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Mandibular incisor crowding is a frequent issue that prompts many adults to seek orthodontic treatment. The treatment may enhance patients' quality of life, facilitate dental plaque control, and improve the quality of periodontal tissue. However, this treatment is accompanied by several side effects, including resorption of the apical portion of the teeth. Platelet-rich concentrates, such as injectable platelet-rich fibrin, have been shown to have positive effects on both soft- and hard-tissue healing. They may serve as a beneficial self-derived material to prevent this complication.
In recent years, increasing attention has been directed toward biologically driven approaches to modulate tissue responses during orthodontic treatment and minimize adverse effects, such as root resorption. Platelet-rich fibrin (PRF), a second-generation autologous platelet concentrate, has emerged as a promising biomaterial due to its high concentration of platelets, leukocytes, and a fibrin matrix that allows gradual release of multiple 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). However, in 2014, injectable platelet-rich fibrin (I-PRF), which is similar to PRF, was introduced in France by Choukroun, using non-glass tubes and adjusting the centrifugal force. Just like traditional PRF, i-PRF contains high levels of growth factors, stem cells, leukocytes, and cytokines.
These growth factors play a crucial role in angiogenesis, tissue regeneration, modulation of inflammation, and bone remodeling, all of which are central processes in orthodontic tooth movement and periodontal healing.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| 4-time i-PRF injection group | Experimental | I-PRF was injected in the buccal region of the mandibular incisors 4 sessions with 28-day interval. |
|
| Control group | Placebo Comparator | Saline serum was injected in the buccal region of the mandibular incisors 4 sessions with 28-day interval |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| 4-time i-PRF injection group | Procedure | I-PRF will be injected in 4 sessions at 28-day intervals. The injection will administered submucosally in the buccal region of the lower incisors, using 2 ml of i-PRF per session (0.5 ml per incisor). Orthodontic wires will be sequenced until they reach 0.019×0.025-inch stainless steel. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in root length | Root resorption (i.e., change in root length) will be measured by calculating the difference in the full linear length of each incisor (incisal edge to the apex) between two assessment times (in millimeters) using CBCT images. | First assessment time: one day before the commencement of treatment. Second assessment time: within one week following the leveling and alignment stage (The stage is expected to finish within 4 to six months after the beginning of treatment) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Mohammad I. Idris, DDS | Faculty of Dentistry, University of Damascus | Principal Investigator |
| Ahmad S. Burhan, DDS MSc PhD | Faculty of Dentistry, University of Damascus | Study Director |
| Mohammad Y Hajeer, DDS MSc PhD | Faculty of Dentistry, University of Damascus | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Orthodontics, Faculty of Dentistry, University of Damsacus | Damascus | DM20 HAJ72 | Syria |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 17014535 | Background | Zhang M, McGrath C, Hagg U. The impact of malocclusion and its treatment on quality of life: a literature review. Int J Paediatr Dent. 2006 Nov;16(6):381-7. doi: 10.1111/j.1365-263X.2006.00768.x. | |
| 34235061 | Background | Valerio CS, Cardoso CAEA, Araujo EA, Zenobio EG, Manzi FR. Bone changes in the mandibular incisors after orthodontic correction of dental crowding without extraction: A cone-beam computed tomographic evaluation. Imaging Sci Dent. 2021 Jun;51(2):155-165. doi: 10.5624/isd.20200260. Epub 2021 Feb 9. |
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| ID | Term |
|---|---|
| D012965 | Sodium Chloride |
| ID | Term |
|---|---|
| D002712 | Chlorides |
| D006851 | Hydrochloric Acid |
| D017606 | Chlorine Compounds |
| D007287 | Inorganic Chemicals |
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| Saline injection | Procedure | Saline serum will be injected in 4 sessions at 28-day intervals. The injection will be administered submucosally in the buccal region of the lower incisors, using 2 ml of i-PRF per session (0.5 ml per incisor). Orthodontic wires will be sequenced until they reach 0.019×0.025-inch stainless steel. |
|
| 33653326 | Background | Zeitounlouian TS, Zeno KG, Brad BA, Haddad RA. Three-dimensional evaluation of the effects of injectable platelet rich fibrin (i-PRF) on alveolar bone and root length during orthodontic treatment: a randomized split mouth trial. BMC Oral Health. 2021 Mar 2;21(1):92. doi: 10.1186/s12903-021-01456-9. |
| 29771300 | Background | Samandara A, Papageorgiou SN, Ioannidou-Marathiotou I, Kavvadia-Tsatala S, Papadopoulos MA. Evaluation of orthodontically induced external root resorption following orthodontic treatment using cone beam computed tomography (CBCT): a systematic review and meta-analysis. Eur J Orthod. 2019 Jan 23;41(1):67-79. doi: 10.1093/ejo/cjy027. |
| 39487452 | Background | Idris MI, Burhan AS, Hajeer MY, Sultan K, Nawaya FR. Efficacy of the injectable platelet-rich fibrin (i-PRF) in gingival phenotype modification: a systematic review and meta-analysis of randomized controlled trials. BMC Oral Health. 2024 Nov 1;24(1):1331. doi: 10.1186/s12903-024-05109-5. |
| 42219245 | Derived | Idris MI, Burhan AS, Hajeer MY, Nawaya FR. Effect of injectable platelet-rich fibrin on orthodontically induced apical root resorption following non-extraction-based orthodontic treatment in adults: A randomized controlled clinical trial. J Int Med Res. 2026 May;54(5):3000605261452234. doi: 10.1177/03000605261452234. Epub 2026 May 31. |
| D017670 |
| Sodium Compounds |