Acute Apical Abscess
Conditions
Keywords
Endodontic Infection, Root Canal Treatment, Intracanal Medicament, Calcium Hydroxide, Calcium Silicate, Real-Time PCR, Bacterial Load
Brief summary
This randomized clinical trial compares the antibacterial effects of calcium hydroxide and a calcium silicate-based intracanal medicament in teeth with acute apical abscesses. Microbiological samples are collected before root canal preparation, after chemomechanical preparation, and after intracanal medication. Bacterial levels are measured using Real-Time PCR. The main objective is to determine which intracanal medicament provides a greater reduction in the total bacterial load after a 7- to 10-day medication period.
Detailed description
Acute apical abscess is an endodontic infection characterized by localized inflammation, pain, swelling, and purulent exudate. Although chemomechanical root canal preparation substantially reduces the bacterial load, microorganisms may remain within the root canal system. Intracanal medicaments are therefore used between treatment sessions to improve microbial reduction. In this randomized, parallel-group clinical trial, teeth diagnosed with acute apical abscess are allocated to receive either a calcium hydroxide intracanal medicament or a calcium silicate-based intracanal medicament. All teeth undergo standardized root canal treatment and irrigation procedures. Microbiological samples are collected at three main treatment stages: before chemomechanical preparation, after chemomechanical preparation and irrigation, and after a 7- to 10-day intracanal medication period. Bacterial DNA is analyzed using SYBR Green Real-Time PCR. Universal 16S rRNA primers are used to quantify the total bacterial load. Selected bacterial species associated with endodontic infections are also evaluated. The primary outcome is the change in total bacterial load between the post-instrumentation sample and the sample collected after intracanal medication. Secondary outcomes include changes in selected bacterial species and bacterial levels across the different sampling stages. The study aims to determine and compare the microbial effectiveness of the two intracanal medicaments in acute apical abscess cases.
Interventions
OTHERCalcium Hydroxide Intracanal Medicament
Calcium hydroxide-based intracanal medicament placed into the prepared root canal to 1 mm short of the working length for 7 to 10 days.
OTHERCalcium Silicate-Based Intracanal Medicament
Calcium silicate-based intracanal medicament placed into the prepared root canal to 1 mm short of the working length for 7 to 10 days.
Sponsors
Ataturk University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Masking description
Participants are unaware of the assigned intracanal medicament. Microbiological samples are coded, and the outcome assessor performing the Real-Time PCR measurements is unaware of group allocation.
Intervention model description
Participants are randomly assigned in parallel to receive either a calcium hydroxide or a calcium silicate-based intracanal medicament.
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Diagnosis of acute apical abscess * A single-rooted permanent tooth requiring primary endodontic treatment * Age between 18 and 65 years * No history of systemic disease * American Society of Anesthesiologists physical status classification I (ASA I) * Provision of written informed consent
Exclusion criteria
* Previous endodontic treatment of the affected tooth * Periodontal probing depth greater than 4 mm * History of trauma involving the affected tooth * Pregnancy or breastfeeding * Immunodeficiency
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Total Bacterial Load After Intracanal Medication | From immediately after chemomechanical preparation to 7 to 10 days after intracanal medicament placement | Total bacterial load will be quantified using universal 16S rRNA gene-based Real-Time PCR in samples collected after chemomechanical root canal preparation (S2) and after the 7- to 10-day intracanal medication period (S3). The antibacterial effect will be evaluated as the change in log10 bacterial load from S2 to S3 and compared between the two intervention groups. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Changes in the Levels of Selected Endodontic Bacterial Species | From before chemomechanical preparation to 7 to 10 days after intracanal medicament placement | The levels of Fusobacterium nucleatum, Prevotella intermedia, Porphyromonas endodontalis, Parvimonas micra, Treponema denticola, Streptococcus anginosus, Dialister pneumosintes, Campylobacter rectus, Filifactor alocis, and Olsenella uli will be evaluated using species-specific Real-Time PCR. Changes between the samples collected before chemomechanical preparation (S1), after chemomechanical preparation (S2), and after intracanal medication (S3) will be assessed and compared between the intervention groups. |
| Change in Total Bacterial Load After Chemomechanical Preparation | From before to immediately after chemomechanical root canal preparation during the first treatment visit | Total bacterial load will be quantified using universal 16S rRNA gene-based Real-Time PCR in samples collected before chemomechanical root canal preparation (S1) and immediately after chemomechanical preparation (S2). The change in log10 bacterial load from S1 to S2 will be evaluated to determine the bacterial reduction achieved by the standardized chemomechanical preparation protocol. |
Countries
Turkey (Türkiye)
Outcome results
None listed