Interventions
bleeding, tooth
BLEEDING, BLOOD CLOT, PERSISTENT INFECTION, POLAND, STERILE, APICAL PERIODONTITIS
The pre-treatment radiographs were taken with the standardized paralleling technique via the Rinn XCP alignment system (Rinn Corporation; Elgin, IL, USA). The periapical radiographs were digitized using a transparency scanner (HP Scanjet G3110; Hewlett-Packard Development Co, Palo Alto, CA, USA) for further comparisons.Teeth were anesthetized by using local anesthesia with a vasoconstrictor (1.8 mg of xylopen 2%, Exir, Boroojerd, Iran). After rubber dam isolation, access cavities were prepared, and root canals were irrigated using 20 mL of 1.5% sodium hypochlorite (Cerkamed, Poland), minimally prepared, and dried with paper points. Then by using a #25 K-file (Mani, Tochighi, Japan), one group of the root canals (The final visit was scheduled when the tooth was asymptomatic with no signs of discharge. In case of persistent infection, one or more visits were scheduled for further drainage and chemical disinfection. The average duration of keeping the medicament was 23 days, ranging from 21 to 28 days. In the final visit, after the application of anesthesia (mepivacaine 3% without vasoconstrictor (Exir Pharmaceutical, Tehran, Iran) and proper isolation, the temporary restoration and cotton pellet were removed. The canal was irrigated with 30 mL of ethylenediamine tetraacetic acid (EDTA) 17% (Morvabon; Tehran, Iran) followed by 10 mL sterile saline and dried with sterile paper points.Intra-canal bleeding was induced with a #20 endodontic K-file (Mani, Tochighi, Japan) beyond the apical foramen. Upon the formation of a blood clot to the level of the cementoenamel junction, mineral trioxide aggregate (MTA, Angelus, Londrina PR, Brazil) was placed on the blood clot, and the teeth were restored with temporary restorations. The patients were referred to replace the restoration with permanent filling materials.The patients were clinically and radiographically followed up for an average of 18 months. The follow-ups were first on a three-month basis (months 3 and 6), and thereafter, every 6 months. Each follow-up visit included clinical and radiographic examinations of the resolution of apical periodontitis. The pre-and post-treatment radiographic images were evaluated by two skilled independent examiners and classified as success and failure. The persistence of clinical signs and symptoms of periapical radiolucency was regarded as a failure. The root development was assessed based on the thickness and length of the root or apical closure. The data were statistically analyzed by using SPSS software (version 16, SPSS INC, Chicago, IL, USA). The inter-rater reliability was measured with Cohen’s kappa coefficient. The chi-square test was used to assess the effect of metformin incorporation into DAP on the root width, root length, apical closure, and periapical status. 