Overview
Successful endodontic treatment depends on effective elimination of microorganisms from the infected root canal system and prevention of reinfection. However, complete disinfection remains difficult because of the complex anatomy of the root canal system, allowing residual microorganisms to persist and contribute to persistent apical periodontitis and treatment failure.
Description
Mechanical instrumentation facilitates root canal shaping and irrigant penetration but cannot contact all canal walls. Consequently, microorganisms may persist within biofilms and dentinal tubules, making complete disinfection difficult. Therefore, intracanal medicaments are used as an adjunct to chemomechanical preparation, particularly in necrotic teeth with apical periodontitis.
Calcium hydroxide is the gold-standard intracanal medicament because of its antibacterial activity, ability to neutralize bacterial endotoxins, and capacity to promote mineralized tissue formation and periapical healing. Its antimicrobial effect is attributed to the release of hydroxyl ions that create a highly alkaline environment.
Despite these advantages, calcium hydroxide has limited efficacy against resistant microorganisms, particularly Enterococcus faecalis, and its activity may be reduced by the buffering effect of dentin. Consequently, researchers have investigated novel vehicles and bioactive compounds to enhance its antimicrobial performance.
The vehicle mixed with calcium hydroxide influences hydroxyl ion release, diffusion, and antimicrobial activity. Although sterile saline is the conventional aqueous vehicle, increasing interest has focused on natural products with antimicrobial, anti-inflammatory, antioxidant, and analgesic properties.
Cyperus articulatus essential oil has demonstrated promising antibacterial and antibiofilm activity against Enterococcus faecalis while maintaining acceptable cytocompatibility. When combined with calcium hydroxide, it may improve antimicrobial efficacy without compromising biocompatibility, but clinical evidence remains scarce.
Successful endodontic treatment depends on effective elimination of microorganisms from the infected root canal system and prevention of reinfection. However, complete disinfection remains difficult because of the complex anatomy of the root canal system, allowing residual microorganisms to persist and contribute to persistent apical periodontitis and treatment failure.
Eligibility
Inclusion Criteria:
- Healthy adult Patient.
- Medically free patients.
- Mandibular permanent premolar teeth:
- Diagnosed clinically with necrotic pulp.
- Absence of pain.
- Radiographic evidence of chronic apical periodontitis .
- Radiographic evidence of single root with single canals.
- Normal occlusal contact with opposing teeth.
- Patients' acceptance to participate in the trial.
Exclusion Criteria:
- Medically compromised patients having significant systemic disorders (ASA III or IV).
- If analgesics or antibiotics have been administrated by the patient during the past 24 hours preoperatively as it might alter their pain perception.
- Pregnant women: to avoid radiation exposure, anaesthesia, medication and hormonal fluctuation that might increase pain prevalence.
- Patients reporting bruxism, clenching, TMJ problems or traumatic occlusion: to avoid further pressure on inflamed tooth which induce subsequent irritation and inflammation.
- Patients with two or more adjacent teeth requiring endodontic treatment.
- Teeth that requires further procedural steps or multidisciplinary approach, which is out of this experiment's scope: i. Association with swelling or fistulous tract. ii. Acute periapical abscess. iii. Mobility Grade II or III. iv. Pocket depth more than 5mm. v. Previous root canal treatment. vi. Non-restorable. vii. Immature root. viii. Radiographic evidence of external or internal root resorption, vertical root fracture, perforation, calcification.
- Inability to perceive the given instructions.
