Effect of Sodium Hypochlorite Concentration on Success of Non-surgical Root Canal Treatment
Condition: Apical Periodontitis
MeSH terms: Periodontitis; Periapical Periodontitis
Study type: Interventional

Summary: 
      .There is no general agreement regarding the optimal concentration of sodium hypochlorite to
      be used in endodontic treatment.Therefore, this study aims to evaluate the effect of sodium
      hypochlorite concentration on the success of primary root canal treatment. The study
      population comprised of patients requiring primary root canal treatment following the
      diagnosis of pulpal necrosis with chronic apical periodontitis in mature mandibular first and
      second molars.Patients were randomly allocated in either High concentration or Low
      concentration group.
    

Detailed description: 
      AIMS AND OBJECTIVES

        1. To evaluate the success of primary endodontic treatment following use of 5% and 1% NaOCl
           in non-vital, posterior teeth.

        2. To compare the success achieved following use of the two different concentrations of
           NaOCl.

        3. To evaluate postoperative pain following use of 5% and 1% NaOCl.

      MATERIALS AND METHODS: Mature mandibular first and second molars with diagnosis of pulp
      necrosis (as confirmed by negative response to cold and electric pulp testing), and having
      apical radiolucency were chosen for the study.The consenting subjects were allocated to one
      of the two study groups based on concentration of NaOCl used: 5% [high concentration (HC)]
      and 1% [low concentration (LC)].Using an equal proportion randomization allocation ratio,
      envelopes containing concealed assignment codes were assigned sequentially to eligible
      patients.It was ensured that neither the patient, nor the primary investigator was aware of
      the treatment protocol before beginning of the treatment procedure.

      CLINICAL PROCEDURE:

      2% lidocaine with 1/80000 epinephrine was used to achieve profound local anaesthesia.

      After proper isolation with rubber dam, access cavity was made with a high speed handpiece
      and carbide bur.

      Debridement of the pulp chamber was done and all canal orifices were identified Lubricant (RC
      Prep) was placed at the entrance of the canal and canals negotiated with 10 no. K file.

      Working length was established 1mm short of apical foramen by electronic apex loactor (Root
      ZX) and confirmed radiographically.

      Root canal preparation was done by using rotary files according to manufacturer's
      instructions.

      In both groups, 5ml of sodium hypochlorite was used as irrigant after each instrument change.
      All the irrigation procedures was performed using a 30 gauge needle. 5% and 1% NaOCl was used
      in HC and LC, respectively.

      After root canal instrumentation, canals was irrigated with 5ml of 17% EDTA solution for 1
      minute followed by final wash with 5ml of 5% or 1% sodium hypochlorite, depending on the
      group.

      Canals were dried with sterile absorbent paper points and filled with calcium hydroxide paste
      and the access cavity restored with Cavit.

      The patients were recalled after 1 week. At the next appointment, the paste was removed with
      the use of Hedstroem files and copious irrigation with 5% or 1% sodium hypochlorite followed
      by 5ml 17% EDTA and a final rinse with 5ml 5% or 1% sodium hypochlorite.

      Then, canals were obturated with the Gutta percha by lateral condensation technique and Zinc
      Oxide- Eugenol based sealer in both the groups.

      After obturation, the cavity was restored permanently. Immediate post-operative radiograph
      was then be taken.

      All the patients were prescribed Ibuprofen 400mg with the instructions to take only one
      tablet every 8 hours in the event of pain, if needed.Patients were asked to record the
      severity of pain using 10 cm VAS scale with 0 depicting no pain and 10 depicting maximum pain
      imaginable. Patients were asked to make a mark on the line that represented their level of
      perceived pain at 6 hr ,12 hr ,1 day,2 days,3 days,4 days,5 days,6 days and 7 days.One week
      later, patients returned with the completed questionnaires.

      Follow up clinical and radiographic examination carried out every 3 months, till 12 month
      period.
    

Intervention name(s): Root canal treatment with 5% NaOCl; Root canal treatment with 1% NaOCl
Intervention type(s): Procedure; Procedure
Other intervention name(s): Endodontic treatment; Endodontic treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment