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Antimicrobial Effect of Modified Antibiotic Nanofibers for Regenerative Endodontics Procedures

Primary Purpose

Necrosis, Pulp

Status
Unknown status
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
electrospun TAP nanofibers
modified TAP paste
Sponsored by
Cairo University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Necrosis, Pulp focused on measuring immature teeth

Eligibility Criteria

7 Years - 25 Years (Child, Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

Maxillary or mandibular single-root tooth with:

  • Non-vital response of pulp tissue.
  • Immature root.
  • Asymptomatic patients.

Exclusion Criteria:

  1. Patients allergic to metronidazole, ciprofloxacin, or clindamycin to avoid allergic reaction in the intervention group.
  2. Patients who received antibiotics in the past 3 months.
  3. Vital cases or previously accessed teeth.
  4. Teeth with unfavorable conditions for rubber-dam application.
  5. Patients with systemic and immune-compromising disease as they have impaired healing

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    Active Comparator

    Arm Label

    electrospun TAP nanofibers

    modified TAP paste

    Arm Description

    Revascularization procedure with Electrospun TAP nanofibers as as an intracanal medicament for immature necrotic teeth

    Revascularization procedure with modified TAP paste as an intracanal medicament for immature necrotic teeth

    Outcomes

    Primary Outcome Measures

    antimicrobial effect
    number of colony forming units of bacteria after using the intracanal medicaments

    Secondary Outcome Measures

    morphology of nanofibers
    surface morphology will be studied under the scanning electron microscope

    Full Information

    First Posted
    September 28, 2018
    Last Updated
    September 28, 2018
    Sponsor
    Cairo University
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    1. Study Identification

    Unique Protocol Identification Number
    NCT03690960
    Brief Title
    Antimicrobial Effect of Modified Antibiotic Nanofibers for Regenerative Endodontics Procedures
    Official Title
    Evaluation of the Antimicrobial Effect of Pre-synthesized Novel Antibiotic Electrospun Nanofibers as an Intracanal Delivery Strategy for Regenerative Endodontics A Randomized Clinical Trial
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    September 2018
    Overall Recruitment Status
    Unknown status
    Study Start Date
    December 2018 (Anticipated)
    Primary Completion Date
    August 2020 (Anticipated)
    Study Completion Date
    October 2020 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    Cairo University

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No
    Product Manufactured in and Exported from the U.S.
    No

    5. Study Description

    Brief Summary
    The treatment for immature teeth with pulp necrosis can be carried out through apexification or regenerative endodontics procedures including platelet rich plasma (PRP), platelet rich fibrin (PRF) and injectable PRF, these techniques used alone or in combination. Revascularization therapy carries on more advantages than apexification, such as inducing root-end development and reinforcement. However, apical repair will not happen in the presence of inflamed and infected tissue.the aim of this study is to evaluate the antimicrobial effect of pre-synthesized novel antibiotic loaded electrospun nanofibers used in patients with immature necrotic teeth.
    Detailed Description
    Title: Evaluation of the Antimicrobial Effect of Pre-synthesized Novel Antibiotic Electrospun Nanofibers as an Intracanal Delivery Strategy for Regenerative Endodontics - A Randomized Clinical Trial Rationale Regenerative endodontics technique outcome depends on microbial elimination because apical repair will not happen in the presence of infected tissues. It is well established that bacteria are essential for the development of pulpal and periapical pathosis. Eradication or control of bacteria may provide optimal treatment outcome. However, elimination of bacteria from infected root canal systems is challenging. Numerous measures have been described to reduce the number of bacteria in the root canal system, including the use of various instrumentation techniques, irrigation regimens and intra-canal medicaments. There is no definitive evidence in the literature that all these measures result in a bacteria-free root canal system. Therefore additional methods such as the use of intra-canal medicaments are required in order to maximize disinfection of root canal system and kill as many bacteria as possible. Antibiotics have been proposed as intracanal medicament but any single antibiotic is unlikely effective to sterilize diverse flora in root canal infection. Recently, triple antibiotic mixture (TAP) has been reported for successful disinfection of infected root dentine. This mixture consist of ciprofloxacin (CIP), metronidazole (MET) and minocycline (MINO) which consistently sterilize bacteria of infected dentine and infected pulps . Specifically, MET is a bactericidal imidazole that is highly effective against obligate anaerobic bacteria, CIP is a bactericidal broad-spectrum synthetic quinolone and MINO is a bacteriostatic broad-spectrum tetracycline. However, as minocycline binds to dentin and causes tooth discoloration, it is recommended to remove minocycline from TAP and use only MET and CIP, or to use modified TAPs containing cefaclor or clindamycin (CLIN). CLIN is a bacteriostatic lincosamide known for its efficacy against a broad spectrum of endodontic bacteria. In recent years, an innovative strategy has been considered to develop a low-concentration, yet antimicrobially effective and biocompatible polymer-based nanofibrous electrospun scaffolds as a drug delivery system to promote intracanal biofilm eradication . Electrospinning has been considered as a highly effective process to obtain extracellular matrix (ECM) mimicking structures with adequate chemistry and three-dimensional porous architectures Moreover, it has enabled the synthesis of bioactive nanofibrous scaffolds The electrospinning technology has attracted great interest in recent decades, thanks to its capability of easily and effectively processing a huge range of polymeric materials in form of nanofibers. In recent years, the health concerns associated with the systemic side effects of synthetic compounds used in medicine and the emergence of antibiotic resistance of pathogens have driven electrospinning research towards the development of antibiotic loaded nanofibers. Hypothesis To test the null hypothesis, which is in patients with necrotic immature teeth, will the use of pre-synthesized clindamycin modified triple antibiotic electrospun nanofibers have more profound antimicrobial effect than modified triple antibiotic paste. Objectives of the present study Primary objective To compare the antimicrobial effect of pre-synthesized novel antibiotic loaded nanofibers used in patients with immature necrotic teeth with modified triple antibiotic paste. Secondary objective To evaluate the morphology of pre-synthesized antibiotic loaded electrospun nanofibers.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Necrosis, Pulp
    Keywords
    immature teeth

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Not Applicable
    Interventional Study Model
    Parallel Assignment
    Masking
    ParticipantOutcomes Assessor
    Allocation
    Randomized
    Enrollment
    30 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    electrospun TAP nanofibers
    Arm Type
    Experimental
    Arm Description
    Revascularization procedure with Electrospun TAP nanofibers as as an intracanal medicament for immature necrotic teeth
    Arm Title
    modified TAP paste
    Arm Type
    Active Comparator
    Arm Description
    Revascularization procedure with modified TAP paste as an intracanal medicament for immature necrotic teeth
    Intervention Type
    Procedure
    Intervention Name(s)
    electrospun TAP nanofibers
    Intervention Description
    electrospun TAP loaded nanofibers containing modified triple antibiotic paste of clindamycin , ciprofloxacin and metronidazole by electrospinning process will be placed in the root canals. The access cavity will be sealed with temporary filling material
    Intervention Type
    Procedure
    Intervention Name(s)
    modified TAP paste
    Intervention Description
    modified TAP paste will be prepared by mixing equal proportions of CIP, MET and CLIN then placed inside the root canal, access cavity will be sealed with temporary filling
    Primary Outcome Measure Information:
    Title
    antimicrobial effect
    Description
    number of colony forming units of bacteria after using the intracanal medicaments
    Time Frame
    2-3 weeks
    Secondary Outcome Measure Information:
    Title
    morphology of nanofibers
    Description
    surface morphology will be studied under the scanning electron microscope
    Time Frame
    1 week

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    7 Years
    Maximum Age & Unit of Time
    25 Years
    Accepts Healthy Volunteers
    Accepts Healthy Volunteers
    Eligibility Criteria
    Inclusion Criteria: Maxillary or mandibular single-root tooth with: Non-vital response of pulp tissue. Immature root. Asymptomatic patients. Exclusion Criteria: Patients allergic to metronidazole, ciprofloxacin, or clindamycin to avoid allergic reaction in the intervention group. Patients who received antibiotics in the past 3 months. Vital cases or previously accessed teeth. Teeth with unfavorable conditions for rubber-dam application. Patients with systemic and immune-compromising disease as they have impaired healing

    12. IPD Sharing Statement

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    Antimicrobial Effect of Modified Antibiotic Nanofibers for Regenerative Endodontics Procedures

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