The aim of this clinical trial is to evaluate anti-inflammatory effect of various intracanal medications:
1. Calcium Hydroxide Slurry mixed with 3% Sodium Hypochlorite 2. Calcium Silicate 3. Calcium Hydroxide
In retreatment cases in terms of:
1. Biological Evaluation: Biomarker (IL 1B) 2. Radiographic Evaluation: CBCT 3. Clinical Evaluation: Pain Score (VAS)
Age: 21-45 years.
Medically free patients. (ASA Class 1)
Gender: males and females
Patients who are cooperative at operation and in attendance at scheduled follow-up visits.
Patients with a history of allergic reactions to any of the study materials.
Teeth that become non-restorable after complete caries excavation.
Teeth that have mobility or deep periodontal pockets.
Teeth with internal or external resorption.
Parallel
Calcium Silicate Intracanal Medication
DrugCalcium silicate-based bioceramic materials have gained attention for their bioactivity and biocompatibility, acting through hydration with calcium hydroxide release followed by hydroxyapatite formation that promotes healing. Bio-C Temp is an example, characterized by high calcium ion release, alkaline pH, adequate radiopacity, and good biocompatibility.
Calcium Hydroxide Slurry mixed with Sodium Hypochlorite Intracanal Medication
DrugCombining calcium hydroxide with sodium hypochlorite (NaOCl) has been proposed. NaOCl provides rapid and potent antimicrobial and tissue-dissolving effects, while Ca(OH)₂ offers prolonged action. Both agents retain their properties when combined, and this combination may produce a synergistic effect that enhances disinfection and reduces chair time in two-visit treatment protocols.
Calcium Hydroxide (Ca(OH)2) Intracanal Medication
DrugCalcium hydroxide ICM being the most widely used due to its high alkalinity, antimicrobial properties, endotoxin neutralization, and ability to reduce periapical inflammation. It is applied as an aqueous mixture or polyethylene glycol-based paste and provides a slow but sustained antimicrobial effect. Despite their benefits, Ca(OH)₂ medicaments re limited by their solubility, susceptibility to tissue fluids, potential to weaken tooth structure over time, and reduced effectiveness against resistant microorganisms such as Candida Albicans and Enterococcus Faecalis.
Biological Evaluation of inflammatory marker (IL-1B)
IL-1B collected by periapical fluid sample using paper points and measured using ELISA.
Radiographic Evaluation using limited FOV CBCT
Pre-operative and post-operative limited FOV CBCT scans are taken to compare volumetric reduction in periapical lesion size.
Clinical Evaluation using Pain Score (Visual Analogue Scale)
evaluation of pain score using Visual Analogue Scale on a scale of 0-10 with 0 representing no pain and 10 representing the most severe pain (subjective)
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