Pain and Microbial Reduction of Antimicrobial Corticosteroid Mixture Versus Cryotherapy in Necrotic Teeth

NCT ID: NCT05739682

Last Updated: 2025-06-05

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

NA

Total Enrollment

28 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-07-01

Study Completion Date

2025-02-09

Brief Summary

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The aim of this study is to compare the effect of antimicrobial-corticosteroid mixture and cryotherapy as final root canal irrigating solutions on post-instrumentation pain in single-canal teeth with necrotic pulps.

Detailed Description

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The trial participants are patients with single-canal teeth with necrotic pulps undergoing root canal treatment on two visits. During the 1st visit, access cavity, root canal cleaning and shaping using rotary files and 2.5% NaOCl irrigation. After apical preparation, a final flush with either a levofloxacin-fluconazole-dexamethasone mixture or cold saline will be used then the tooth access cavity will be sealed with a temporary filling. After the first visit, the participants will be given a pain chart with a numerical rating scale to rate their pain levels from zero to 10 at 6, 12, 24, and 48 hours. Three microbial swabs will be collected for each participant: before instrumentation (S1), after instrumentation before final irrigation (S2), and after final irrigation (S3). After collecting data from all participants, statistical analysis will be conducted to compare the pain intensity and microbial load reduction percentages between the two groups.

Conditions

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Dental Pulp Necrosis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors
Both final irrigating solutions are colorless and will be delivered inside the root canal using a plastic syringe without the patient knowing the type of solution used.

The microbial samples will be sent to the lab for microbial count assessment with a code without identification of the type of irrigating solution used.

Study Groups

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Antimicrobial Corticosteroid mixture

Each canal will receive 5 minutes of final irrigation with the antimicrobial-corticosteroid solution of a freshly prepared mixture of:

1 ml of Levofloxacin (Tavanic, Sanofi Aventis, Egypt).

1 ml of Fluconazole (Sunny fungal, Sunny pharmaceuticals, Egypt).

1 ml of Dexamethasone sodium phosphate (Dexamethasone, Amriya, Egypt).

Group Type EXPERIMENTAL

Local anaesthetic injection of 4% articaine with 1:100000 epinephrine

Intervention Type PROCEDURE

Buccal infiltration injection using a side loading aspirating syringe and a 30-gauge needle

Tooth isolation

Intervention Type PROCEDURE

Rubber dam application to the affected tooth

Access cavity preparation

Intervention Type PROCEDURE

Complete removal of caries, undermined tooth structure, and defective restoration. Access cavity preparation with complete removal of the pulp chamber roof using a sterile bur other than the ones used for caries removal.

Root canal shaping and cleaning

Intervention Type PROCEDURE

Working length determination using an electronic apex locator and then canal instrumentation using Hyflex CM rotary files up to size 40.04 with irrigation using 2.5% NaOCl between files.

Final irrigation with antimicrobial-corticosteroid mixture

Intervention Type PROCEDURE

1 ml of levofloxacin will be withdrawn in a 3ml plastic syringe followed by 1 ml of fluconazole and 1 ml of dexamethasone sodium phosphate, the whole solution is then passively delivered into the canal using a 30-gauge side vented needle reaching 1 mm shorter than the working length. The solution will be left inside the canal for 5 minutes

Temporary restoration and patient's instructions

Intervention Type PROCEDURE

The canals are dried using paper points and the access cavity is sealed using a non-eugenol temporary filling.

Root canal obturation

Intervention Type PROCEDURE

After the 1st visit by 3 days to 1 week, the patient is scheduled for a second appointment for root canal obturation.

Cryotherapy

Each canal will receive final irrigation with 20ml of cold saline (2.5°c) for 5 minutes.

Group Type ACTIVE_COMPARATOR

Local anaesthetic injection of 4% articaine with 1:100000 epinephrine

Intervention Type PROCEDURE

Buccal infiltration injection using a side loading aspirating syringe and a 30-gauge needle

Tooth isolation

Intervention Type PROCEDURE

Rubber dam application to the affected tooth

Access cavity preparation

Intervention Type PROCEDURE

Complete removal of caries, undermined tooth structure, and defective restoration. Access cavity preparation with complete removal of the pulp chamber roof using a sterile bur other than the ones used for caries removal.

Root canal shaping and cleaning

Intervention Type PROCEDURE

Working length determination using an electronic apex locator and then canal instrumentation using Hyflex CM rotary files up to size 40.04 with irrigation using 2.5% NaOCl between files.

Final irrigation with cold saline

Intervention Type PROCEDURE

Frozen sterile saline will be brought at room temperature and monitored using a digital liquid thermometer till the temperature reaches 2.5°c. 4ml are then withdrawn in a 5ml plastic syringe and delivered inside the canal in 1 minute. The process is then repeated 5 times so that the canal receives 20 ml of 2.5°c cold saline for 5 minutes.

Temporary restoration and patient's instructions

Intervention Type PROCEDURE

The canals are dried using paper points and the access cavity is sealed using a non-eugenol temporary filling.

Root canal obturation

Intervention Type PROCEDURE

After the 1st visit by 3 days to 1 week, the patient is scheduled for a second appointment for root canal obturation.

Interventions

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Local anaesthetic injection of 4% articaine with 1:100000 epinephrine

Buccal infiltration injection using a side loading aspirating syringe and a 30-gauge needle

Intervention Type PROCEDURE

Tooth isolation

Rubber dam application to the affected tooth

Intervention Type PROCEDURE

Access cavity preparation

Complete removal of caries, undermined tooth structure, and defective restoration. Access cavity preparation with complete removal of the pulp chamber roof using a sterile bur other than the ones used for caries removal.

Intervention Type PROCEDURE

Root canal shaping and cleaning

Working length determination using an electronic apex locator and then canal instrumentation using Hyflex CM rotary files up to size 40.04 with irrigation using 2.5% NaOCl between files.

Intervention Type PROCEDURE

Final irrigation with antimicrobial-corticosteroid mixture

1 ml of levofloxacin will be withdrawn in a 3ml plastic syringe followed by 1 ml of fluconazole and 1 ml of dexamethasone sodium phosphate, the whole solution is then passively delivered into the canal using a 30-gauge side vented needle reaching 1 mm shorter than the working length. The solution will be left inside the canal for 5 minutes

Intervention Type PROCEDURE

Final irrigation with cold saline

Frozen sterile saline will be brought at room temperature and monitored using a digital liquid thermometer till the temperature reaches 2.5°c. 4ml are then withdrawn in a 5ml plastic syringe and delivered inside the canal in 1 minute. The process is then repeated 5 times so that the canal receives 20 ml of 2.5°c cold saline for 5 minutes.

Intervention Type PROCEDURE

Temporary restoration and patient's instructions

The canals are dried using paper points and the access cavity is sealed using a non-eugenol temporary filling.

Intervention Type PROCEDURE

Root canal obturation

After the 1st visit by 3 days to 1 week, the patient is scheduled for a second appointment for root canal obturation.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

1. Patients in good physical health; American Society of Anesthesiologists class I or II.
2. Patients whose age ranges between 18 and 50 years.
3. Male and female patients.
4. Patients having a single canal-tooth with necrotic pulp.
5. Patients who can understand the number rating scale (figure).
6. Patients who accept to participate in the trial and can sign the informed consent (figure).

Exclusion Criteria

1. Pregnant females.
2. Patients with swelling.
3. Patients whose tooth is non-restorable.
4. Teeth with open apices.
5. Teeth with radiographic evidence of root resorption.
Minimum Eligible Age

18 Years

Maximum Eligible Age

50 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Cairo University

OTHER

Sponsor Role lead

Responsible Party

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Mohammed Fawzy Omar Mohammed Habib

Principal investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Maged M Negm, Professor in Endodontics

Role: STUDY_CHAIR

Cairo University

Locations

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Faculty of Dentistry, Cairo University

Cairo, Manial, Egypt

Site Status

Countries

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Egypt

Other Identifiers

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ENDO 18-11-21

Identifier Type: -

Identifier Source: org_study_id

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