontic surgery. Materials and Methods: Fifty patients with a history of dental trauma and periapical pathology involving the maxillary and mandibular anterior and premolar tooth regions were randomly allocated into two groups, with 25 patients in each group. All patients underwent endodontic surgery following root canal treatment. Bony defects were managed with autologous PRF in Group I and bone putty in Group II. After a 1-year follow-up period, 2D healing was assessed using intraoral periapical radiographs (IOPARs), and area calculation was performed using ImageJ software. 3D healing was evaluated using cone-beam computed tomography (CBCT), and volumetric analysis was conducted using ITK-SNAP software. Results: Patients in Group II exhibited a significantly greater reduction in lesion volume (95.017% ±5.809%) and area (98.376% ± 2.916%) compared to those in Group I (volume reduction: 72.449% ± 14.264% and area reduction: 87.868% ± 11.048%). Bone healing assessed through CBCT and volumetric analysis using ITK-SNAP (83.733 ± 15.668%) was found to be more accurate than 2D area evaluation (93.122 ± 9.598) using IOPAR. Conclusion: Calcium phosphosilicate-based bone putty demonstrated significantly faster bone regeneration than PRF. CBCT-based volumetric assessment (3D) provides a more objective and accurate evaluation of bone healing than conventional IOPAR-based area assessment (2D) and may serve as a valuable tool for assessing treatment outcomes in complex endodontic surgeries.