The aim of the study is first, to evaluate the clinical antibacterial efficacy of two different NaOCl concentrations (2,5% and 5%) under a predefined irrigant flow rate in teeth with pulp necrosis and apical periodontitis by using Real-time PCR. . Second, to evaluate the efficacy of final irrigation by assessing, if possible, a numerical definition for that "so called" as "copious irrigation". Besides the total microbial load, the antibacterial efficacy of final irrigation procedure against two different bacterial species (namely Pseudoramibacter alactolyticus and Treponema denticola) will also be examined.
The antibacterial efficacy of two different NaOCl concentrations (2,5% and 5%) under a predefined irrigant flow rate in teeth with pulp necrosis and apical periodontitis will be examined through the calculation of the total bacterial load before any treatment procedure and the possible bacteria reduction after each treatment procedure (chemomechanical preparation, and final irrigation treatments). In addition, the antimicrobial efficacy of the above two different concentrations of NaOCl will be compared in terms of treatment outcome. All patients will be asked for one-year recall examination where the outcome of endodontic treatment will be evaluated through clinical and radiographic examination. For the identification of the"copious irrigation" the total amount of final irrigation will be divided in two equal parts of volume/ time (15ml for 5 minutes each). Total bacterial load that will remain after chemomechanical preparation will be compared to the number of bacteria calculated after the first and the second part of irrigation. It will be investigated if final irrigation provides to further microbial reduction and whether prolonged irrigation augments the antibacterial effect. Besides the total microbial load, the antibacterial efficacy of final irrigation procedure against two different bacterial species (namely Pseudoramibacter alactolyticus and Treponema denticola) will also be examined. First, the prevalence of these specific species will be investigated in primary endodontic infections in Greek-living population. In addition, the effect of chemomechanical preparation and final irrigation procedure on the number of these species will be relatively examined though the reduction curves that will be obtained by qPCR.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
44
Root canal procedures including access cavity preparation, chemomechanical instrumentation, irrigation with sodium hypoclorite (NaOCl), microbiological sampling and obturation with warm vertical compaction.
Sodium Hypoclorite used as the primary irrigant in the root canal treatment at concentrations of 2.5% (Group A) and 5% (Group B).
Applied to the operating field and tooth as part of initial disinfection prior to cavity access.
Used to inactivate sodium hypoclorite prior to sample collection.
Used to determine the working length of the root canal.
Used for coronal flaring in root canal instrumentation.
Used for root canal instrumentation to full working length.
Used to deliver irrigant into the root canal.
National and Kapodistrian University of Athens
Athens, Greece
Reduction of total bacterial load after chemomechanical preparation using 2.5% and 5% NaOCl.
Clinical antibacterial efficiency of two different NaOCl concentrations (2.5% and 5%) will be assessed by measuring the total bacteria load reduction using qPCR. The unit measure is the Log reduction in total Bacterial DNA copies per sample.
Time frame: DAY 1: Immediately after chemomechanical preparation.
Reduction of total bacterial load after chemomechanical preparation using 2.5% and 5% NaOCl.
Further reduction of total bacterial load after final irrigation using the same two NaOCl concentrations. he unit measure is the Log reduction in total Bacterial DNA copies per sample.
Time frame: DAY 1: Immediately after final irrigation.
Clinical and radiographic treatment success.
Comparison of endodontic treatment outcome between the two NaOCl concentrations groups, assessed by clinical exam and periapical index (PAI). Unit measure: Number of teeth scored as healed PAI \<2 vs not healed PAI\>3. Scale Information: The Periapical Index (PAI) is a radiographic scoring system ranging from 1 to 5, where: 1 = Normal periapical structures (best outcome) 5 = Severe periodontitis with exacerbating features (worst outcome) Lower scores indicate better healing.
Time frame: 1 year post tratment.
Additional bacterial load reduction between two sequential 15 ml irrigation periods
Evaluation of "copious irrigation" effectiveness by measuring bacterial load after each of two equal 15 ml/5 min final irrigation stages. Unit of Measure: Log reduction in total bacterial DNA copies per sample
Time frame: Beteen 1 and 6 months after samples collection.
Prevalence of Pseudoramibacter alactolyticus and Treponema denticola in primary infections
Detection and prevalence rate of two specific bacterial species in untreated teeth with apical periodontitis using qPCR. Unit of Measure: Presence/absence and DNA copy number
Time frame: Beteen 1 and 6 months after samples collection.)
Reduction in P. alactolyticus and T. denticola load after treatment procedures
Quantification of bacterial load changes in P. alactolyticus and T. denticola following chemomechanical preparation and final irrigation. Unit of measure: Log reduction in species-specific DNA copy numbers
Time frame: Beteen 1 and 6 months after samples collection.
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