Clinical Research Directory

Cost-Effectiveness of Upfront Supplemental Anaesthesia in Symptomatic Irreversible Pulpitis

The goal of this clinical trial is to learn whether giving extra (supplemental) local anaesthetic injections at the start of treatment, rather than only after the standard injection fails, makes numbing of painful lower molar teeth more successful and lowers the overall cost of care in adults with symptomatic irreversible pulpitis (a severe toothache caused by an inflamed nerve) attending a public-sector dental hospital in India. The main questions it aims to answer are: * Does adding an articaine buccal infiltration, alone or together with an intraligamentary injection, to the standard inferior alveolar nerve block (IANB) increase the number of patients who can have their root canal treatment started without pain and without rescue injections? * What is the extra cost per additional successful anaesthesia of each upfront strategy compared with IANB followed by rescue injections only when needed? Researchers will compare three groups: IANB with rescue injections only if needed (control), IANB plus upfront articaine buccal infiltration, and IANB plus upfront articaine buccal infiltration and intraligamentary injection. Participants will: * Receive a standard IANB, followed (depending on their group) by one or two additional injections before treatment starts * Rate their pain during access and cleaning of the tooth on a visual analogue scale; rescue injections will be given if pain is moderate or severe * Have the time taken and the injections used recorded by an independent observer * Answer a short questionnaire about travel, time and earnings lost for each visit * Receive a phone call 24 hours later about pain and any side effects

Effect of Temperature Elevation on the Antimicrobial Efficacy of Two Root Canal Irrigants in Primary Root Canal Infections: A Randomized Controlled Clinical Trial

evaluate the antimicrobial efficacy of preheated sodium hypochlorite and dexamethasone sodium phosphate and at room temperature in patients with primary root canal infection.

Effect of Different Methods of Cryotherapy Applications on Postoperative Pain and Substance P Level in Patients With Acute Irreversible Pulpitis With Apical Periodontitis: A Randomized Controlled Trial

This randomized controlled clinical trial evaluates the effect of different methods of cryotherapy (extra-oral, intra-canal, and combination) on postoperative pain and periapical Substance P levels in patients with acute irreversible pulpitis and symptomatic apical periodontitis. Forty participants will be divided into four groups to compare the therapeutic benefits of cold applications in endodontic treatment

Child's Behavior Using Single Rotary File System Versus Manual Instrumentation in Pulpectomy of Primary Molars

The primary aim is to compare the behavior of the children during using conventional manual instrumentation versus rotary instrumentation by single rotary system for pulpectomy in primary molars through a Randomized Clinical Trial. The main question it aims to answer is: Is there a difference in the behavior of the children when using single rotary file system versus manual instrumentation in pulpectomy in primary molars?

The Effect of Bitewing Radiography on Outcomes and Costs of Treating Caries in Permanent Teeth

Dentists commonly use bitewing radiographs (dental X-rays) together with a visual-tactile (clinical) examination to detect cavities between the back teeth. While bitewing radiography can identify some lesions that are not visible during a visual-tactile examination, it is unclear whether its use improves outcomes that are important to patients. Radiographs may lead to the detection and treatment of lesions that would not otherwise cause problems, resulting in additional costs and dental procedures. Despite the widespread use of bitewing radiography in adult dental care, its effects on treatment decisions, patient outcomes, and cost-effectiveness have not been evaluated in randomized controlled trials among adults. Therefore, the investigators aim to conduct a randomized controlled trial to compare two strategies for caries diagnosis in young adults: visual-tactile examination alone and visual-tactile examination supplemented with bitewing radiography. Participants will undergo a standardized oral examination and will be randomly assigned to one of the two diagnostic strategies. Treatment recommendations will be based on the findings obtained using the allocated diagnostic approach and will follow predefined treatment criteria. The investigators will compare the effects of these diagnostic strategies on patient-important outcomes, treatment decisions, resource use, examination time, and cost-effectiveness. The results of this study will provide evidence on whether including bitewing radiography in routine caries diagnostics offers benefits that justify its additional costs and radiation exposure in young adults.

Articaine Versus Lidocaine for Supplemental Buccal Infiltration in Lower First Molars With Irreversible Pulpitis

Local anesthetic is used to numb a tooth before a root canal treatment. In lower back teeth with irreversible pulpitis (a painful, inflamed tooth nerve), the standard numbing injection near the jaw nerve, called an inferior alveolar nerve block, often does not numb the tooth enough. When this happens, patients may feel pain during treatment, and dentists often give an extra injection beside the tooth. This study compares two numbing medicines used for that extra injection: 4% articaine and 2% lidocaine, both with epinephrine. Articaine is a newer medicine that may pass through bone more easily, but it is not clear whether it works better than lidocaine in this situation. Adults aged 18 to 50 with a painful lower first molar needing a root canal first receive the standard nerve block with lidocaine. Patients who still feel pain when the dentist begins opening the tooth then receive an extra injection beside the tooth, with either articaine or lidocaine. Which medicine is given is decided by chance, and neither the patient nor the dentist knows which one it is.

Success of Pulpotomy in Molars With Pulpitis With Periodontitis Detected Using AI and Those Without Periodontitis

Statement of problem: Although performing full pulpotomy in mature permanent molars with irreversible pulpitis showed success rates comparable to RCT, there is a growing need for further studies in order to determine the predictability of pulpotomy in teeth with apical periodontitis. Aim of the study: The aim of this study is to compare the success rates in cases of moderate pulpitis without apical periodontitis in comparison to cases of severe pulpitis with AI-Detected apical periodontitis. Additionally, the study aims to evaluate the accuracy of a novel AI technology in identifying apical periodontitis from radiographs, comparing its findings to the operator\'s radiographical and clinical observations. Subjects and methods: Patients with mature permanent molars diagnosed with irreversible pulpitis will be selected. The teeth will be divided according to the presence or absence of apical periodontitis into 2 groups. The first group being moderate pulpitis without apical periodontitis to be treated with full pulpotomy and the second group being severe pulpitis with apical periodontitis to be treated with full pulpotomy. Finally, a third control group of teeth with irreversible pulpitis to be treated with conventional root canal treatment will be added. An artificial intelligence software will process the preoperative radiographs to detect the presence of apical periodontitis, and its accuracy will be compared to the blinded operator using clinical and radiographic methods. The patients will be randomly allocated to receive either full pulpotomy or conventional root canal treatment. Full pulpotomy using MTA will be performed for groups 1 and 2, and a final restoration will be placed. While group 3 will receive conventional root canal treatment and a final restoration. Cases will be followed up after 1, 3, and 6 months respectively to assess the clinical and radiographic success.

Pain Assessment Governing Partial or Full Pulpotomy of Immature Molars With Irreversible Pulpitis in Molar Incisor Hypomineralization

This randomized controlled clinical trial aims to evaluate and compare pain levels associated with partial pulpotomy (PP) and full pulpotomy (FP) in immature permanent first molars diagnosed with irreversible pulpitis. The study specifically investigates differences between molars affected by molar incisor hypomineralization (MIH) and those without MIH. A total of 132 children aged 6-8 years will be randomly allocated into four groups based on MIH status and type of pulpotomy. All participants will receive pre-emptive ibuprofen prior to treatment. Pain will be assessed preoperatively, intraoperatively, and postoperatively using validated scales. The study aims to evaluate pre-, intra-, and postoperative pain levels after partial pulpotomy (PP) and full pulpotomy (FP) in MIH-affected immature permanent first molars (PFMs) with irreversible pulpitis.

Outcome of Complete Pulpotomy in Healthy and Type 2 Diabetic Patients in Permanent Teeth With Irreversible Pulpitis

Endodontic research on the effects of DM on pulp tissues is scarce. Diabetic human and animal histological research demonstrated a decreased reparatory response in the pulp, resulting in chronic pulp inflammation and reduced dentin bridge formation. To date, there is no human clinical trial examining the impact of diabetes mellitus on teeth with irreversible pulpitis. As a result of the paucity of data in the literature, there is a clinical dilemma whether to recommend vital pulp therapy techniques or root canal treatment in diabetic patients with irreversible pulpitis. To the best of our knowledge, no prospective study has evaluated the outcome of complete pulpotomy in T2DM patients and healthy controls with irreversible pulpitis. The aim of this preliminary study is to compare and evaluate the success rates of pulpotomy in healthy and type 2 diabetes mellitus patients in mature permanent teeth presenting with clinical symptoms of irreversible pulpitis.

CLINICAL AND RADIOGRAPHIC SUCCESS OF MODIFIED LSTR TECHNIQUES IN PRIMARY SECOND MOLARS

This study aimed to evaluate and compare the clinical and radiographic success of different antibiotic and vehicle modifications of the Lesion Sterilization and Tissue Repair (LSTR) technique in infected mandibular primary second molars. The study included systemically healthy children aged 4-11 years. Participants were assigned to four treatment groups according to the antibiotic combination (3Mix or 2Mix) and vehicle used \[Macrogol-Propylene Glycol (MP) or normal saline (NS)\]: 3Mix-MP, 3Mix-NS, 2Mix-MP, and 2Mix-NS. Clinical outcomes were evaluated at 3, 6, and 12 months after treatment, and radiographic outcomes were evaluated at 6 and 12 months. The clinical and radiographic success of the four LSTR modifications was compared over the 12-month follow-up period.

The Effect of Intra-pulpal Anesthesia With Cryotherapy on Intra-operative Pain

The goal of this clinical trial is to compare the effect of cooling of local anesthesia on intraoperative pain during root canal treatment in mandibular molars diagnosed as symptomatic irreversible pulpitis. The main question it aims to answer is: Is there a difference in intra-operative pain levels using intra-pulpal anesthesia with and without cryotherapy during root canal treatment? Participants will undergo root canal treatment using intrapulpal anesthesia with and without cooling. Researchers will compare cold and room temperature intrapulpal anesthesia to see the intensity of intraoperative pain.

The Effect of Totalfil and Neosealer Sealers on the Post-endodontic Pain

The goal of this clinical trial is to evaluate the effect of Totalfil and Neosealer sealers on post-endodontic pain compared to AH plus sealer in mandibular molars with symptomatic irreversible pulpitis. The main question: do Totalfil and Neosealer sealers affect postoperative pain intensity after root canal treatment in mandibular molars with symptomatic irreversible pulpitis? Participants will undergo root canal treatment using totalfil, Neosealer, or AH-Plus sealer. Researchers will compare Totalfil, Neosealer, and AH-Plus to assess the intensity of post-endodontic pain.

Impact of Cross-Sectional Design in Single-File Rotary System on Apical Debris Extrusion

Endodontic treatment aims to achieve optimal biological outcomes while minimizing patient's discomfort during and after the procedure. Postoperative pain remains a common complication and is considered a multifactorial phenomenon influenced by several factors, including preoperative pain, age, gender, systemic health, presence of apical periodontitis, instrumentation technique, type and design of endodontic instruments, and the use of intracanal medications.

Clinical and Radiographic Outcomes of Pulpotomy Versus Pulpectomy in Primary Molars With Symptomatic Irreversible Pulpitis

The goal of this clinical trial is to learn if MTA pulpotomy compared to pulpectomy have the same clinical and radiographic success in treatment of primary molars diagnosed with symptomatic irreversible pulpitis. The main questions it aims to answer are: Does MTA pulpotomy compared to pulpectomy have the same clinical and radiographic success in treatment of primary molars diagnosed with symptomatic irreversible pulpitis?

Epigallocatechin Gallate (EGCG) as a Flushing Agent During Full Pulpotomy in Mature Permanent Molars With Irreversible Pulpitis

This study evaluates the effect of two flushing agents (epigallocatechin gallate (EGCG) and sodium hypochlorite (NaOCl)) during full pulpotomy using two different calcium silicate-based materials (MTA and premixed bioceramic putty) on postoperative pain, success rate and dentin bridge formation in mature permanent mandibular molars with irreversible pulpitis. Participants will be divided into four groups based on the flushing fluid and the pulp capping material to be used.

Treatment Outcomes of Pulpotomy vs. Pulpectomy in Vital Primary Molars With Symptomatic Irreversible Pulpitis

This randomised controlled trial aims to compare treatment outcomes between pulpotomy and pulpectomy when used to treat vital primary molars diagnosed with symptomatic irreversible pulpitis. Compared to the standard pulpectomy treatment, pulpotomy is a technically simpler procedure, less time consuming, easier for young patients to tolerate, while retaining the proprioceptive sensation of the tooth - all important advantages when treating young children.

Treatment Outcomes of Pulpotomy Versus Pulpectomy in Vital Primary Molars Diagnosed With Irreversible Pulpitis

This randomised controlled trial aims to compare treatment outcomes between pulpotomy and pulpectomy when used to treat vital primary molars diagnosed with symptomatic irreversible pulpitis. Compared to the standard pulpectomy treatment, pulpotomy is a technically simpler procedure, less time consuming, easier for young patients to tolerate, while retaining the proprioceptive sensation of the tooth - all important advantages when treating young children.

Pulpotomy in Vital Primary Molars Diagnosed With Symptomatic Irreversible Pulpitis

This is a clinical trial to assess the treatment outcomes of pulpotomy in vital primary molars diagnosed with symptomatic irreversible pulpitis. Pulpotomy is a more conservative treatment option over the conventional pulpectomy treatment. Compared to pulpectomy, pulpotomy is a technically simpler procedure, less time consuming, easier for young patients to tolerate, and retains the proprioceptive sensation of the tooth - all important advantages when treating young children.

Clinical and Radiographic Evaluation of Propolis as a Hemostatic Agent in Full Pulpotomy of Mature Permanent Molars With Irreversible Pulpitis

The goal of this randomized clinical trial is to assess the effectiveness of propolis as a hemostatic agent in full pulpotomy for mature permanent molars with irreversible pulpitis, compared to sodium hypochlorite (NaOCl). The study also compares how bioceramic putty performs compared to mineral trioxide aggregate (MTA) as pulpotomy dressing materials. Participants will be randomly allocated into four groups (15 patients each) according to the hemostatic agent and dressing material used: * Propolis + bioceramic putty * Propolis + MTA * Sodium hypochlorite + bioceramic putty * Sodium hypochlorite + MTA Bleeding time and postoperative pain will be recorded. Clinical and radiographic success will be evaluated at 1, 3, and 6 months following treatment.

Efficacy of Different Drugs to Control Post Root Canal Treatment Pain

Root canal therapy will ideally eliminate post-endodontic pain but occasionally analgesics are needed to diminish the pain \[Owatz et al 2007\]. Development of pain after completion of root canal treatment may undermine patients' confidence in the procedure and the clinician \[Albashaireh and Alnegrish 1998\]. Non-steroidal anti-inflammatory drugs are one of the most frequently taken analgesic medications for dental pain. Their popularity attributed to their efficacy in relieving pain and fever and low side effect profile at therapeutic doses \[Attar et al 2008\]. Mono-therapy analgesic has a low effect on dental pain. Improvement was performance by combining analgesics with different mechanisms of action without raising any adverse effects \[Mehlisch 2002\], was effective in controlling moderate to severe pain. The combination of a non-steroidal anti-inflammatory drug (NSAID) and paracetamol has shown additive analgesia for treating dental pain in several studies \[Breivik et al1999, Keiser and Hargreaves 2002\]. Endodontic treatment with a lower prevalence of postoperative pain is usually the treatment of choice.There have been no controlled dental studies evaluating the additive effects of combining a non-steroidal anti-inflammatory drug with paracetamol. Breivik et al1999 \& Menhinick et al 2004 found that a combination of acetaminophen and ibuprofen was more effective than ibuprofen alone in managing postoperative pain \[Breivik et al1999 \& Menhinick et al 2004\]. Aim of the present study, to evaluate the efficacy of the paracetamol when used alone and in combinations with three groups of drugs to control postoperative endodontic pain.

Biomarkers for Differentiating Reversible and Irreversible Pulpitis

This observational study aims to evaluate the role of inflammatory, oxidative stress, neurogenic, and immunological biomarkers obtained from pulpal blood in the differential diagnosis of normal pulp, reversible pulpitis, and irreversible pulpitis. A total of 75 teeth from systemically healthy individuals aged 12-35 years will be included and classified into three groups: normal pulp, reversible pulpitis, and irreversible pulpitis, based on clinical examination, radiographic findings, and pulp sensibility tests. No additional treatment procedures will be performed for research purposes. All dental procedures will be carried out according to routine clinical protocols. During routine treatment, after pulp exposure, approximately 50 μL of pulpal blood that would otherwise be discarded as medical waste will be collected using a micropipette. Samples will be stored and analyzed using Enzyme-Linked ImmunoSorbent Assay (ELISA) to determine the levels of inflammatory, neurogenic, immunological, and oxidative stress biomarkers. The results will be compared among the three groups to identify biomarkers that may improve the accuracy of pulpitis diagnosis and support clinical decision-making.

Comparative Evaluation of NeoPUTTY and MTA Pulpotomy in Mature Permanent Molars With Irreversible Pulpitis

When a permanent back tooth develops severe nerve inflammation that cannot heal on its own, a procedure called pulpotomy can be performed to remove the diseased nerve tissue from the crown of the tooth while preserving the healthy roots. This helps save the tooth and avoid extraction. Two materials are commonly used to cover the remaining nerve tissue after pulpotomy: Mineral Trioxide Aggregate (MTA), which is considered the gold standard, and NeoPUTTY, a newer premixed calcium silicate material that is easier to use and requires no mixing. This study was conducted to compare the success of NeoPUTTY and MTA when used for full pulpotomy in mature permanent back teeth of children aged 9 to 14 years who had severe toothache due to irreversible nerve inflammation. Forty-six children were enrolled and randomly assigned to receive either NeoPUTTY or MTA after complete removal of the nerve tissue from the crown of the tooth. All teeth were restored with a definitive filling in the same visit. Children were followed up at 1, 3, 6, and 12 months to assess clinical success, and radiographic assessment was performed at 6 and 12 months. Pain after the procedure was recorded at 24 hours and the time taken to stop bleeding during the procedure was also recorded. The study aimed to determine whether NeoPUTTY offers comparable results to MTA as a pulpotomy material in permanent teeth of children, which could help guide clinical decision-making in pediatric dental practice.

Endodontic Success of Coronally Sealed Non-obturated Canals, Regeneration-based Canals

Statement of problem: Limitations and drawbacks associated with root canal obturation have the potential to impair periapical healing especially in the absence or delay of a proper coronal seal. Aim of the study: Evaluate the endodontic treatment success in terms of resolution of signs and symptoms and periapical status using conventional periapical radiographs following two different treatment modalities, Coronally Sealed Non-obturated Canals, Regeneration-based Non-obturated Canals and comparing them to a control group of gutta percha obturated canals. Materials and methods: Forty-eight Patients with mature, double canal, vital upper first premolars with irreversible pulpitis. In a single visit, the tooth is to be anesthetized, isolated and an access cavity is to be performed. Mechanical preparation of root canals is to be performed using the standardized technique reaching apical canal preparation to size #35 with taper of 4%. The patients will then be divided into three groups (n=16). Group One (Control group) will be conventionally obturated with gutta percha and resin sealer, and coronally sealed with glass ionomer and composite restoration. Group Two will be left unobturated and will receive a seal of MTA 2-3 mm below the CEJ then coronal restoration of glass ionomer and composite restoration. In Group Three, an induction of bleeding will be performed by apical violation and the tooth will receive a seal of MTA 2-3 mm below the CEJ then coronal seal of glass ionomer and composite restoration.

Comparison of Endodontic Postoperative Pain Using Different Irrigation Systems

Summary: After a root canal procedure, it is common to experience postoperative pain. Cleaning the root canal thoroughly is crucial for pain relief, but removing all debris with standard methods is difficult. Irrigation, using either traditional endodontic needles or newer methods like endodontic activation, helps clean the canal. This study aims to compare pain levels after using conventional needles versus an Endo1 Ultrasonic Endo Activate Device for irrigation. Patients will undergo standard root canal preparation and then be randomly assigned to one of two groups for final irrigation: the Endo1 device (EA) and the conventional endodontic needles (EN). The study will provide insights into which method is more effective in reducing postoperative pain.