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Adjunctive Oral Probiotics in Endodontic Retreatment: Effects on Postoperative Pain and RANKL/OPG Levels (RANKL/OPG)

1. juli 2026 opdateret af: Amina Mamdouh Badawy, Ain Shams University

The Effect of Systemic Administration of Probiotics and Intra-Canal Medications on Level of Nuclear Factor Kappa B Ligand, Osteoprotegerin and Postoperative Pain in Patients With Chronic Apical Periodontitis: (Randomized Controlled Clinical Trial)

This study aimed to evaluate the effect of oral administration of probiotics as an adjunctive treatment to local intracanal medicaments, namely propolis and calcium hydroxide or empty canal, on the levels of receptor activator of nuclear factor kappa B ligand (RANKL) and osteoprotegerin (OPG), as well as on postoperative pain following root canal retreatment of teeth with chronic apical periodontitis

Studieoversigt

Status

Afsluttet

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

Post-treatment chronic apical periodontitis is an inflammatory condition caused by persistent microbial infection within the root canal system, characterized by progressive periapical bone destruction mediated by host immune-inflammatory mechanisms. Root canal retreatment remains the treatment of choice for failed endodontic cases; however, postoperative pain and incomplete resolution of inflammatory mediators remain common concerns. Clinical evidence demonstrates that postoperative pain following endodontic retreatment is influenced by microbial persistence, host inflammatory response, and intracanal medication protocols.

The RANK/RANKL/OPG axis is a key regulator of osteoclastic activity and periapical bone resorption. Elevated RANKL levels and altered RANKL/OPG ratio are associated with active periapical bone destruction. Modulation of this pathway may improve healing outcomes. Recent studies suggest that probiotics can regulate immune response, reduce inflammatory cytokines, and decrease RANKL expression.

This randomized clinical trial includes patients diagnosed with previously root-filled teeth presenting with chronic apical periodontitis indicated for non-surgical retreatment.

Standardized retreatment procedures are performed under aseptic conditions. Periapical exudate samples collected for biochemical analysis of RANKL and OPG levels at predetermined time points. Postoperative pain is assessed to investigate whether systemic probiotic administration can act as a host-modulating adjunct in endodontic retreatment and improve both symptomatic and biological healing outcomes.

Undersøgelsestype

Interventionel

Tilmelding (Faktiske)

72

Fase

  • Fase 4

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

    • Cairo Governorate
      • Cairo, Cairo Governorate, Egypten, 11566
        • Faculty of dentistry, Ain shams university

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

  • Voksen

Tager imod sunde frivillige

Ingen

Beskrivelse

Inclusion Criteria:

  • Previously treated failed single rooted teeth with chronic apical periodontitis.
  • No use of antibiotic three months before treatment.
  • Patients are free of any systemic disease.
  • Positive patient acceptance for participation

Exclusion Criteria:

  • Teeth that are badly broken down with difficult isolation.
  • Signs of acute infection, root fracture, root surface caries, swellings or ankylosis
  • Periodontally affected teeth with pockets deeper than 4mm.
  • Pregnant or lactating woman.
  • Patients who needs any prophylactic antibiotic.
  • Patients with allergy to pollen.

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Dobbelt

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: Oral probiotics + Local Ca(OH)2 ICM
Following endodontic retreatment, calcium hydroxide placed as an intracanal medicament . Participants receive Linex Adult® (oral probiotics: Lactobacillus acidophilus, Bifidobacterium animalis ), one capsule daily for 21 days.
Linex Adult® is an oral probiotic formulation containing Lactobacillus acidophilus, Bifidobacterium animalis, It is administered as one capsule once daily for 21 days.
Andre navne:
  • Lactobacillus acidophilus, Bifidobacterium animalis
Intracanal medication kept for 21 days
Andre navne:
  • Metapaste
Eksperimentel: Oral probiotics + Local Propolis ICM
Following endodontic retreatment, propolis placed as an intracanal medicament. Participants receive Linex Adult® (oral probiotics: Lactobacillus acidophilus, Bifidobacterium animalis), one capsule daily for 21 days.
Linex Adult® is an oral probiotic formulation containing Lactobacillus acidophilus, Bifidobacterium animalis, It is administered as one capsule once daily for 21 days.
Andre navne:
  • Lactobacillus acidophilus, Bifidobacterium animalis
Intracanal medication kept for 21 days
Andre navne:
  • Intracanal propolis medicament
Eksperimentel: Oral probiotics + Empty canal
Following endodontic retreatment, the canal was left empty without intracanal medicament. Participants received Linex Adult® (oral probiotics: Lactobacillus acidophilus, Bifidobacterium animalis), one capsule daily for 21 days.
Linex Adult® is an oral probiotic formulation containing Lactobacillus acidophilus, Bifidobacterium animalis, It is administered as one capsule once daily for 21 days.
Andre navne:
  • Lactobacillus acidophilus, Bifidobacterium animalis
Empty canal for 21 days
Andre navne:
  • No intracanal medicament
Aktiv komparator: Oral placebo + Local Ca(OH)2 ICM
Following endodontic retreatment, Ca(OH)2 was placed as an intracanal medicament. Participants received placebo, one capsule daily for 21 days
Intracanal medication kept for 21 days
Andre navne:
  • Metapaste
Placebo capsule for 21 days
Andre navne:
  • Matchende placebo
Aktiv komparator: Oral placebo+ Local propolis ICM
Following endodontic retreatment, propolis was placed as an intracanal medicament. Participants received placebo, one capsule daily for 21 days
Intracanal medication kept for 21 days
Andre navne:
  • Intracanal propolis medicament
Placebo capsule for 21 days
Andre navne:
  • Matchende placebo
Placebo komparator: Oral placebo + Empty canal
Following endodontic retreatment, the canal was left empty without intracanal medicament. Participants received Linex Adult® (oral probiotics: Lactobacillus acidophilus, Bifidobacterium animalis), one capsule daily for 21 days.
Empty canal for 21 days
Andre navne:
  • No intracanal medicament
Placebo capsule for 21 days
Andre navne:
  • Matchende placebo

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
The effect on RANKL and OPG levels in teeth with chronic apical periodontitis.
Tidsramme: (S1) measured in the first visit Immediately post-instrumentation and before ICM placement or oral supplement administration. (S2) After 21 days, immediately after removal of ICM and before obturation.
Level of RANKL and OPG measured with periapical samples (S1) and (S2) and analysed using ELISA test
(S1) measured in the first visit Immediately post-instrumentation and before ICM placement or oral supplement administration. (S2) After 21 days, immediately after removal of ICM and before obturation.

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
The effect on postoperative pain.
Tidsramme: Inter-appointment pain: baseline (start of the first visit), 4, 12, 24, 48, and 72 hours, and Week 1 and Week 2 after the first visit. Post-obturation pain: baseline (start of the second visit), 4, 12, 24, 48, and 72 hours after obturation.
Pain level measured using the Numeric Rating Scale (NRS), ranging from 0 (no pain) to 10 (worst possible pain), to evaluate inter-appointment pain between the first and second retreatment visits and post-obturation pain after the second retreatment visit and root canal obturation.
Inter-appointment pain: baseline (start of the first visit), 4, 12, 24, 48, and 72 hours, and Week 1 and Week 2 after the first visit. Post-obturation pain: baseline (start of the second visit), 4, 12, 24, 48, and 72 hours after obturation.

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Efterforskere

  • Studieleder: Abeer A.Elhakim El Gendy, PHD, Professor of Endodontics, AinShams university

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Faktiske)

4. oktober 2025

Primær færdiggørelse (Faktiske)

4. juni 2026

Studieafslutning (Faktiske)

20. juni 2026

Datoer for studieregistrering

Først indsendt

26. juni 2026

Først indsendt, der opfyldte QC-kriterier

1. juli 2026

Først opslået (Faktiske)

6. juli 2026

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

6. juli 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

1. juli 2026

Sidst verificeret

1. juli 2026

Mere information

Begreber relateret til denne undersøgelse

Andre undersøgelses-id-numre

  • END 20-15 P

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