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Synergistic application of platelet-rich fibrin and mineral trioxide aggregate for apexification: A scoping review

Rahmadani Puspitasari1 ,  Andari Sarasati2 ,  Muhammad Hidayat Syahruddin3,4 ,  Diatri Nari Ratih1 ,  Yulita Kristanti1 ,  Tunjung Nugraheni1*
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1 Department of Conservative Dentistry, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
2 Department of Oral Medicine, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
3 Department of Periodontics, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
4 Centre of Excellence for Carbonate Apatite-based Extracellular Matrix and Adjuvant, Universitas Gadjah Mada, Yogyakarta, Indonesia
BMT, 202 https://doi.org/10.12336/bmt.25.00202
Submitted: 10 October 2025 | Revised: 16 March 2026 | Accepted: 30 March 2026 | Published: 25 May 2026
© 2026 by the Author(s). Licensee Biomaterials Translational, USA. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 (CC BY-NC-SA 4.0) (https://creativecommons.org/licenses/by-nc-sa/4.0/deed.en)
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Abstract

Traumatically induced immature teeth, characterized by open apices, pose significant challenges in endodontic management, as the lack of an apical barrier predisposes to overextension of the filling material, microbial leakage, and compromised apical sealing. Mineral trioxide aggregate (MTA) has been extensively used for apexification due to its excellent sealing ability and biocompatibility; however, it mainly functions as a mechanical plug and lacks true biological integration with periapical tissues, thereby limiting its regenerative potential. In contrast, platelet-rich fibrin (PRF), which is enriched with autologous growth factors, enhances cellular responses, promotes tissue regeneration, and provides a biologically favorable environment for apical healing. This scoping review aims to critically synthesize the current evidence on the combined use of PRF and MTA for apexification in immature teeth with open apices, with an emphasis on the biological rationale underlying their proposed synergy and the key knowledge gaps relevant to future clinical translation. The scoping review was conducted across ScienceDirect, PubMed, and Scopus, focusing on the biological mechanisms and clinical outcomes of PRF and MTA in apexification, particularly in reducing extrusion, improving sealing, and supporting periapical tissue regeneration. Thirteen studies were included, showing that PRF promotes mineralized tissue formation through increased proliferation and lineage-specific differentiation of progenitor cells within periapical tissues, whereas its fibrin matrix prevents the overextension of MTA and provides a scaffold that creates a favorable microenvironment for cellular activity. The combination of MTA and PRF was found to enhance biological sealing and support hard tissue formation at the apex, facilitating a more controlled and biologically integrated apexification process. Nevertheless, further clinical studies with larger cohorts and extended follow-ups are warranted to confirm therapeutic efficacy and establish standardized clinical protocols.

Keywords
Apexification
Mineral trioxide aggregate
Platelet-rich fibrin
Regenerative materials
Tooth injury
Funding
None.
Conflict of interest
The authors declare no conflict of interest.
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