Therapeutic Irrigant Procedures for Treating Apical Periodontitis (TIPTAP): A triple-blinded parallel-group...

Area of Science:

• Endodontics
• Regenerative Medicine
• Biomaterials Science

Background:

• Solubilized endogenous dentine extracellular matrix components (dECMs) are crucial for pulp regeneration.
• dECMs may enhance healing in diseased periradicular tissues by stimulating mesenchymal stem cell activity.
• Investigating novel irrigation strategies for periradicular healing is essential.

Purpose of the Study:

• To compare endodontic treatment outcomes between 17% ethylenediaminetetraacetic acid (EDTA) and 5.25% sodium hypochlorite (NaOCl) irrigation regimes.
• To evaluate the effects of these irrigants on pain scores, inflammatory mediators in periradicular tissue fluid (PTF), and lesion size.
• To determine if EDTA-enhanced dECM release is equivalent to conventional NaOCl irrigation in asymptomatic apical periodontitis.

Main Methods:

• Forty single-rooted teeth with asymptomatic apical periodontitis were randomized to receive either 17% EDTA or 5.25% NaOCl irrigation.
• Pain scores, PTF inflammatory analytes (O-link Target-48 cytokine array), and lesion size (cone beam computed tomography) were assessed.
• Clinical and radiographic outcomes were evaluated at one year; participants, operators, and assessors were blinded.

Main Results:

• One-year favourable outcomes were high in both groups (NaOCl: 89.5%, EDTA: 94.1%), with no statistically significant difference (p > 0.05).
• Median lesion volume reduction was significant in both groups, with EDTA showing slightly greater reduction (95.84%) vs. NaOCl (92.5%).
• Fifteen inflammatory analytes decreased pre-obturation; IL-6 and IL-18 were significantly higher in the EDTA group pre-obturation (p < 0.05).

Conclusions:

• Therapeutic irrigation promoting dECM solubilization with 17% EDTA yielded one-year treatment outcomes equivalent to conventional NaOCl protocols.
• No serious adverse effects were reported, suggesting EDTA is a safe alternative for endodontic irrigation.
• The findings support the potential of dECM-based regenerative strategies in endodontic therapy.