{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T15:50:39Z","timestamp":1788277839233,"version":"build-2803163510"},"reference-count":44,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Endodontic J"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>\n                      To assess whether there was an additive antimicrobial effect between calcium hydroxide (Ca(OH)\n                      <jats:sub>2<\/jats:sub>\n                      ) and sodium hypochlorite (NaOCl) in an inter\u2010visit root canal dressing.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methodology<\/jats:title>\n                    <jats:p>\n                      Patients presenting with a single\u2010rooted tooth with pulpal necrosis and asymptomatic apical periodontitis were included in this randomised controlled single\u2010center clinical superiority trial with two parallel arms. Teeth were instrumented using a rotary file system and irrigated with 3% NaOCl. Subsequently, the root canals were dressed with a Ca(OH)\n                      <jats:sub>2<\/jats:sub>\n                      slurry that was prepared from pure Ca(OH)\n                      <jats:sub>2<\/jats:sub>\n                      powder mixed with either 3% NaOCl (test group) or physiological saline solution (control group). Microbial samples were obtained after accessing the root canal, after chemo\u2010mechanical preparation, and after the root canal dressing with the test or control slurries. A periapical fluid sample was collected after the root canal dressing removal. Samples were transferred to the microbiology lab immediately and assessed for anaerobic growth. The levels of MMP\u20109 were measured using a specific enzyme\u2010linked immunosorbent assay. Negative to positive growth ratios were compared between groups using Fisher's exact test. Colony\u2010forming units (CFUs) between and within groups and MMP\u20109\/total protein were compared using non\u2010parametric tests,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      From the 110 patients recruited for this study, 48 were available for all three sampling procedures in the test (NaOCl) and 50 in the control (saline) group. All canals showed anaerobic growth initially. Chemo\u2010mechanical instrumentation significantly reduced CFU counts (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), yet all canals remained growth\u2010positive. After dressing with Ca(OH)\n                      <jats:sub>2<\/jats:sub>\n                      \/NaOCl, 19 of the 48 (40%) root canals were free of growth, compared to 3 of 50 (6%) in the Ca(OH)\n                      <jats:sub>2<\/jats:sub>\n                      \/saline group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). MMP\u20109\/TP levels in the periapical fluid were similar when root canals were dressed with Ca(OH)\n                      <jats:sub>2<\/jats:sub>\n                      slurries mixed with NaOCl or saline (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Placing a combined NaOCl\/Ca(OH)\n                      <jats:sub>2<\/jats:sub>\n                      dressing significantly reduced the microbial load in the root canals of teeth with primary apical periodontitis compared to a conventional slurry prepared with saline solution, without causing any apparent inflammatory response in the periapical tissues.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>Trial Registeration:<\/jats:bold>\n                      CTRI\/2020\/10\/028484 (Clinical Trials Registry India)\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/iej.70078","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T10:37:21Z","timestamp":1764585441000},"page":"469-476","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Randomised Controlled Trial on the Additive Effect Between Calcium Hydroxide and Sodium Hypochlorite in an Inter\u2010Visit Root Canal Dressing"],"prefix":"10.1111","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2208-9443","authenticated-orcid":false,"given":"Nidambur V.","family":"Ballal","sequence":"first","affiliation":[{"name":"Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal Manipal Academy of Higher Education  Manipal Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7454-6300","authenticated-orcid":false,"given":"Namith","family":"Rai","sequence":"additional","affiliation":[{"name":"Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal Manipal Academy of Higher Education  Manipal Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6781-5579","authenticated-orcid":false,"given":"Padmaja A.","family":"Shenoy","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Kasturba Medical College, Manipal Manipal Academy of Higher Education  Manipal Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0910-659X","authenticated-orcid":false,"given":"Vibha","family":"Acharya","sequence":"additional","affiliation":[{"name":"Department of Forensic Medicine and Toxicology, Kasturba Medical College, Manipal Manipal Academy of Higher Education  Manipal Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9457-9492","authenticated-orcid":false,"given":"Vinutha R.","family":"Bhat","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Kasturba Medical College Manipal, Manipal Academy of Higher Education  Manipal Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9545-7828","authenticated-orcid":false,"given":"Matthias","family":"Zehnder","sequence":"additional","affiliation":[{"name":"University of Zurich Clinic of Conservative and Preventive Dentistry  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,1]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joen.2024.09.002"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joen.2009.09.035"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/iej.13129"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0099-2399(87)80153-X"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0099-2399(96)80077-X"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004770-200112000-00013"},{"key":"e_1_2_10_8_1","volume-title":"Tietz Textbook of Clinical Chemistry","author":"Burtis C. 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