Regeneration of Pulp-Dentin Development in Teeth With Necrotic Pulps and Immature Roots

NCT ID: NCT01976065

Last Updated: 2023-09-07

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE1

Total Enrollment

125 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-09-30

Study Completion Date

2018-09-24

Brief Summary

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This multi-center exploratory clinical trial is a randomized trial designed to test whether a regenerative endodontic procedure using tissue engineering principles (REGENDO), or a revascularization (REVASC) endodontic procedure, in comparison to standard apexification treatment using a mineral trioxide aggregate barrier (apexification; APEX), produces a significantly better composite clinical outcome for the treatment of immature permanent teeth with pulpal necrosis.

Detailed Description

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This is a multi-center randomized clinical trial designed to test whether a regenerative endodontic procedure using tissue engineering principles (REGENDO), or a revascularization (REVASC) endodontic procedure, when compared to the standard apexification treatment using mineral trioxide aggregate barrier-MTA apexification (APEX), produces a significantly better composite clinical outcome for the treatment of immature permanent teeth with pulpal necrosis. This study will use an antibiotic mixture called Triple Antibiotic Paste (TAP), consisting of ciprofloxacin, metronidazole and minocycline, in the tooth for disinfection of the root canal in study arms REGENDO and REVASC. The FDA has issued an Investigational New Drug (IND) number allowing use of the triple antibiotic mixture in this trial. Other dental materials used in this study have already been FDA approved for use in humans to provide a matrix for the promotion of tissue growth in the root canal space. The study will also attempt to identify the type of bacteria within the root canal space and surrounding tissues by analyzing a small sample collected on a cotton-tip applicator. This clinical trial hopes to determine which of the three treatment methods helps the tooth to grow stronger and survive for at least two years after treatment.

Conditions

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Pulp Necrosis Regeneration

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Mineral Trioxide Aggregate (MTA)

Standard Treatment group consisting of placement of Mineral Trioxide Aggregate (MTA), an FDA approved dental material at the end of an immature root followed by a composite restoration (crown).

Group Type OTHER

Standard Treatment

Intervention Type OTHER

Standard Treatment no use of study drug

Revascularization Treatment (REVASC)

Consists of standard treatment procedure PLUS disinfection of the canal space with Triple Antibiotic Paste study medication followed by placement of Collaplug, an FDA approved material to help promote clotting. A composite restoration in then placed.

Group Type EXPERIMENTAL

Triple Antibiotic Paste

Intervention Type DRUG

USP antibiotic drugs mixed at a 1:1:1 ratio into a powder that is mixed with sterile saline to a paste-like consistency

Regeneration Treatment (REGENDO)

Consists of standard treatment procedure PLUS Triple Antibiotic Paste study medication PLUS use of Emdogain, an FDA approved medication used in an FDA approved manner, that is a growth factor to help surrounding tissues to grow together and heal.

Group Type EXPERIMENTAL

Triple Antibiotic Paste

Intervention Type DRUG

USP antibiotic drugs mixed at a 1:1:1 ratio into a powder that is mixed with sterile saline to a paste-like consistency

Interventions

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Triple Antibiotic Paste

USP antibiotic drugs mixed at a 1:1:1 ratio into a powder that is mixed with sterile saline to a paste-like consistency

Intervention Type DRUG

Standard Treatment

Standard Treatment no use of study drug

Intervention Type OTHER

Other Intervention Names

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Ciprofloxacin, Metronidazole, & Minocycline No use of study drug

Eligibility Criteria

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Inclusion Criteria

* Age 6-20
* Participant has a permanent tooth with a necrotic pulp (as defined by lack of responsiveness to both electrical pulp tests and cold \[EndoIce\] tests). If the tooth was traumatized, then pulpal necrosis is defined as either: 1) no response to both electrical pulp test and cold \[EndoIce\] test by three months after trauma, or 2) presence of a periapical lesion, or 3) radiographic evidence of root resorption, or 4) discoloration of the crown.
* Tooth in question is restorable (as defined by Class A or Class B using Samet and Jotkowitz classification) without the need of a stainless steel crown.
* Incomplete (i.e., immature) root development defined by apical foramen ≥1.0mm (each foramina \>1.0mm for multi-rooted teeth).
* At least 5 mm of root development (CEJ to radiographic apex).
* Willing and able to provide informed assent/consent.
* Legal guardian willing and able to provide informed consent.

Exclusion Criteria

* No access to telephone for study contacts.
* Unable to comprehend study materials in English or Spanish.
* Subject not available for follow up at 12 or 24 months.
* Previous allergic response to ciprofloxacin, metronidazole or minocycline or any materials used in the study.
* History of systemic diseases with altered immune function including diabetes, immunodeficiency, leukemia, Addison's or Cushing's disease.
* History of taking immunosuppressants or chemotherapeutic agents including glucocorticoids in the past 3 months.
* Clinical or radiographic evidence of root fracture or alveolar fracture.
* Tooth in question received prior endodontic obturation.
* Tooth in question has class III mobility or dens invaginatus.
* Tooth in question has a history of avulsion with extra-oral dry time longer than 1 hour.
* Clinical judgement (with documentation of the reason)
* Radiographic or clinical identification of ankylosis (replacement resorption) or inflammatory (infection-related) root resorption.
Minimum Eligible Age

6 Years

Maximum Eligible Age

20 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University of Maryland, Baltimore

OTHER

Sponsor Role collaborator

Loma Linda University

OTHER

Sponsor Role collaborator

University of North Carolina

OTHER

Sponsor Role collaborator

American Association of Endodontists

OTHER

Sponsor Role collaborator

Kenneth Hargreaves

OTHER

Sponsor Role lead

Responsible Party

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Kenneth Hargreaves

Chair, Dept. of Endodontics, UTHSCSA

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Kenneth Hargreaves, DDS, PhD

Role: STUDY_CHAIR

University of Texas

Locations

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Loma Linda University

Loma Linda, California, United States

Site Status

University of Maryland

Baltimore, Maryland, United States

Site Status

University of North Carolina

Chapel Hill, North Carolina, United States

Site Status

University of Texas Health Science Center

San Antonio, Texas, United States

Site Status

Countries

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United States

Other Identifiers

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HSC20130467H

Identifier Type: -

Identifier Source: org_study_id

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