In primary root canal therapy, implementing a facile and enhanced infection control protocol led to reduced detectable bacterial DNA prior to canal filling and considerably greater successful outcomes at one year.

This study was performed for investigating the impact of an improved infection control protocol on outcomes of root canal therapy and on the microbial load within the root canals following chemomechanical preparation.

Overall, 144 molar teeth from 139 healthy people receiving primary root canal therapy were block randomized to either standard protocol or an enhanced infection control protocol. Both the groups abided by the current best practice guidelines. For minimizing the risk of iatrogenic contaminations, the enhanced infection control protocol encompassed extra steps like the replacement of rubber dams, files, gloves, all the instruments and surface barriers during root canal filling.

In this randomized clinical trial, the  radiographic examiners and participants were blinded to the study protocol used. At the baseline (S1) and following completing chemomechanical preparation (S2), the intracanal samples were taken. With the aid of quantitative polymerase chain reaction, enumeration of the microbial 16S rDNA copy numbers was done. Prior to therapy and at one-year follow-up, the cone beam computed tomography (CBCT) scans were done. Using CBCT by logistic regression modelling, the outcome was evaluated radiographically and clinically.

In total, 115 teeth were analyzed (61 in the enhanced infection control protocol and 54 in the standard protocol) at 1-year follow-up. The percentage of favourable outcomes evaluated by CBCT was more in enhanced infection control protocol when compared to standard protocol. The decline in the median bacterial reads in S1 samples in standard protocol and enhanced infection control protocol group is shown in Table 1:

The odds of 12-months success was three times greater in the enhanced infection control protocol arm in comparison with the standard protocol arm (Odds Ratio=2.89).

In comparison with the standard protocol, the enhanced protocol remarkably decreased bacterial counts in the pre-canal filling samples.