Comparative Evaluation of three differ-ent intracanal medicaments for antimi-crobial efficacy in single rooted teeth with Pulp Necrosis and Asymptomatic Apical periodontitis–A Randomized double-blinded Clinical Study

Dental caries, a progressive disease of the dental hard tissue, if left untreated in its initial stages, may lead to pulpal, periapical, and/or intraradicular infections. Reduction or elimination of the bacterial infection seems to be one of the important factors for the success of endodontic treatment of teeth with necrotic pulp . However, several studies have reported that chemomechanical instrumentation alone is unable to eliminate all root canal bacteria. The remaining viable bacteria left in the root canal may multiply between appointments or following obturation often reaching a pathogenic level and leading to failure. Hence, a suitable intracanal medicament is required to disinfect the root canal system prior to obturation so as to promote healing and prevent recurrence. Calcium hydroxide is the most commonly used intracanal medicament during root canal therapy. Studies using agar diffusion method have reported that Calcium Hydroxide associated with an inert substance (distilled water, saline solution or glycerine) was ineffective in inhibiting the growth of several obligate and facultative anerobic bacteria8. To overcome this drawback a combination of different antibiotics has been studied to increase the scope of antibacterial coverage. DAP is an intracanal medicament that is a combination of metronidazole and ciprofloxacin. But calcium hydroxide and double antibiotic paste (DAP) can have deleterious effects on root dentin. Angelus Bio-C Temp is a ready-to-use bioceramic tricalcium silicate paste for intracanal dressing. Bio-C Temp (Angelus, Paraná, Brazil) is the first calcium-silicate based medicament for use between sessions. Bio-C Temp contains calcium silicates associated with calcium tungstate and titanium oxide radiopacifiers, besides calcium aluminate, calcium oxide and base resin. Bio-C Temp is a highly alkaline material that has microsized particles (<2 μm), which improve flow, penetration into dentinal tubules, and material reactivity, favoring the release of Ca2+ and OH– ions, and bactericidal action due to high pH (12.5). Despite thorough search in various databases like PubMed, Medline and EBSCO host conducted till March 2024 suggested no availability of studies evaluating the effect of Angelus Bio-C Temp on antimicrobial efficacy in vivo; this clinical study is therefore designed to compare and evaluate the antimicrobial efficacy of the same with that of Calcium Hydroxide and Double antibiotic paste in patients with pulp necrosis and asymptomatic apical periodontitis.