Effect of using etidronate in sodium hypochlorite versus sodium hypochlorite irrigating solution on the intensity of postoperative pain and bacterial load reduction in patients with necrotic pulp : a randomized clinical trial / by Laila Zakaria Ismail ; Supervisors Prof. Dr. Randa El Boghdadi , Prof Dr. Shaimaa Ismail Gawdat , Prof. Noha Salah Eldin El Sayed Soliman.

Thesis (Ph.D)-Cairo University, 2022.

Bibliography: pages 152-165.

Aim: The purpose of this study was to compare the effect of using Etidronate in sodium hypochlorite versus sodium hypochlorite irrigating solution on intensity of postoperative pain in patients with necrotic pulp, bacterial load reduction after root canal preparation and periapical (MMP-9) post-instrumentation and pre-obturation.
Methods: Thirty-four patients with necrotic single canalled mandibular premolars were included. After confirming the diagnosis clinically and radiographically, patients were randomly assigned into two equal groups of 17 patients each. The teeth assigned to the intervention group were irrigated using Dual Rinse in 2.5 % NaOCl; while 2.5% NaOCl was used in those assigned to the control group. Standard endodontic treatment was performed in two visits using M-pro rotary files for instrumentation and modified single cone technique with resin sealer for obturation.
Post-instrumentation and post-obturation pain were assessed after 6, 12, 24 hours and48 hours. Heft-parker visual analogue Scale (Heft parker VAS) was used as the primary outcome measure. The secondary outcome was the intracanal bacterial levels assessed pre- and post-instrumentation through microbiological sampling, transport, dispersion, dilution, culture, and counting of CFU/ml. Also, the periapical MMP-9 levels were assessed post-instrumentation and pre-obturation by ELISA. All demographic data and VAS scores were collected from the patients and statistically analyzed.
Results: The results showed that the incidence and intensity of post-instrumentation pain in Dual rinse group was similar to NaOCl group at 12 and 24 hours and the difference was not statistically significant at all time intervals. Both groups showed the highest mean pain score at 12 hours which decreased gradually to reach the lowest value at 48 hours postoperatively. The results also showed that the incidence and intensity post-obturation pain were not significantly different between both groups at all time intervals There was a significant decrease in the intracanal bacterial counts following instrumentation in both groups with no significant difference. The MMP-9 levels in periapical fluid declined significantly in 1 week without significant differences between both groups.
Conclusions: In the present study, there was no increase in the incidence and severity of post-instrumentation or post-obturation pain by the addition of etidronate (Dual Rinse HEDP) to 2.5% NaOCl solution. The antimicrobial efficacy of the NaOCl was maintained, whilst no increase in a marker molecule related to neutrophil activity (MMP-9) with no apparent inflammatory effects to the periapical tissues in the form of postoperative pain. Both irrigating solutions succeeded in reducing bacterial levels in primary infected root canals with no significant difference.

غرض البحث:
غرض من هذه الدراسه السريريه هو تقييم و مقارنه تأثير استخدام ايتدرونات في هيبوكلوريد الصوديم مقابل هيبوكلوريد الصوديم كغسولللقنوات العصبية على الألم المصاحب لما بعد علاج الجذور و الحد من الحمل البكتيري في المرضي الدي يعانون من اللب النخري من خلال تجربة إكلينيكية بالانتقاء العشوائي
طريقة البحث:
اربعة و ثلاثون مريضا تم انضمامهم فى الدراسه لعلاج جذور الضواحك فى الفك السفلى أحاديه القناه ذات اللب الناخر. بعد التأكد من التشخيص اكلينيكيا و بفحص الاشعه, تم تقسيم المرضى المشاركين في البحث عشوائيا إلى مجموعتين متساويتين: فى المجموعة الأولى يتمغسيل القنوات باستخدام ايتدرونات في هيبوكلوريد الصوديم و فى المجموعة الثانية يتم استخدام ٢.٥٪؜ هيبوكلوريد الصوديم. تم علاج الأسنان فى زيارتين . تم تحديد طول قنوات العصب باستخدام جهاز محدد الاطوال الالكترونى و الاشعه الداخل فمويه, ثم تحضيرالقنوات باستخدام الملفات الدوارة ام برو, ثم حشو القنوات من خلال تقنيه الكبس الجانبى باستخدام جاتبركا و رزن سيلر.
تم تقييم الألم باستخدام المقياس البصري التناظري كمقياس النتيجة الاولية بين الجلستين وبعد الجلسة العلاجية الثانية بعد ٦ساعات, ١٢ ساعة, ٢٤ ساعه, و ٤٨ ساعة. تم قياس مستويات البكتيريا داخل القنوات و تقييمها قبل وبعد التحضير وغسل القنوات منخلال أخذ العينات الميكروبيولوجية ، و النقل و التشتت ىالتخفيف والاستنبات ، و عد المستعمرات البكتيريه/ مل. قد تم تقييم مستوي مصفوفة البروتين المعدني بواسطة جهاز اليزا بعد تحضير القنوات و قبل الحشو

Issues also as CD.

Text in English and abstract in Arabic & English.