Effect of Different Irrigation Protocols on Postoperative Endodontic Pain and Inflammation

NCT ID: NCT07116252

Last Updated: 2025-08-11

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

75 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-08-20

Study Completion Date

2025-12-31

Brief Summary

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This study aims to improve the postoperative endodontic outcome by assessing the effect of different irrigants on postoperative endodontic pain and their anti-inflammatory effects.

Detailed Description

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Alternating application of ethylenediaminetetraacetic acid (EDTA) and sodium hypochlorite (NaOCl) is frequently recommended for removal of organic and inorganic tissues debris including the smear layer. But EDTA can cause loss of available chlorine affecting organic tissue dissolving ability of NaOCl when mixed with it. Etidronic acid is a first-generation bisphosphonate. It is a mild chelator that is compatible with NaOCl in the short term without affecting available chlorine, a concept that has been termed 'continuous chelation'. Clodronate also, was identified with improved stability in NaOCl mixtures compared with EDTA and etidronate.

Aim: Assessment of postoperative endodontic pain and matrix metalloproteinase-9 levels after sequential versus continous chelation protocols.

Methods: This study will be conducted on 75 patients having necrotic pulp with asymptomatic apical periodontitis. Patients will be randomly divided into five groups (Group 1: 2.5% NaOCl during instrumentation then sequential chelation by 17% EDTA, Group 2: 2.5% NaOCl during instrumentation then sequential chelation by 9% HEBP, Group 3: 2.5% NaOCl during instrumentation then sequential chelation by 0.26 M (7.6%) clodronate, Group 4: continuous chelation during instrumentation by 2.5% NaOCl + 9% HEBP, Group 5: continuous chelation by 2.5% NaOCl + 0.26 M (7.6%) clodronate). Postoperative pain will be assessed after 6, 12, 24, 48 hours and 7 days after the first visit using a numerical rating scale. MMP-9 levels in periapical tissues will be quantified using a commercially available ELISA kit applied on the periapical samples that will be collected after the final rinse (S1) and after one week (S2).

Conditions

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Irrigation Solution Postoperative Pain Inflammation Endodontic Treatment

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

5 groups with different treatment protocols to assess two parameters
Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Caregivers Outcome Assessors

Study Groups

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17% EDTA - sequential chelation

Irrigation by 2.5% NaOCl during instrumention and a final rinse by 17% EDTA (sequential chelation protocol)

Group Type EXPERIMENTAL

EDTA

Intervention Type PROCEDURE

17% EDTA as a final rinse after instrumentaion (sequential chelation)

9% HEBP - sequential chelation

Irrigation by 2.5% NaOCl during instrumention and a final rinse by 9% HEBP (sequential chelation protocol)

Group Type EXPERIMENTAL

Etidronate

Intervention Type PROCEDURE

9% HEBP as a final rinse after instrumentation (sequential chelation)

0.26 M (7.6%) clodronate - sequential chelation

Irrigation by 2.5% NaOCl during instrumention and a final rinse by 0.26 M (7.6%) clodronate (sequential chelation protocol)

Group Type EXPERIMENTAL

clodronate

Intervention Type PROCEDURE

0.26 M (7.6%) clodronate as a final rinse after instrumentation (sequential chelation)

2.5% NaOCl + 9% HEBP - continous chelation

Irrigation by 2.5% NaOCl + 9% HEBP during instrumention and as final rinse (continous chelation protocol)

Group Type EXPERIMENTAL

Etidronic acid /sodium hypochlorite

Intervention Type PROCEDURE

(2.5% NaOCl + 9% HEBP) during instrumentation and as a final rinse after instrumentation (continous chelation)

2.5% NaOCl + 0.26 M (7.6%) clodronate - continuous chelation

Irrigation by 2.5% NaOCl + 0.26 M (7.6%) clodronate during instrumention and as final rinse (continous chelation protocol)

Group Type EXPERIMENTAL

clodronate + sodium hypochlorite

Intervention Type PROCEDURE

2.5% NaOCl + 0.26 M (7.6%) clodronate during instrumentation and as a final rinse after instrumentation (continuous chelation)

Interventions

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EDTA

17% EDTA as a final rinse after instrumentaion (sequential chelation)

Intervention Type PROCEDURE

Etidronate

9% HEBP as a final rinse after instrumentation (sequential chelation)

Intervention Type PROCEDURE

clodronate

0.26 M (7.6%) clodronate as a final rinse after instrumentation (sequential chelation)

Intervention Type PROCEDURE

Etidronic acid /sodium hypochlorite

(2.5% NaOCl + 9% HEBP) during instrumentation and as a final rinse after instrumentation (continous chelation)

Intervention Type PROCEDURE

clodronate + sodium hypochlorite

2.5% NaOCl + 0.26 M (7.6%) clodronate during instrumentation and as a final rinse after instrumentation (continuous chelation)

Intervention Type PROCEDURE

Other Intervention Names

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17% Ethylenediaminetetraacetic Acid. 9% HEBP or HEDP (1-Hydroxyethylidene-1,1-bisphosphonate) 0.26 M (7.6%) clodronate or clodronic acid 2.5% NaOCl + 9% HEBP - continous chelation 2.5% NaOCl + 0.26 M (7.6%) clodronate - continuous chelation

Eligibility Criteria

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Inclusion Criteria

1. Patients presenting with a single rooted tooth (maxillary anteriors and mandibular premolars) with closed apex and a single patent canal type I in Vertucci's classification (Vertucci et al., 1974)
2. Having a necrotic pulp and asymptomatic apical periodontitis (periapical lesion).
3. Periapical lesions of endodontic origin with a diameter ranging from 2 to 5mm, having a periapical index score of 4 or 5 (Orstavik, Kerekes and Eriksen, 1986)

Exclusion Criteria

(i) Patients with pain before treatment (ii) Patients having chronic condition requiring the intake of anti-inflammatory/antibiotic drugs.

(iii) Teeth having non-restorable tooth with gross carious lesions, fractures, internal or external root resorption or cracks involving the periodontium.

(iv) Root canals in which patency for periapical fluid sampling could not be achieved.

(v) immune-compromised patients or patients with complicated systemic diseases, physical disability or psychological problems (vi) patients received antibiotic therapy within the last 3months. (vii) Teeth associated with bone expansion or with a history of endodontic treatment.

(viii) Teeth with periodontal pockets deeper than 4mm, with or without concomitant or combined endo-perio communication.
Minimum Eligible Age

18 Years

Maximum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Suez Canal University

OTHER

Sponsor Role lead

Responsible Party

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Abdelrahman elkholy

Assisstant lecturer of endodontics

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Dalia Fayyad

Role: STUDY_DIRECTOR

Professor of endodontics, faculty of dentistry, Suez Canal University

Dalia Abdallah

Role: STUDY_DIRECTOR

Associate Professor of endodontics, faculty of dentistry, Suez Canal University

Locations

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Faculty of dentistry, suez canal university

Ismailia, , Egypt

Site Status

Countries

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Egypt

References

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La Rosa GRM, Plotino G, Nagendrababu V, Pedulla E. Effectiveness of continuous chelation irrigation protocol in endodontics: a scoping review of laboratory studies. Odontology. 2024 Jan;112(1):1-18. doi: 10.1007/s10266-023-00835-8. Epub 2023 Jul 11.

Reference Type BACKGROUND
PMID: 37433927 (View on PubMed)

Rath PP, Yiu CKY, Matinlinna JP, Kishen A, Neelakantan P. The effects of sequential and continuous chelation on dentin. Dent Mater. 2020 Dec;36(12):1655-1665. doi: 10.1016/j.dental.2020.10.010. Epub 2020 Nov 5.

Reference Type BACKGROUND
PMID: 33162115 (View on PubMed)

Bassam S, El-Ahmar R, Salloum S, Ayoub S. Endodontic postoperative flare-up: An update. Saudi Dent J. 2021 Nov;33(7):386-394. doi: 10.1016/j.sdentj.2021.05.005. Epub 2021 Jun 3.

Reference Type BACKGROUND
PMID: 34803278 (View on PubMed)

Ahmed GM, El-Baz AA, Hashem AA, Shalaan AK. Expression levels of matrix metalloproteinase-9 and gram-negative bacteria in symptomatic and asymptomatic periapical lesions. J Endod. 2013 Apr;39(4):444-8. doi: 10.1016/j.joen.2012.11.009. Epub 2013 Jan 16.

Reference Type BACKGROUND
PMID: 23522533 (View on PubMed)

Zollinger A, Mohn D, Zeltner M, Zehnder M. Short-term storage stability of NaOCl solutions when combined with Dual Rinse HEDP. Int Endod J. 2018 Jun;51(6):691-696. doi: 10.1111/iej.12875. Epub 2017 Dec 5.

Reference Type BACKGROUND
PMID: 29121393 (View on PubMed)

Wright PP, Cooper C, Kahler B, Walsh LJ. From an assessment of multiple chelators, clodronate has potential for use in continuous chelation. Int Endod J. 2020 Jan;53(1):122-134. doi: 10.1111/iej.13213. Epub 2019 Sep 26.

Reference Type BACKGROUND
PMID: 31483863 (View on PubMed)

Ballal NV, Gandhi P, Shenoy PA, Shenoy Belle V, Bhat V, Rechenberg DK, Zehnder M. Safety assessment of an etidronate in a sodium hypochlorite solution: randomized double-blind trial. Int Endod J. 2019 Sep;52(9):1274-1282. doi: 10.1111/iej.13129. Epub 2019 May 13.

Reference Type BACKGROUND
PMID: 30993696 (View on PubMed)

Other Identifiers

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Endodontics

Identifier Type: -

Identifier Source: org_study_id

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