Effect of Different Instrumentation Technique on Endodontic Outcome
Condition: Apical Periodontitis
MeSH terms: Periodontitis; Periapical Periodontitis
Study type: Interventional

Summary: 
      Aim: To evaluate and compare the outcome of primary endodontic treatment following use of
      different instrumentation techniques.

      Materials and methods: Study subjects were recruited from the pool of patients referred for
      the non-surgical root canal treatment in the Department of Conservative Dentistry &
      Endodontics at PGIDS, Rohtak (Haryana).

      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.

      Subjects were allocated to one of the three study groups: manual instrumentation, ProTaper
      instrumentation and Hybrid instrumentation.
    

Detailed description: 
      AIMS AND OBJECTIVES

      The present study has been designed with the following aims and objective:

        -  To evaluate the effect of manual / rotary/hybrid instrumentation techniques on success
           of primary non surgical root canal treatment in teeth with apical periodontitis.

        -  To assess the incidence of postoperative pain in teeth treated with and without rotary
           instrumentation.

        -  To compare manual, rotary and hybrid instrumentation techniques in terms of periapical
           healing in teeth with apical periodontitis.

      METHODOLOGY

      Prior to treatment a thorough clinical and radiological examination was carried out. A
      thorough history was taken from each patient. Prior informed consent was taken after
      explaining the procedure, risks and benefits.

      Clinical procedure: A total of 90 patients (n=30 in each group) were included in the study.
      Mature mandibular permanent molar with diagnosis of apical periodontitis (as confirmed
      clinically & by periapical radiograph) were chosen for the study. Patients were randomly
      allocated into three groups :Group I- manual instrumentation, Group II -rotary
      instrumentation (ProTaper) and Group III -Rotary instrumentation (Hybrid ).

      After administration of local anesthesia, rubber dam isolation of the involved tooth was
      done. Caries excavation was done and access cavity was prepared using carbide burs in high
      speed handpiece with copious irrigation.Debridement of the pulp chamber was done and all
      canal orifices were identified. Negotiation of canals was done. Working length was determined
      using root ZX apex locator and verified radiographically. Instrumentation was done as
      follows.

      GROUP A: Manual instrumentation: Hand instrumentation with the stainless steel K files was
      performed using step back technique.

      GROUP B: Rotary instrumentation (ProTaper files): The cleaning and shaping of the canals was
      completed in accordance with a crown down technique recommended by the manufacturer, using
      the following operative sequence. Canals were instrumented with ProTaper rotary instruments.
      Recapitulation was carried out with size 10 k file.

      GROUP C: rotary instrumentation (Hybrid): Roots canals were shaped with a combination of two
      NiTi rotary systems: ProTaper Universal instruments were used to shape the coronal and middle
      thirds and Hyflex CM files to prepare the apical third.

      After completion of canal instrumentation in all the groups, canals were irrigated with 5.0
      mL of 17% ethylene-diamine-tetra acetic acid for 1 minute followed by a final irrigation with
      5.0 mL of 5.25% sodium hypochlorite. Canals were then be dried with sterile paper points. A
      lentulo-spiral was used to fill all canals with a Calcium hydroxide paste and the access
      cavity to be restored with intermediate restorative material. The patient were recalled after
      1 week. At the second appointment, the calcium hydroxide paste were removed by using
      circumferential filing with Hedstrom files and copious irrigation with 5.25% sodium
      hypochlorite followed by 5.0 mL of 17% ethylenediaminetetraacetic acid and a final rinse of
      5.0 mL 5.25% sodium hypochlorite. Canals were dried with the help of absorbent paper points
      and obturated. After obturation, the cavity was permanently restored. Immediate
      post-operative radiograph was then taken using preset exposure parameters and processed
      manually.

      FOLLOW UP

      Follow up and clinical and radiographic examination was carried out at 3, 6, 9 & 12 month
      period.

      Outcome variables

        -  The primary outcome variables observed for the study was long term clinical and
           radiographic success rates.

        -  The secondary outcome measure was the incidence of postoperative pain.

      Radiographic success: Radiographic success (change in Periapical Index score) of the root
      canal therapy was drawn by comparing the pre-operative; 3 month, 6month, 9 month & 12-month
      follow up radiographs.

      Clinical success: it was determined by

        -  Absence of inter appointment flare ups and pain.

        -  Absence of tenderness to palpation /percussion

        -  Absence of sinus or any associated soft tissue swelling.

        -  Tooth mobility of grade I or less.

        -  No deterioration in periodontal pocket depth.
    

Intervention name(s): Root Canal Treatment with hand instruments; Root canal treatment with Protaper instruments; Root canal treatment with hybrid instrumentation
Intervention type(s): Other; Other; Other
Intervention description(s): Root canal treatment was performed with K files.; Root canals were enlarged with S1 S2 F1F2 F2 Protaper instruments; Root canal were enlarged with combination of a combination of ProTaper Universal instruments to shape the coronal and middle thirds and Hyflex CM to prepare the apical third
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary purpose: Treatment
Keywords: apical periodontitis; hybrid; ProTaper; rotary