Endotoxin Levels after Calcium Hydroxide Placement in Root Canals Irrigated with Continuous or Sequential Chelation in Previously Treated Teeth with Symptomatic Apical Periodontitis: A Randomized Controlled Clinical Trial
Bibliographic record
Abstract
Introduction Endotoxins are pro-inflammatory components of Gram-negative bacteria. The aim of this randomized clinical trial was to test the null hypotheses that (i) there is no significant difference between continuous chelation irrigation (5.25% sodium hypochlorite + 9% etidronic acid) and sequential chelation (5.25% sodium hypochlorite - 17% Ethylene diaminetetraacetic acid) in endotoxin reduction, and (ii) placement of calcium hydroxide (CH) does not further improve endotoxin reduction in previously treated teeth with symptomatic apical periodontitis. Methods Previously treated teeth with symptomatic apical periodontitis ( n = 48) were randomly allocated to ( n = 24) Group 1, Sequential chelation (SC) or Group 2, Continuous chelation (CC). Root canal sampling was performed with sterile paper points at three time intervals: immediately after gutta-percha removal (T 0 ), following chemomechanical preparation (T 1 ), and following 7 days of CH placement (T 2 ). A turbidimetric kinetic LAL assay was used for endotoxin quantification. Repeated measures ANOVA was used to compare SC and CC at different time points and between different time points for each protocol. P < .05 was considered to be statistically significant. Results Both SC and CC showed significant endotoxin reduction from T 0 to T 1 ( P < .05), while only SC group exhibited further significant reduction from T 1 to T 2 ( P < .05). CC group demonstrated significantly lower endotoxin levels than the SC group at T 1 ( P < .01) and T 2 ( P < .001). Conclusion This study shows for the first time that continuous chelation irrigation resulted in significantly lower quantity of endotoxins than sequential chelation followed by calcium hydroxide.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.003 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".