Comparison of Root Canal Desinfection Protocols

This study aims to evaluate and compare the disinfecting efficacy of two supplementary antimicrobial protocols in teeth with apical periodontitis: Er,Cr:YSGG laser activated irrigation and ultrasonic activation using a piezoelectric ultrasonic device (Dentsply International Inc., York, PA, USA) and Irrisafe tip (Satelec/Acteon, Merignac, France), comparing the detection of bacteria before and after instrumentation.

Secondary aims are to assess presence of bacteria before and after chemomechanical preparation using two microbiological methods:

• ATP level analysis using the Endocator device
• Quantitative PCR (qPCR) for total bacterial quantification.

Inclusion criteria

• Adult patients able to give informed consent and willing/able to comply with study procedures and follow-up.
• Molar teeth indicated for endodontic treatment.
• Teeth with intact pulp-chamber walls (no extensive coronal destruction).
• Necrotic pulp confirmed by pulp testing.
• Clinical and radiographic evidence of asymptomatic apical periodontitis.

Exclusion criteria

• Immature teeth
• Teeth with calcified or obliterated canals
• Teeth with extensive coronal destruction
• Teeth with previous endodontic treatment
• Symptomatic apical periodontitis
• Teeth with periodontal pockets greater than 4 mm
• Patients who have received systemic antibiotics in the last 3 months
• Patients with a history of diabetes or immune impairment
• Pregnant patients