Effectiveness of Glycyrrhizin as Intracanal Medication in Root Canal Disinfection and Inflammatory Cytokines
Clinical Investigation of the Effectiveness of Glycyrrhizin as Intracanal Medication in Root Canal Disinfection and Inflammatory Cytokines
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Periodontitis is a dynamic inflammatory process located at the periapical region, the type of immune-inflammatory response to periapical periodontitis is determined by a network of chemical mediators produced by immune cells in response to the stimulus caused by the action of microorganisms and/or virulence factors. This may result in damage to the tissues and in the development of endodontic signs and symptoms (1-3).
In infected root canals, the destruction of periapical tissues is mediated by tumor necrotizing factor (TNF-α) and interleukin-1β (IL-1β) that appears to be directly related to high levels of infectious content present in the root canal (4). Arachidonic acid metabolism plays a key role in many inflammatory diseases, one of its products is the prostaglandin E2 (PGE2) which has been also shown to potentially stimulate bone resorption and to inhibit reparative bone formation in vitro and in vivo (5). Particularly, IL-1β, TNF-α, and PGE2 have been detected in periapical tissues (6-9), being considered as an important inflammatory biomarker in the periapical disease (1, 2, 5, 7, 10).
To identify a specific inflammatory mediator as a diagnostic marker of disease status, the mediator should not only be present or elevated in disease and absent or low in health, but it should also longitudinally increase during active disease progression and subside following therapy (5).
Although instrumentation may be assumed to be of greater importance in the clinical practice, the use of intracanal medication has been proven to optimize the root canal disinfection (11-14). As root canal medicaments can come in direct contact with periapical tissues, in addition to having good antibacterial ability and being biocompatible, so a wide variety of intracanal medications have been proposed. In selecting root canal medicaments, it is necessary to consider their therapeutic benefits against their potential cytotoxic effects. Ideal root canal medicaments should have strong antibacterial properties and minimal cytotoxic effect on the host tissues (11-16).
Calcium hydroxide (Ca(OH)2) has been used extensively in dentistry since the 1920s (17). Today, it is still the most commonly used endodontic medicament throughout the world(18).Ca(OH)2 also inactivates lipopolysaccharide so it can assist in periapical tissue repair (19).
Corticosteroids have also shown to interfere with the repair process. This interference includes an inhibition of fibroblastic proliferation and a decrease in polymorphonuclear leukocyte locomotion. In addition, corticosteroids interfere with the immune response, which could disseminate bacteria leading to infectious disease. Considering these potential pitfalls, some investigators have advocated supplemental use of an antibiotic to help control infection. As a result, ledermix paste was used where it consists of both a corticosteroid "triamcinolone" and an antibiotic "dimethyl chlortetracycline" (20, 21).
Herbs have been used in clinical medicine for thousands of years. Recently researchers have been able to employ scientific methods to prove the efficacy of many of these herbs and to provide a better understanding of their mechanisms of action (22).
Glycyrrhiza glabra which is known as licorice belonging to the Fabaceae, is native to southern Europe and parts of Asia including Iran (23). Licorice roots have been used as a remedy for cough, constipation, menopausal hot flashes, peptic ulcer, and viral diseases (24). Licorice contains more than 20 triterpenoids and nearly 300 flavonoids. Among them, glycyrrhizin, 18 β-glycyrrhetinic acid, liquiritigenin, licochalcone A, licochalcone E and glabridin are the main active components which possess antimicrobial, antioxidant and anti-inflammatory activities (25-27). Badr et al. (28) reported that Licorice extract either separately or as Liquorice/Ca(OH)2 mixture had a potent bactericidal effect against Enterococcus faecalis and retained compatibility with fibroblasts in tissue culture compared to the commonly used root canal medicament Ca(OH)2.
Glycyrrhizin (an oleanane-type triterpenoid glucuronide), the main active and important constituent in licorice, is 50 times sweeter than sugar (29) and is used in large quantities as a well-known natural sweetener and as a pharmaceutical (30). It is a conjugate of two molecules of glucuronic acid and glycyrrhetinic acid and is found chiefly in roots and stolons but not in aerial parts (31). Glycyrrhizin possesses anti-allergic (32), anti- diabetic (33), anti-inflammatory (34), anti-ocular hypertension (35), immune-modulatory (36), anti-cholestasis (37), hepatoprotective (38) and neuroprotective pharmacological activities (39). It also has protective effect on the respiratory system (40).
So based on the above mentioned data, it is believed to be of interest to investigate clinically the use of Glycyrrhizin as an intracanal medication.
Study Type
Enrollment (Estimated)
Phase
- Phase 2
- Phase 3
Contacts and Locations
Study Contact
- Name: Alaa Eltantawi, phD
- Phone Number: 00201062885600
- Email: alaa_reda@mans.edu.eg
Study Contact Backup
- Name: Ghada Abdelrazik
- Phone Number: 00201003455012
- Email: alaa.92.ar@gmail.com
Study Locations
-
-
-
Mansoura, Egypt
- Recruiting
- Alaa Reda Mohamed Eltantawi
-
Contact:
- Alaa Eltantawi, phD
- Phone Number: 00201062885600
- Email: alaa_reda@mans.edu.eg
-
Contact:
- Mohamed Asar
- Phone Number: 00201069888408
- Email: alaa.92.ar@gmail.com
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Single-rooted with pulp necrosis and apical periodontitis.
Exclusion Criteria:
- Receiving antibiotic treatment within the preceding 3 months.
- Reporting systemic disease.
- Teeth that could not be isolated with rubber dam.
- Teeth with periodontal pockets deeper than 3 mm.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
|
Active Comparator: Calcium Hydroxide
|
Intracanal medication
|
|
Active Comparator: Leddermix
|
Intracanal medication
|
|
Active Comparator: Glycirrhizin
|
Intracanal medication
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
counting the number of colonies forming units of bacterial cells
Time Frame: up to 7 months
|
Microbiology cell culturing (manual counting technique to the bacterial cells)
|
up to 7 months
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
using enzyme-linked immunosorbent assay (ELISA test) to measure the amount of Inflammatory Cytokines (TNF-α), (IL-1β) and (PG2)
Time Frame: 25 weeks
|
ELISA test to measure the amount of tumor necrotizing factor (TNF-α), interleukin 1β(IL-1β) and prostaglandin E2 (PG2)
|
25 weeks
|
Collaborators and Investigators
Sponsor
Investigators
- Study Chair: Amany Badr, Prof, Faculty of Dentistry Mansoura University
- Study Director: Youssry Elhawary, prof, Faculty of Dentistry Mansoura University
- Study Director: Ghada Abdelrazik, Dr, Faculty of Dentistry Mansoura University
Publications and helpful links
General Publications
- Vianna ME, Horz HP, Conrads G, Zaia AA, Souza-Filho FJ, Gomes BP. Effect of root canal procedures on endotoxins and endodontic pathogens. Oral Microbiol Immunol. 2007 Dec;22(6):411-8. doi: 10.1111/j.1399-302X.2007.00379.x.
- Martinho FC, Chiesa WM, Leite FR, Cirelli JA, Gomes BP. Antigenic activity of bacterial endodontic contents from primary root canal infection with periapical lesions against macrophage in the release of interleukin-1beta and tumor necrosis factor alpha. J Endod. 2010 Sep;36(9):1467-74. doi: 10.1016/j.joen.2010.06.012.
- Athanassiadis B, Abbott PV, Walsh LJ. The use of calcium hydroxide, antibiotics and biocides as antimicrobial medicaments in endodontics. Aust Dent J. 2007 Mar;52(1 Suppl):S64-82. doi: 10.1111/j.1834-7819.2007.tb00527.x.
- Tang G, Samaranayake LP, Yip HK. Molecular evaluation of residual endodontic microorganisms after instrumentation, irrigation and medication with either calcium hydroxide or Septomixine. Oral Dis. 2004 Nov;10(6):389-97. doi: 10.1111/j.1601-0825.2004.01015.x.
- Badr AE, Omar N, Badria FA. A laboratory evaluation of the antibacterial and cytotoxic effect of Liquorice when used as root canal medicament. Int Endod J. 2011 Jan;44(1):51-8. doi: 10.1111/j.1365-2591.2010.01794.x. Epub 2010 Aug 31.
- van der Sluis LW, Versluis M, Wu MK, Wesselink PR. Passive ultrasonic irrigation of the root canal: a review of the literature. Int Endod J. 2007 Jun;40(6):415-26. doi: 10.1111/j.1365-2591.2007.01243.x. Epub 2007 Apr 17.
- Martinho FC, Chiesa WM, Leite FR, Cirelli JA, Gomes BP. Antigenicity of primary endodontic infection against macrophages by the levels of PGE(2) production. J Endod. 2011 May;37(5):602-7. doi: 10.1016/j.joen.2010.12.005. Epub 2011 Mar 5.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- Intracanal medication
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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