Clinical Investigation of Chemomechanical Parameters for an Efficient Disinfection of the Root Canal

NCT ID: NCT06949176

Last Updated: 2025-05-11

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

ACTIVE_NOT_RECRUITING

Clinical Phase

NA

Total Enrollment

44 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-12-01

Study Completion Date

2025-06-23

Brief Summary

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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.

Detailed Description

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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.

Conditions

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Apical Periodontitis Root Canal Infection

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

The present research will be designed as two-arm, parallel, randomized clinical study. The randomization of the teeth for sampling will be performed through the use of a special software . All the treatment and sampling procedures will be carried out by the same investigator (PhD candidate Dr. Agapi Zervaki).
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Experimental group A (2,5% NaOCl concentration)

Group A will be formed by 22 patients and each teeth will receive 2,5% NaOCl . Working length (WL) will be established according to apex locator (Root ZX mini, Morita). Chemomechanical preparation will be completed in the same appointment.

Group Type EXPERIMENTAL

Root canal tratment using mecchanical and chemical preparation.

Intervention Type PROCEDURE

Root canal procedures including access cavity preparation, chemomechanical instrumentation, irrigation with sodium hypoclorite (NaOCl), microbiological sampling and obturation with warm vertical compaction.

Sodium Hypochlorite.

Intervention Type DRUG

Sodium Hypoclorite used as the primary irrigant in the root canal treatment at concentrations of 2.5% (Group A) and 5% (Group B).

Hydrogen peroxide.

Intervention Type DRUG

Applied to the operating field and tooth as part of initial disinfection prior to cavity access.

Sodium Sulfate.

Intervention Type DRUG

Used to inactivate sodium hypoclorite prior to sample collection.

Experimental group B (5% NaOCl concentration)

Group B will be formed by 22 patients and each teeth will receive 5 % NaOCl .

Group Type EXPERIMENTAL

Root ZX mini apex locator (Morita).

Intervention Type DEVICE

Used to determine the working length of the root canal.

Protaper Gold rotary files (Dentslpy Maillefer).

Intervention Type DEVICE

Used for coronal flaring in root canal instrumentation.

Smarttrack and Hyflex totary files.

Intervention Type DEVICE

Used for root canal instrumentation to full working length.

Endo-Eze 27G irrigation needle (Ultradent).

Intervention Type DEVICE

Used to deliver irrigant into the root canal.

Interventions

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Root canal tratment using mecchanical and chemical preparation.

Root canal procedures including access cavity preparation, chemomechanical instrumentation, irrigation with sodium hypoclorite (NaOCl), microbiological sampling and obturation with warm vertical compaction.

Intervention Type PROCEDURE

Sodium Hypochlorite.

Sodium Hypoclorite used as the primary irrigant in the root canal treatment at concentrations of 2.5% (Group A) and 5% (Group B).

Intervention Type DRUG

Hydrogen peroxide.

Applied to the operating field and tooth as part of initial disinfection prior to cavity access.

Intervention Type DRUG

Sodium Sulfate.

Used to inactivate sodium hypoclorite prior to sample collection.

Intervention Type DRUG

Root ZX mini apex locator (Morita).

Used to determine the working length of the root canal.

Intervention Type DEVICE

Protaper Gold rotary files (Dentslpy Maillefer).

Used for coronal flaring in root canal instrumentation.

Intervention Type DEVICE

Smarttrack and Hyflex totary files.

Used for root canal instrumentation to full working length.

Intervention Type DEVICE

Endo-Eze 27G irrigation needle (Ultradent).

Used to deliver irrigant into the root canal.

Intervention Type DEVICE

Other Intervention Names

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Endodontic thereapy. NaOCl H202 Na2S2O3 Morita apex locator. Dentsply Maillefer rotary system. Nikinc and Coltene/Whaledent rotary systems. 27G Luer Lock needle.

Eligibility Criteria

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Inclusion Criteria

* Informed consent by the patients who wish to participate in the study.
* Single-rooted teeth with pulp necrosis confirmed by pulp sensibility tests, negative response to both cold and electric pulp testing and radiographic evidence of apical periodontitis.
* Teeth with relatively straight canals, complete root development and no pulp canal obliteration.

Exclusion Criteria

* Patients who have received antibiotic treatment the last 3 months or need chemoprophylaxis for dental treatment.
* Teeth with previous endodontic treatment.
* Teeth with cracks or incomplete vertical root fracture which disturbs the integrity of the pulp chamber walls.
* Teeth with periodontal pocket more than 4mm.
Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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National and Kapodistrian University of Athens

OTHER

Sponsor Role lead

Responsible Party

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Giorgos Tzanetakis

Associate Professor, Department of Endodontics

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Giorgos Tzanetakis

Role: PRINCIPAL_INVESTIGATOR

National and Kapodistian University of Athens

Locations

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National and Kapodistrian University of Athens

Athens, , Greece

Site Status

Countries

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Greece

References

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Alves FR, Almeida BM, Neves MA, Rocas IN, Siqueira JF Jr. Time-dependent antibacterial effects of the self-adjusting file used with two sodium hypochlorite concentrations. J Endod. 2011 Oct;37(10):1451-5. doi: 10.1016/j.joen.2011.06.001. Epub 2011 Jul 27.

Reference Type RESULT
PMID: 21924201 (View on PubMed)

Antunes HS, Rocas IN, Alves FR, Siqueira JF Jr. Total and Specific Bacterial Levels in the Apical Root Canal System of Teeth with Post-treatment Apical Periodontitis. J Endod. 2015 Jul;41(7):1037-42. doi: 10.1016/j.joen.2015.03.008. Epub 2015 Apr 17.

Reference Type RESULT
PMID: 25892512 (View on PubMed)

Barbosa-Ribeiro M, Arruda-Vasconcelos R, Louzada LM, Dos Santos DG, Andreote FD, Gomes BPFA. Microbiological analysis of endodontically treated teeth with apical periodontitis before and after endodontic retreatment. Clin Oral Investig. 2021 Apr;25(4):2017-2027. doi: 10.1007/s00784-020-03510-2. Epub 2020 Aug 28.

Reference Type RESULT
PMID: 32860137 (View on PubMed)

Cavrini F, Pirani C, Foschi F, Montebugnoli L, Sambri V, Prati C. Detection of Treponema denticola in root canal systems in primary and secondary endodontic infections. A correlation with clinical symptoms. New Microbiol. 2008 Jan;31(1):67-73.

Reference Type RESULT
PMID: 18437843 (View on PubMed)

Gazzaneo I, Vieira GCS, Perez AR, Alves FRF, Goncalves LS, Mdala I, Siqueira JF Jr, Rocas IN. Root Canal Disinfection by Single- and Multiple-instrument Systems: Effects of Sodium Hypochlorite Volume, Concentration, and Retention Time. J Endod. 2019 Jun;45(6):736-741. doi: 10.1016/j.joen.2019.02.017. Epub 2019 Apr 10.

Reference Type RESULT
PMID: 30981431 (View on PubMed)

Haapasalo M, Shen Y, Wang Z, Gao Y. Irrigation in endodontics. Br Dent J. 2014 Mar;216(6):299-303. doi: 10.1038/sj.bdj.2014.204.

Reference Type RESULT
PMID: 24651335 (View on PubMed)

Orstavik D, Kerekes K, Eriksen HM. The periapical index: a scoring system for radiographic assessment of apical periodontitis. Endod Dent Traumatol. 1986 Feb;2(1):20-34. doi: 10.1111/j.1600-9657.1986.tb00119.x. No abstract available.

Reference Type RESULT
PMID: 3457698 (View on PubMed)

Paiva SS, Siqueira JF Jr, Rocas IN, Carmo FL, Ferreira DC, Curvelo JA, Soares RM, Rosado AS. Supplementing the antimicrobial effects of chemomechanical debridement with either passive ultrasonic irrigation or a final rinse with chlorhexidine: a clinical study. J Endod. 2012 Sep;38(9):1202-6. doi: 10.1016/j.joen.2012.06.023. Epub 2012 Jul 25.

Reference Type RESULT
PMID: 22892736 (View on PubMed)

Rocas IN, Siqueira JF Jr. Comparison of the in vivo antimicrobial effectiveness of sodium hypochlorite and chlorhexidine used as root canal irrigants: a molecular microbiology study. J Endod. 2011 Feb;37(2):143-50. doi: 10.1016/j.joen.2010.11.006.

Reference Type RESULT
PMID: 21238793 (View on PubMed)

Rocas IN, Siqueira JF Jr. In vivo antimicrobial effects of endodontic treatment procedures as assessed by molecular microbiologic techniques. J Endod. 2011 Mar;37(3):304-10. doi: 10.1016/j.joen.2010.11.003. Epub 2010 Dec 30.

Reference Type RESULT
PMID: 21329812 (View on PubMed)

Rocas IN, Siqueira JF Jr. Characterization of microbiota of root canal-treated teeth with posttreatment disease. J Clin Microbiol. 2012 May;50(5):1721-4. doi: 10.1128/JCM.00531-12. Epub 2012 Mar 7.

Reference Type RESULT
PMID: 22403423 (View on PubMed)

Rocas IN, Provenzano JC, Neves MA, Siqueira JF Jr. Disinfecting Effects of Rotary Instrumentation with Either 2.5% Sodium Hypochlorite or 2% Chlorhexidine as the Main Irrigant: A Randomized Clinical Study. J Endod. 2016 Jun;42(6):943-7. doi: 10.1016/j.joen.2016.03.019. Epub 2016 Apr 30.

Reference Type RESULT
PMID: 27142579 (View on PubMed)

Rodrigues RCV, Zandi H, Kristoffersen AK, Enersen M, Mdala I, Orstavik D, Rocas IN, Siqueira JF Jr. Influence of the Apical Preparation Size and the Irrigant Type on Bacterial Reduction in Root Canal-treated Teeth with Apical Periodontitis. J Endod. 2017 Jul;43(7):1058-1063. doi: 10.1016/j.joen.2017.02.004. Epub 2017 May 5.

Reference Type RESULT
PMID: 28483164 (View on PubMed)

Siqueira JF Jr, Rocas IN. Exploiting molecular methods to explore endodontic infections: Part 1--current molecular technologies for microbiological diagnosis. J Endod. 2005 Jun;31(6):411-23. doi: 10.1097/01.don.0000157989.44949.26.

Reference Type RESULT
PMID: 15917679 (View on PubMed)

Siqueira JF Jr, Rocas IN. Pseudoramibacter alactolyticus in primary endodontic infections. J Endod. 2003 Nov;29(11):735-8. doi: 10.1097/00004770-200311000-00012.

Reference Type RESULT
PMID: 14651280 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Other Identifiers

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594/07.06.2023

Identifier Type: -

Identifier Source: org_study_id

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