Investigate"Clinically" the Effectiveness of Boswellia Based Intracanal Medication Compared to Calcium Hydroxide Ca(OH)2 and Ledermix on the Levels of Bacteria and Inflammatory Cytokines in Root Canals and Periradicular Tissues of Teeth With Apical Periodontitis

June 13, 2024 updated by: Mansoura University

Effectiveness of Boswellia as Intracanal Medication on Infectious/Inflammatory Contents in Teeth With Apical Periodontitis

The objective of this study is to investigate "clinically" the effectiveness of Boswellia based intracanal medication compared to the commonly used intracanal medicaments (calcium hydroxide Ca(OH)2 and Ledermix) on the levels of bacteria and inflammatory cytokines in root canals and periradicular tissues of teeth with apical periodontitis.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

Apical periodontitis is an inflammatory disorder of the periradicular tissue caused by bacterial infection of endodontic origin, which is characterized by periapical bone resorption. Primary endodontic disease has a polymicrobial etiology, with predominance of Gram-negative anaerobic bacteria. This species presents lipopolysaccharides (LPSs), one of the most important inflammatory molecules present in the outer layer of its membrane, which can be released during multiplication or bacterial death, thus continuously stimulating the surrounding tissues even at low levels.

Endotoxins have been detected in 100% of the primarily infected root canals, with high levels being related to more severe inflammatory response in periapical tissues. When bacteria and their toxins (e.g., LPS) present in the root canal infection egress into the periapical tissues via apical foramen, they activate immune response locally, culminating in a very complex inflammatory disorder involving a variety of inflammatory cells as well as different proinflammatory cytokines. IL-1β, TNF-α, and PGE2 have been detected in periapical tissues, being considered important inflammatory biomarkers in the apical disease. Since bacteria and their by-products are one of the main causes of apical periodontitis, special emphasis is given to the search for an optimal root canal disinfection protocol.

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. For this reason, a wide variety of intracanal medications have been proposed. Calcium hydroxide [Ca(OH)2] is the most commonly used intracanal medication. Lately, chlorhexidine (CHX) has emerged as a potential intracanal medication and suggested to be used alone or combined with Ca(OH)2 in a paste. Although studies have investigated the antibacterial property of Ca(OH)2, including CHX associations, the effects on immune periapical response is incipient.

Another effective intracanal medication is Ledermix which contains 1% triamcinolone (TAA) and 3% demeclocycline (DOC). This formulation was first recommended for use in endodontics. The use of Ledermix appear to be more likely related to the anti-inflammatory effects of corticosteroid rather than its antibacterial effect .The antibiotic component does not appear to be ideal, and the use of other antibiotics may help to improve the antimicrobial effects of Ledermix.

Because root canal medicaments can come in contact with periapical tissue, in addition to having good antibacterial ability, they must also be biocompatible. 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. Herbs have been used in clinical medicine for thousands of years. However, it is only in recent times that 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 (Graf 2000).

Ayurveda (Indian traditional medicine practice) used Boswellia for the treatment of gastrointestinal diseases such as diarrhea, constipation, flatulence and vomiting. It was also stated that the extract is useful in the treatment for diabetic patients and also for respiratory complications including cough, cold, hoarseness, bronchitis, asthma and dyspnea.

So based on the above mentioned data, it is believed to be of interest to investigate clinically the use of Boswellia as an intracanal medication.

Study Type

Interventional

Enrollment (Estimated)

36

Phase

  • Phase 2
  • 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 Contact

Study Locations

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

  • Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Single-rooted with pulp necrosis and apical periodontitis.
  • The age range from 20 to 60 years

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

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: Treatment
  • Allocation: Randomized
  • Interventional Model: Crossover Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Calcium Hydroxide
intracanal medicament
Drug: Calcium hydroxide
intracanal medicament
Active Comparator: Leddermix
intracanal medicament
Drug: Leddermix
Leddermix
Active Comparator: Boswellia
intracanal medicament
Drug: Boswellia
Boswellia

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Microbiological culture (manual counting to bacterial cells)
Time Frame: up to 8 months
Bacterial counting after culturing of bacteria
up to 8 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
ELISA test to measure levels of Inflammatory cytokines (tumor necrotizing factor, prostaglandin E2, Interleukin 1B)
Time Frame: 30 weeks
ELISA test to measure levels of Inflammatory cytokines (tumor necrotizing factor, prostaglandin E2, Interleukin 1B)
30 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Mansoura University

Investigators

  • Study Chair: Amany Badr, Professor, Mansoura University
  • Study Director: Youssry RM Elhawary, Professor, Mansoura University

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.

General Publications

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)

June 1, 2022

Primary Completion (Estimated)

July 1, 2024

Study Completion (Estimated)

July 20, 2024

Study Registration Dates

First Submitted

June 8, 2024

First Submitted That Met QC Criteria

June 13, 2024

First Posted (Actual)

June 20, 2024

Study Record Updates

Last Update Posted (Actual)

June 20, 2024

Last Update Submitted That Met QC Criteria

June 13, 2024

Last Verified

June 1, 2024

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • Root Canal Medicament

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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