Comparison of the Efficacy of Calcium Hydroxide With Silver Nanoparticle and Conventional Calcium Hydroxide Intra Canal Medications on Post-Operative Pain in Symptomatic Root Canal Treatment Failure Cases:
Condition: Retreatment; Root Canal Retreatment; Nonsurgical Retreatment; Endodontic Failure; Symptomatic Endodontic Failure; Nanosilver; Intracanal Medicament; Intracanal Dressing; AgNPs; Calcium Hydroxide; Ca (OH)2; Discomfort; Pain; Flare up; Postoperative; Ache; Post-operative; Post Obturation
MeSH terms: Pain, Postoperative
Study type: Interventional
Phase: Phase 2

Summary: 
      The aim of this study is to measure and compare the effectiveness of nanosilver combined
      calcium hydroxide and conventional calcium hydroxide intracanal medications in reducing
      postoperative pain in patients with Symptomatic Root Canal treatment Failure .
    

Detailed description: 
      -  After confirming the diagnosis and making sure that the patient conforms to all
           eligibility criteria, the principal investigator will enroll the patient in the study.

        -  The operator will complete treatment of all cases in two visits as follows:

             1. First session:

                  -  Patients will be asked to rate their pain level on NRS before treatment is
                     started.

                  -  Patient will be anesthetized by using nerve block local anesthesia or
                     infiltration local anesthesia according to the tooth location in mandibular or
                     maxillary arch respectively.

                  -  Previous coronal restoration will be removed:

                       -  If the access will be cut through metal (amalgam alloy or cast metal) or
                          composite resin, carbide fissure bur will be used.

                       -  In case of porcelain fused to metal (PFM) crown a round diamond is used
                          to cut through the porcelain layer, then Transmetal bur is used to cut
                          through and remove the core material.

                  -  Teeth will be isolated with rubber dam.

                  -  Gutta percha removal will be done using protaper rotary retreatment files in
                     the following manner D1 has a cutting tip to facilitate initial penetration
                     into the filling material (coronal third). D2 and D3 both have non-cutting
                     tips and are used to remove material from the middle and apical thirds,
                     respectively using gutta percha solvent

                  -  Working length will be determined using an electronic apex locator then
                     confirmed with intraoral periapical radiograph, to be 0.5-1 mm, shorter than
                     radiographic apex.

                  -  Cleaning and shaping will be done using crown down preparation technique with
                     the use of protaper rotary files in an endodontic motor according to the
                     manufacturer instructions, the canals will be thoroughly irrigated using 3ml
                     of 2.5% Sodium hypochlorite between every subsequent instruments.

                  -  MD-Chelcream will be used as lubricant during mechanical preparation.

                  -  After instrumentation of the canals paper points (Protaper Paper Points) will
                     be used for drying.

                  -  Using Lentulo Spiral Filler, medicaments will be placed under aseptic
                     conditions into the canals according to each group, Experimental group Ca (OH)
                     2 ( Ca (OH) 2with nanosilver suspension and comparison group Ca (OH) 2 with
                     sterile water then access cavity will be closed with a temporary filling

                  -  Patient will be instructed to call in case of severe pain in between visits,
                     an emergency analgesics are to be prescribed to the patient (Brufen 400mg)

             2. Second session:

                  -  After 7 days, rubber dam will be placed , the temporary fillings will be
                     removed and master apical file will be introduced in each root canal to loosen
                     medicament and to create a space for subsequent irrigant, then each root canal
                     will be washed with 5 mL of sterile saline, irrigated with 1 mL of 20% citric
                     acid and again irrigated with 5 mL sterile saline.

                  -  Dryness of the canals by paper points (Protaper Paper Points).

                  -  Obturation will be carried out using the cold lateral condensation technique
                     with protaper gutta percha cones and resin sealer with spreader size according
                     to master cone size , its depth short 2 mm of the working length, and
                     auxiliary cones size 25.

                  -  After obturation a cotton pellet will be placed in the pulp chamber and the
                     access cavity will be closed with a temporary filling to avoid coronal
                     leakage.

                  -  The patient is given a NRS and asked to rate his pain level at 6, 12, 24 & 48
                     hours after root canal retreatment .
    

Intervention name(s): silver nano particulate solution mixed with calcium hydroxide powder; conventional calcium hydroxide
Intervention type(s): Combination Product; Combination Product
Intervention description(s): 1ml of nanosilver solution 30ppm concentration mixed with 100 mg of calcium hydroxide powder used as intracanal medication; 1ml of distilled water mixed with 100 mg of calcium hydroxide powder and used as intracanal medication after root canal retreatment
Intervention MeSH terms: Calcium, Dietary; Calcium
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Interventions: (60) Intracanal medication of 1ml combined nanosilver particle solution 30ppm / 100 mg calcium hydroxide Control : (60) Intracanal medication of 100 mg powder of calcium hydroxide mixed with 1ml distilled water
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Keywords provided by rawda mohammad abdel rahman baghdady, Cairo University:; root canal retreatment; calcium hydroxide; distilled water; silver nanoparticles; postoperative pain