- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02629042
Efficacy of Oral Prednisolone on Pain Reduction in Emergency Care of Acute Irreversible Pulpitis (PULPISOLONE)
December 19, 2018 updated by: University Hospital, Bordeaux
Efficacy of Oral Prednisolone Versus Partial Endodontic Treatment on Pain Reduction in Emergency Care of Acute Irreversible Pulpitis of Mandibular Molars: Non Inferiority Randomized Clinical Trial
Irreversible pulpitis is an inflammatory condition of the dental pulp, highly painful, representing one of the main reasons for consulting dental emergency.
The recommended emergency care is a partial endodontic treatment under local and/or locoregional anesthesia.
The purpose of the emergency partial endodontic treatment is to stop the pain of pulpitis by removing a portion of the pulp.
The final endodontic treatment is ideally performed 72 hours after.
The literature reports major difficulty in obtaining adequate anesthesia in the mandible to perform partial endodontic treatment, especially for the mandibular molars.
This results in a very painful care for the patient.
The management of this type of emergency is costly in terms of equipment and time for health facilities.
Patient comfort, cost saving and rationalization of the care time justify the search for an alternative to emergency partial endodontic treatment.
In current practice, the short course oral corticotherapy is used in the management of oral pain from inflammatory origin.
Glucocorticoids, thanks to their anti-inflammatory action, can neutralize the inflammatory mediators and thus pain.
The pulp inflammation can be treated with this molecule: the effectiveness of intraosseous local steroid injection for irreversible pulpitis of mandibular molars has already been shown but results in local comorbidities and requires specific device.
Oral administration of short-course prednisolone is simple and safe but its effectiveness to manage pain caused by irreversible pulpitis has not yet been demonstrated.
Per-os administration of prednisolone has a very high (90%) and rapid (≤ 4 hours) bioavailability.
No difference in effectiveness between intravenous and oral administration of this molecule was reported.
This oral treatment could limit comorbidities and technical difficulties related to intraosseous injection and could delay the endodontic treatment to 72 hours in optimal conditions of anesthesia for the patient.
Despite the difficulties described for the partial endodontic treatment, it is very effective in pain reduction and can reach 100% of success.
Therefore a non-inferiority design was chosen to compare the effect of a short-course oral corticotherapy to a partial endodontic treatment for the reduction of pain at the emergency care of the irreversible pulpitis in mandibular molars.
The intervention arm will receive an oral dose of prednisolone (1 mg/kg) during the emergency visit followed-up by one morning dose by day during three days and the reference arm will have partial endodontic treatment.
Both groups will have planned complete endodontic treatment 72 hours after enrolment.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Study Type
Interventional
Enrollment (Actual)
5
Phase
- Phase 3
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
-
Bordeaux, France, 33000
- CHU de Bordeaux
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years to 70 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Clinical signs of irreversible pulpitis on a mandibular molar,
- ASA1 or ASA2 score (American Society of Anesthesiologists)
- Age between 18 and 70 years (of either gender)
- Ability to give written informed consent
- Affiliation to a health insurance scheme
- Agreement to be contacted by phone 24h after the emergency visit
- Availability to come back 72 hours after the emergency visit for endodontic treatment
Exclusion Criteria:
- Diagnosis of reversible pulpitis, acute apical periodontitis, periodontal lesion of endodontic origin or dentin syndrome
- Not retainable tooth requiring extraction
- Contraindication of endodontic treatment (endocarditis risk) or local anaesthesia
- Contraindication for the prescription of glucocorticoids, paracetamol or codeine,
- Oral infection, viral disease in evolution (hepatitis, herpes zoster, .. ),
- Machine operators ,
- Psychosis uncontrolled by treatment, or chronic consumption of drugs or alcohol
- Allergy to one or more of the components,
- Diabetes, drug intake with direct interaction with glucocorticoids, paracetamol or codeine,
- Woman of child-bearing age without contraceptive, pregnancy, breastfeeding
- Not able to give informed consent,
- Participating in another interventional study
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Experimental
|
The evaluated intervention consists in per-os administration of prednisolone (1 mg / kg) during the emergency visit followed-up by one morning dose by day during three days.
At the end of the emergency visit, all the patients, whatever their randomization group, will be given two types of antalgics and will be recommended to take them only if they have pain.
Seventy-two hours after, all the patients, whatever their randomization will have endodontic treatment under local and locoregional anesthesia.
|
Active Comparator: Control
|
The reference management consists in local and locoregional anesthesia of the molar and partial endodontic treatment.
At the end of the emergency visit, all the patients, whatever their randomization group, will be given two types of antalgics and will be recommended to take them only if they have pain.
Seventy-two hours after, all the patients, whatever their randomization will have endodontic treatment under local and locoregional anesthesia.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Pain intensity on a numeric scale
Time Frame: 24 hours after the emergency visit (inclusion)
|
24 hours after the emergency visit (inclusion)
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
The number of antalgic drugs taken after the emergency visit
Time Frame: 72 hours after the emergency visit (inclusion)
|
72 hours after the emergency visit (inclusion)
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The number of patients coming back to consultation at 72h
Time Frame: 72 hours after the emergency visit (inclusion)
|
72 hours after the emergency visit (inclusion)
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The number of injected anesthetic cartridges when performing the endodontic treatment
Time Frame: 72 hours after the emergency visit (inclusion)
|
72 hours after the emergency visit (inclusion)
|
Patient's comfort evaluation during the endodontic treatment using a questionnaire with numeric scales
Time Frame: 72 hours after the emergency visit (inclusion)
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72 hours after the emergency visit (inclusion)
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Study Chair: Elise ARRIVE, USMR, CHU de Bordeaux
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
May 15, 2017
Primary Completion (Actual)
November 28, 2018
Study Completion (Actual)
December 3, 2018
Study Registration Dates
First Submitted
December 7, 2015
First Submitted That Met QC Criteria
December 10, 2015
First Posted (Estimate)
December 11, 2015
Study Record Updates
Last Update Posted (Actual)
December 20, 2018
Last Update Submitted That Met QC Criteria
December 19, 2018
Last Verified
December 1, 2018
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Pathologic Processes
- Disease Attributes
- Stomatognathic Diseases
- Tooth Diseases
- Dental Pulp Diseases
- Emergencies
- Pulpitis
- Physiological Effects of Drugs
- Anti-Inflammatory Agents
- Antineoplastic Agents
- Glucocorticoids
- Hormones
- Hormones, Hormone Substitutes, and Hormone Antagonists
- Antineoplastic Agents, Hormonal
- Prednisolone
Other Study ID Numbers
- CHUBX 2014/09
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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