Association of Apical Periodontitis With Systemic Level of Inflammatory Markers : A Longitudinal Intervention Study

NCT ID: NCT05814965

Last Updated: 2023-04-18

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

RECRUITING

Clinical Phase

NA

Total Enrollment

280 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-04-05

Study Completion Date

2025-12-31

Brief Summary

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While cross-sectional studies have reported a significant association between diabetes and Apical Periodontics, prospective studies are scarce. This will be the first prospective interventional study to explore the cause-and-effect relation between AP and diabetes by assessment of levels of inflammatory markers in a longitudinal setting. Periapical healing in diabetics and nondiabetics will be compared after root canal treatment to evaluate the role of various physical and metabolic attributes on endodontic outcomes.

Detailed Description

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This prospective longitudinal interventional study will be conducted on patients with radiographic evidence of AP in at least one teeth. Total of 280 patients will be selected from the pool of the patients referred to the Outpatient Department of Conservative Dentistry and Endodontics, Post Graduate Institute of Dental Sciences, Rohtak. They will be equally divided into two broad groups either without any systemic disease (140 patients) or with type 2 DM.(140 Patients with DM). Each group further divided into 70 patients with AP and 70 control in a systemically healthy group (selected to match participants in age, sex and BMI). Similarly,70 patients with AP and 70 control for participants with type 2 DM will be selected to additionally match with glycaemic control, drugs, and dietary measures apart from other physical attributes.

Analysis of systemic inflammatory markers IL-1b, IL-6, TNF- α and hsCRP will be done at baseline in both healthy and diabetic participants. Root canal treatment will be done in all the participants with AP and assessment of periapical healing and change in inflammatory markers will be done at 3, 6, and 12-month follow-up.

Sample size: Sample size was estimated based on the difference in hsCRP level in patients with AP and healthy control. Effect size of 0.52 was calculated based on the mean difference and pooled SD of 0.91 and 1.75 respectively. Sample size of 58 per group was obtained at 80% power and 0.05 alpha level. Anticipating 20% dropout, total 70 patients per group (in 4 groups total 280 patients)will be recruited.

Root Canal treatment Access opening will be done after rubber dam isolation and administration of local anesthesia.

debridement of the pulp chamber will be done and all canal orifices will be identified.

Negotiation of canals will be done. Working length will be determined using root ZX apex locator and will be verified radiographically. Root canal treatment will be performed with protaper rotary instrument using standard protocol. Coronal 2/3rd pre-enlargement will be performed with S1 and S2 files and apical third will be prepared with S1 followed by S2 and suitable finishing files depending on the size of apical binding file. Irrigation will be carried out using 5 mL of a 5% NaOCl solution between files. After preparation, the root canals will be irrigated with 5 mL 17% EDTA for 3 minutes to remove smear layer, followed by 5 mL 5% NaOCl. The final irrigation will be done with 5 mL distilled water. Intracanal dressing of Calcium hydroxide will be applied for 7 days and obturation of canal will be performed after 7 days on 2nd visit. The root canals will be dried using paper points and filled with laterally condensed gutta-percha (Dentsply Maillefer) and AH plus resin-after manipulation following manufacturers' instructions. Gutta- percha will be cut with a heated instrument and vertically condensed right at the orifice opening of the canals. Final composite resin restoration will be performed following manufacturer instruction. All the posterior teeth will be metal/ceramic crown after the completion of root canal treatment.

Follow up Follow-up and clinical and radiographic examinations will be carried out after every three months for one year. Glycaemic control in diabetes patients will also be evaluated by HbA1c values at each follow-up interval.

Conditions

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Diabetes Mellitus, Type 2 Apical Periodontitis

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

280 patients 140 in DM (70 each with AP and 70 without AP) and 140 Systemically healthy (70 each with AP and 70 without AP)will be enrolled and compared for systemic markers .Subjects with AP will be provided Endodontics treatment and levels of markers will be assessed one year after Endodontics treatment. markers.
Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Caregivers Investigators Outcome Assessors

Study Groups

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Diabetic patients with Apical periodontitis

Diabetic patients with Apical periodontitis received Endodontics treatment in form of Root canal treatment and assessment of inflammatory and metabolic markers

Group Type EXPERIMENTAL

endodontic treatment in the form of root canal treatment

Intervention Type PROCEDURE

Patients will receive endodontic treatment, and inflammatory markers will be assessed

Healthy patients with Apical periodontitis

systemically healthy participants patients with Apical periodontitis received Endodontics treatment in the form of root canal treatment and assessment of inflammatory markers

Group Type EXPERIMENTAL

endodontic treatment

Intervention Type PROCEDURE

Patients will receive endodontic treatment in the form of root canal treatment, and inflammatory markers will be assessed along with metabolic markers assessment

Diabetic patients with out Apical periodontitis

systemic inflammatory markers along with metabolic markers will be assessed

Group Type ACTIVE_COMPARATOR

inflammatory markers will be assessed along with metabolic markers assessment

Intervention Type DIAGNOSTIC_TEST

inflammatory markers will be assessed along with metabolic markers assessment

Healthy participants without Apical periodontitis

systemic inflammatory markers will be assessed

Group Type ACTIVE_COMPARATOR

assessment of inflammatory marker

Intervention Type DIAGNOSTIC_TEST

assessment of inflammatory markers

Interventions

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endodontic treatment in the form of root canal treatment

Patients will receive endodontic treatment, and inflammatory markers will be assessed

Intervention Type PROCEDURE

endodontic treatment

Patients will receive endodontic treatment in the form of root canal treatment, and inflammatory markers will be assessed along with metabolic markers assessment

Intervention Type PROCEDURE

assessment of inflammatory marker

assessment of inflammatory markers

Intervention Type DIAGNOSTIC_TEST

inflammatory markers will be assessed along with metabolic markers assessment

inflammatory markers will be assessed along with metabolic markers assessment

Intervention Type DIAGNOSTIC_TEST

Other Intervention Names

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RCT

Eligibility Criteria

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Inclusion Criteria

* Patients 30-55 year age group with minimum 20 natural teeth, with pulp necrosis confirmed by cold test and electric pulp test and radiographic evidence of periapical radiolucency with PAI score of ≥3 (24) or more in at least one mature tooth.
* control in the systemically healthy group will be selected to match participants in terms of age, sex, and BMI.
* control for participants with type 2 DM will be selected to additionally match with glycaemic control, drugs and dietary measures apart from other physical attributes.

Exclusion Criteria

* Patients with clinical diagnosis of moderate to severe periodontitis (≥6 sites with probing depth ≥5 mm at separate teeth, with attachment loss and radiographic alveolar bone loss), Patients with immunosuppression, pregnancy, conditions requiring prophylactic antibiotics prior to dental treatment, bleeding disorders, medical conditions that may affect study participation (e.g., unstable cardiovascular disease) and chronic inflammatory conditions like rheumatoid
Minimum Eligible Age

30 Years

Maximum Eligible Age

55 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Postgraduate Institute of Dental Sciences Rohtak

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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SANJAY TEWARI

Role: PRINCIPAL_INVESTIGATOR

POST GRADUATE INSTITUTE OF DENTAL SCIENCES,ROHTAK

Locations

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PGIDS

Rohtak, Haryana, India

Site Status RECRUITING

Countries

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India

Central Contacts

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SANJAY TEWARI, MDS

Role: CONTACT

01262-283876

SANJAY TEWARI

Role: CONTACT

01262-283876

Facility Contacts

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Dr. Sanjay Tewari, MDS

Role: primary

01262283876

Other Identifiers

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Dr. Sanjay Tewari 2023

Identifier Type: -

Identifier Source: org_study_id

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