Regenerative Endodontics Using Different Intracanal Medicaments on Radiographic Outcomes and Periapical MMP-8 Levels
Condition: Regenerative Endodontics
Study type: Interventional

Summary: 
      Two-session regenerative endodontic treatment was applied to 20 immature mandibular first
      molars with symptomatic irreversible pulpitis and symptomatic apical periodontitis. At the
      end of the first session, calcium hydroxide [Ca(OH)2] was applied to 10 randomly selected
      teeth and double antibiotic paste (DAP) intracanal medicaments were applied to the other 10
      teeth. The effects of intracanal medicaments on periapical MMP-8 levels were determined by
      immunofluorometric assay (IFMA) in periapical tissue fluid samples taken from the distal root
      canal in the first and second sessions.
    

Detailed description: 
      The aim of the study was to investigate the effects of two different intracanal medicaments
      used during regenerative endodontic treatment (RET) on periapical MMP-8 in relation to the
      radiological outcomes of RET. After local anesthesia and rubber dam isolation were provided,
      disinfection procedures were applied gently in accordance with the current RET protocol of
      American Association of Endodontics (AAE) on the molar teeth. Periapical tissue fluid samples
      were taken with paper points placed to protrude 2 mm from the distal root canal tip. Calcium
      hydroxide [Ca(OH)2] was placed in 10 randomly selected teeth and double antibiotic paste
      (DAP) intracanal medicaments were placed in the other 10 teeth. Fourteen days later in the
      second session, the final sampling procedure was performed as in the first session. Then, the
      treatment was completed according to the current RET protocol of AAE and permanent
      restorations were made. The success of the treatment and its effect on root development were
      evaluated by comparing the standard radiographs taken at the end of the treatment and 12
      months follow up. MMP-8 levels were measured by immunofluorometric assay (IFMA) in the
      periapical tissue fluid samples. First and second session MMP-8 levels were compared
      according to the groups of medicaments [Ca(OH)2 and DAP groups] placed in the root canals.
    

Intervention name(s): Place the freshly prepared calcium hydroxide in to the root canals; Place the freshly prepared double antibiotic paste in to the root canals; Taking standart periapical radiography with film holder; Sample collection for immunofluorometric assay
Intervention type(s): Combination Product; Combination Product; Diagnostic Test; Other
Intervention description(s): Calcium hydroxide (Merck, Darmstadt, Germany): prepared by mixing with sterile distilled water and then placed in the coronal 1/3 of the root canals.; Double antibiotic paste (DAP): metronidazole (Flagyl, Sanofi-Aventis, Turkey) and ciprofloxacin (Cipro, Biofarma, Turkey) powdered antibiotics were stored and sealed in airtight containers. The same amount of each drug powder (1:1) was mixed and the mixed samples were combined with sterile distilled water to form an ointment. DAP was introduced in roots canals using a lentulo to fill the entire root canal space.; Post-operative periapical radiographs were obtained with Digora Optime SPP system (Soredex Corp., Tuusula, Finland) using intraoral film holders to keep the plates parallel to the long axis of the teeth. A size #2 SPP was used for all exposures. SPPs were exposed with a Gendex Oralix DC dental x-ray unit (Gendex Dental Systems, Milan, Italy) operating at 60 kVp, 7 mA, 0.25 sec. and the plates were scanned immediately after exposure. The clinical and radiographical follow up was performed on 12th months.
Image-J program (version 1.47, National Institutes of Health, Bethesda, MD) with TurboReg plug-in (Biomedical Imaging Group, Swiss Federal Institute of Technology, Lausanne, Switzerland) was used to determine the increase in root length, root width, and radiographic root area at 12th month follow up.; Periapical exudate samples were collected at the beginning of the RET and at 14th day. MMP-8 levels were measured by immunofluorometric assay (IFMA). Briefly, two monoclonal MMP-8-specific antibodies, 8708 and 8706 (Oy Medix Biochemica Ab, Espoo, Finland) were used as catching antibody and tracer antibody, respectively. Samples were diluted in enzyme buffer (50 mM Tris-HCl, pH 7.5; 0.2 mM NaCl, 1 mM CaCl2). Twenty microlitres of samples and 80 μl of assay buffer (20 mM Tris-HCl, pH 7.5, 0.5 M NaCl, 5 mM CaCl2, 0.5% BSA, 0.05% sodium azide and 20 mg/l diethylenetriaminepentaacetic acid with 2 μg/ml normal mouse serum) were pipetted into the wells. The tracer antibody was labelled using europium chelate. After adding the enhancement solution, fluorescence was measured using a 1234 Delfia Research Fluorometer (Wallac, Turku, Finland).
Other intervention name(s): Ca(OH)2 medicament; DAP medicament; Determination of rooth lenght, rooth width, radiographic root area; IFMA
Intervention MeSH terms: Anti-Bacterial Agents; Calcium
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: regenerative endodontics; intracanal medicaments; MMP-8