The goal of this clinical trial is to determine whether a PRF (platelet-rich fibrin) membrane helps improve recovery after periapical surgery in adults. The main questions it seeks to answer are:

Does the use of a PRF membrane reduce swelling and pain after surgery? Does the use of a PRF membrane improve healing as observed on 3D imaging? Researchers will compare the outcomes of participants who receive a PRF membrane during surgery with those who do not, to assess whether the PRF membrane improves recovery.

Participants will:

Undergo periapical surgery with or without the use of a PRF membrane. Have swelling and pain assessed at specific time points after surgery. Participate in 3D imaging scans to evaluate healing.

Participants will:

Undergo periapical surgery with or without the use of a PRF membrane. Have swelling and pain measured at specific time points after surgery. Take part in 3D imaging scans to evaluate healing.

Inclusion Criteria:

• Adults aged 20-65 years, both male and female.
• Diagnosed with periapical disease, including periapical cysts or granulomas.
• Requiring periapical surgery as part of their treatment plan.
• Presenting a tooth needing endodontic surgery with periradicular lesions of strictly endodontic origin.
• Size of the bone crypt between 6 mm and 12 mm.
• Non-surgical retreatment considered unfeasible or previously failed.
• Apical root canal free from posts over a length of at least 6 mm.
• Adequate coronal restoration without coronal leakage.
• Willing and able to provide written informed consent.
• Capable of attending follow-up visits and participating in required assessments.
• Maxillary and mandibular teeth limited to the 2nd premolar to 2nd premolar regions.
• Without general medical contraindications for oral surgical procedures.

Exclusion Criteria:

• Patients with systemic conditions affecting healing, such as:

  • • Uncontrolled diabetes mellitus.
  • • Autoimmune disorders.
  • • Chronic inflammatory diseases.

• Pregnant or breastfeeding individuals.

• Use of medications or therapies that may interfere with healing, including:

  • • Bisphosphonates.
  • • Immunosuppressants.
  • • Radiotherapy.
  • • Oncological therapies (e.g., chemotherapy, immunotherapy).

• Requires antibiotic prophylaxis or therapy.

• History of allergies or adverse reactions to blood-derived products.

• Neuropsychiatric disorders.

• Active infection or severe periodontal disease in the surgical area.

• Periodontal probing depths greater than 5 mm.

• Moderate to severe periodontal bone loss.

• Vertical root fractures.

• Perforation of the furcation area or root canal, except for the apical area.

• Smokers or individuals unwilling to refrain from smoking during the study period.

• Participation in another clinical trial within the last 30 days.

• Absolute or relative contraindications for surgery.