Novel Application of Advanced Platelet-rich Fibrin in Multiple Avulsed Lower Anterior Teeth: a 36-month Follow-up Case Report

valuable for advancing clinical practice.The aim of this case report is to evaluate the clinical efficacy and long-term outcomes of A-PRF in managing multiple anterior tooth avulsions. Case DesCriptionA 10-year-old female presented to the Department of Pediatric Dentistry approximately less than 20 minutes following dental trauma sustained during playground activities.The patient presented with a noncontributory medical history with no known allergies, current medications, or systemic conditions.There was no history of previous dental trauma or significant medical interventions.The patient was fully cooperative and in good general health.Clinical examination revealed three avulsed mandibular introDuCtion Dental avulsion affects 0.5-16% of traumatic dental injuries, predominantly in children aged 7-10 years, with prognosis critically dependent on extra-alveolar time and treatment protocols.1 The "golden period" for optimal outcomes is within 20 minutes of avulsion, though successful replantation can be achieved with extended times when appropriate protocols are used.2 Current literature reveals significant variability in long-term outcomes, with functional healing observed in only 26.5% of avulsion cases and replacement resorption affecting 51.0% of replanted teeth.3 However, adherence to International Association of Dental Traumatology (IADT) guidelines has shown improved long-term survival rates of 79.3% in pediatric populations.4,5 Advanced platelet-rich fibrin (A-PRF) represents a revolutionary second-generation platelet concentrate containing enhanced growth factors, including platelet-derived growth factor (PDGF), transforming growth factor-β (TGF-β), vascular endothelial growth factor (VEGF), and insulin-like growth factor (IGF-1). 6 These bioactive molecules promote angiogenesis, cellular proliferation, and tissue regeneration while providing a natural scaffold for periodontal ligament healing with sustained release over 7-10 days.7 The integration of A-PRF in avulsion management represents a paradigm shift from traditional approaches, offering enhanced biological support during critical healing phases.8,9 Multiple tooth avulsions present increased complexity compared to single-tooth cases due to extensive tissue trauma and potential complications.Limited literature exists specifically addressing A-PRF applications in multiple anterior avulsions in pediatric patients, making this case documentation particularly 1-