Comparison of three intracanal dressings for infected primary molar teeth in children: a randomized clinical trial

Group 1: Pure Antibiotic Intracanal Dressing (PURE-TAP) After standard access cavity preparation, chemomechanical debridement, and irrigation with sterile saline, a pure antibiotic intracanal dressing will be placed. The dressing consists of ciprofloxacin, metronidazole, and cefixime in equal proportions (1:1:1), prepared from pure active pharmaceutical ingredients without excipients. Each antibiotic is weighed (10 mg), mixed to form a homogeneous powder, and combined with sterile distilled water to obtain a paste consistency suitable for intracanal application. Group 2: Commercial Antibiotic Intracanal Dressing (Commercial-TAP) Participants will receive an intracanal dressing prepared from commercially available tablet formulations of ciprofloxacin, metronidazole, and cefixime containing pharmaceutical excipients. Tablets are pulverized, mixed in equal proportions (1:1:1), and combined with sterile distilled water to obtain a paste with consistency comparable to the PURE-TAP group. Clinical procedure (applies to both groups) All treatments will be performed by a qualified pediatric dentist/endodontic operator under standardized clinical conditions. The procedure includes local anesthesia, rubber dam isolation, access cavity preparation, removal of necrotic pulp tissue, mechanical instrumentation of root canals using hand files, irrigation with sterile saline, collection of a baseline intracanal microbiological sample using sterile paper points, placement of the allocated intracanal dressing, and temporary restoration with glass ionomer cement. The first visit (approximately 40–50 minutes) involves clinical and radiographic examination, canal preparation, microbiological sampling, and placement of the intracanal dressing. At the second visit after two weeks (approximately 30–40 minutes), the intracanal dressing will be removed and a second microbiological sample collected. The canals will then undergo final irrigation, followed by obturation with zinc oxide–eugenol cement and placement of a definitive coronal restoration. Monitoring of adherence to the intervention protocol Adherence to the intervention will be ensured by using a standardized clinical protocol and procedural checklist completed for each participant. All treatments will be performed by the same operator, and clinical records will document the treatment steps, materials used, and visit completion to ensure consistency across participants