Effect of tricalcium silicate-based intracanal dressing on bone resorption and inflammatory mediators in periapical lesions: a randomized controlled clinical trial.

This study aimed to investigate the effect of tricalcium silicate- and calcium hydroxide-based intracanal dressing on the release of nuclear factor kappa B ligand (RANKL), osteoprotegerin (OPG), tumor necrosis factor-alpha (TNF-α), prostaglandin-E2 (PGE-2), and transforming growth factor-beta (TGF-β) in asymptomatic periapical lesions. The 60 patients included in the study were randomly divided into two groups according to the intracanal dressing. After removing gutta-percha from the root canals, RANKL, OPG, TNF-α, PGE-2, and TGF-β samples were obtained from the apical tissues using three paper cones and the selected dressing material was placed into the canals. In the second appointment, the dressing was removed, and the second samples were taken using the same method. Pre-treatment and post-treatment RANKL, OPG, TNF-α, PGE-2, and TGF-β levels were determined using an enzyme-linked immunosorbent assay test. Data were analysed using t-test, the Mann-Whitney U test, the Wilcoxon test, The Fisher-Freeman-Halton test, and Path analysis. No significant difference was found between the groups in terms of demographic variables (age, gender, tooth region, and smoking) (p > 0.05). There was a statistically significant decrease in RANKL/OPG, TNF-α, PGE-2, and TGF-β levels before and after treatment in both groups (p < 0.05). A significant difference was observed in the percentage change of RANKL/OPG, TNF-α, and TGF-β ratios between the groups (p < 0.05). A statistically higher decrease in RANKL/OPG, TNF-α, and TGF-β levels was observed in the calcium hydroxide-based intracanal dressing group (p < 0.05). No significant difference was observed between the groups in terms of PGE-2 percentage change (p > 0.05). Tricalcium silicate-based intracanal dressing effectively reduced RANKL/OPG, TNF-α, PGE-2, and TGF-β levels in periapical lesions, but calcium hydroxide-based intracanal dressing resulted in a higher percentage reduction in RANKL/OPG, TNF-α, and TGF-β levels. The effects of both medicaments on PGE-2 levels were similar.Trial registration The study was registered in clinical trials database on 12 March 2024 ( https://www.clinicaltrials.gov ). Registration number: NCT06307678.