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N-Acetyl Cysteine Protects Pulpal Stem Cells in Endodontic Revascularization (NAC)

Primary Purpose

Endodontic Disease

Status
Unknown status
Phase
Early Phase 1
Locations
United States
Study Type
Interventional
Intervention
N acetyl cysteine
Sponsored by
University of California, Los Angeles
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Endodontic Disease

Eligibility Criteria

6 Years - 18 Years (Child, Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Inclusion criteria include the following:

    1. Subjects will be self and parent-reported as healthy individuals with no significant medical issues.
    2. Radiographic assessment will determine that root(s) have not grown to completion

    2) Vitality tests (cold testing with Endo ice and Electric pulp testing) will determine the tooth to be necrotic 3) Palpation and percussion tests may or may not be positive 4) Probings will be within 1-5mm 5) Patient will commit to coming to 2-3 treatment appointments lasting 1-3 hours each. Thereafter, patient will commit to come for followup recall appointments 6 and 12 months following last treatment appointment.

    6) Patient must be able to tolerate sitting in a dental chair for 1-3 hours. 7) Patient will be in the age range of 6 to 18 years

Exclusion Criteria:

  • Exclusion criteria include patients who cannot tolerate sitting in a dental chair due to anxiety for 1-2 hours.

Sites / Locations

  • University of California, Los Angeles Dept of Graduate EndodonticsRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

No Intervention

Experimental

Arm Label

Control

NAC Treatment

Arm Description

No intervention will be administered in this group as it serves as a control group.

N-Acetyl Cysteine treatment during root canal revascularization

Outcomes

Primary Outcome Measures

Change of Root length
Change of root length in millimeters over time

Secondary Outcome Measures

Full Information

First Posted
February 23, 2018
Last Updated
October 29, 2019
Sponsor
University of California, Los Angeles
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1. Study Identification

Unique Protocol Identification Number
NCT03451435
Brief Title
N-Acetyl Cysteine Protects Pulpal Stem Cells in Endodontic Revascularization
Acronym
NAC
Official Title
N-Acetyl Cysteine Helps Pulp Stem Cells Differentiate During Endodontic Revascularization
Study Type
Interventional

2. Study Status

Record Verification Date
October 2019
Overall Recruitment Status
Unknown status
Study Start Date
June 15, 2018 (Actual)
Primary Completion Date
June 15, 2020 (Anticipated)
Study Completion Date
June 15, 2020 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of California, Los Angeles

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Pulp re-vascularization/regeneration is a procedure performed to allow pulpal stem cells to survive and/or differentiate to allow immature tooth root structures to grow to full maturity. Currently, the procedure includes disinfection of the necrotic root canal space and induction of bleeding to potentiate pulpal stem cell differentiation to allow root growth on an immature root. A number of studies conducted previously demonstrate that N-acetyl cysteine (NAC) potentiates differentiation of pulpal stem/stromal cells and protects pulpal cells from apoptosis. 14-18 human subjects will be recruited forming two groups where pulp re-vascularization/regeneration procedures will be performed with or without the use of NAC treatment prior to induction of bleeding. Recall follow-up appointments will be done at 6 months and 1 year post treatment with subsequent yearly appointments until full root growth has been achieved.
Detailed Description
We will recruit 14-18 patients under the age of 18 by means of advertising at UCLA. Two groups will be formed, one with NAC treatment during endodontic revascularization and one without. Each patient will have an adult tooth where the following criteria are met: Tooth with necrotic pulp and immature apex(apices) Pulp space is not needed for post/core, final restoration Compliant patient who is willing to come for at least 2-3 treatment appointments and 2-3 follow-up recall appointments. Patients are not allergic to calcium hydroxide intra-canal medicament Appropriate consent forms will be obtained by the patient and the patient's parent or legal guardian. If we recruit 18 patient, 9 patients will be under regenerative endodontic therapy/re-vascularization with NAC and 9 patients without NAC. The following procedures will be applied to the patients. First Appointment: Local anesthesia administration, dental dam isolation and access Copious, gentle irrigation with 20mL NaOCL (sodium hypochlorite) using an irrigation system that minimizes the possibility of extrusion of irrigants into the periapical spaces. The concentration of NaOCL will be low (1.5%, 20mL/canal for 5 minutes). Afterwards, irrigation with 17% EDTA (20mL/canal for 5 minutes) will be done. Irrigating needle position should be about 1mm from root end, to minimize cytotoxicity to stem cells in the apical tissues. Dry canals with paper points Place calcium hydroxide into canal(s) delivered via syringe Seal access with 3-4mm of a temporary restorative material such as CavitTM, IRMTM or glass ionomer. Dismiss patient for 2-4 weeks. Second Appointment: Assess response to initial treatment. If there are signs/symptoms of persistent infection, consider repeating the procedures of the First appointment. Anesthesia with 3% mepivacaine without vasoconstrictor, dental dam isolation Copious gentle irrigation with 20mL of 17% EDTA Take a radiograph to ensure previous calcium hydroxide has been fully removed form the canal system Dry with paper points For study patients only: Irrigate canal system with NAC (20mM NAC, 30mL/canal) gently for 10 minutes and then dry canal(s) with paper points Create bleeding into the canal system by over-instrumenting (endo file, endo explorer). Induce bleeding by rotating a pre-curved (approximately 45 degrees at the apical 1-2mm of file) K-file at 2mm past the apical foramen with the goal of having the entire canal filled with blood to the level of the cemento-enamel junction. Stop the bleeding at a level that allows for 3-4mm of restorative material. Place a resorbable matrix (CollaPlugTM, CollacoteTM, CollatTapeTM) over the blood clot if necessary to achieve a better stop for mineral trioxide aggregate (MTA) or Bioceramic fast set putty (BC). Place white MTA as capping material on top of the resorbable matrix. The access is closed with 3-4mm layer of glass ionomer (Fuji IXTM, GC America, Alsip, IL), composite or alloy over the capping material. For resin modified glass ionomers and composite, 40 seconds of light curer will be done. Follow-up recall appointments: Clinical and Radiographic exam Extra-oral examination: No pain, extra-oral swelling nor extra-oral sinus tract Intra-oral examination: No pain, intra-oral swelling of mucosa nor intra-oral sinus tract Take 1 straight on periapical radiograph and 1 angled periapical radiograph. Resolution of apical radiolucency (often observed within 6-12months). Record any increased width of root walls (this is generally observed before apparent increase in root length and often occurs 12-24 months after treatment) Record any increase in root length (in mm) Test vitality of pulp with Endo-Ice and Electric pulp tester (EPT). Record which goals have been attained (primary, secondary and/or tertiary) The degree of success of RET is measured by the extent to which it is possible to attain primary, secondary and tertiary goals: Primary goal: The elimination of symptoms and the evidence of bony healing Secondary goal: Increased root wall thickness and/or increased root length Tertiary goal: Positive response to vitality testing

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Endodontic Disease

7. Study Design

Primary Purpose
Treatment
Study Phase
Early Phase 1
Interventional Study Model
Parallel Assignment
Masking
ParticipantOutcomes Assessor
Allocation
Randomized
Enrollment
14 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Control
Arm Type
No Intervention
Arm Description
No intervention will be administered in this group as it serves as a control group.
Arm Title
NAC Treatment
Arm Type
Experimental
Arm Description
N-Acetyl Cysteine treatment during root canal revascularization
Intervention Type
Drug
Intervention Name(s)
N acetyl cysteine
Intervention Description
N acetyl cysteine at 20mM will be utilized as the final stage of irrigation prior to induction of bleeding during endodontic revascularization procedure.
Primary Outcome Measure Information:
Title
Change of Root length
Description
Change of root length in millimeters over time
Time Frame
6 months and 1 year

10. Eligibility

Sex
All
Minimum Age & Unit of Time
6 Years
Maximum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Inclusion criteria include the following: Subjects will be self and parent-reported as healthy individuals with no significant medical issues. Radiographic assessment will determine that root(s) have not grown to completion 2) Vitality tests (cold testing with Endo ice and Electric pulp testing) will determine the tooth to be necrotic 3) Palpation and percussion tests may or may not be positive 4) Probings will be within 1-5mm 5) Patient will commit to coming to 2-3 treatment appointments lasting 1-3 hours each. Thereafter, patient will commit to come for followup recall appointments 6 and 12 months following last treatment appointment. 6) Patient must be able to tolerate sitting in a dental chair for 1-3 hours. 7) Patient will be in the age range of 6 to 18 years Exclusion Criteria: Exclusion criteria include patients who cannot tolerate sitting in a dental chair due to anxiety for 1-2 hours.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
David C Han, DDS, MS
Phone
3108254348
Email
dhan@dentistry.ucla.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Anahid Jewett, PhD
Phone
3108256528
Email
ajewett@dentistry.ucla.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
David C Han, DDS, MS
Organizational Affiliation
University of California, Los Angeles
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of California, Los Angeles Dept of Graduate Endodontics
City
Los Angeles
State/Province
California
ZIP/Postal Code
90095
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
David C Han, DDS, MS
Phone
310-825-4348
Email
dhan@dentistry.ucla.edu

12. IPD Sharing Statement

Plan to Share IPD
No

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N-Acetyl Cysteine Protects Pulpal Stem Cells in Endodontic Revascularization

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