Karthikeyan Anbalagan, Amit Jena, Luna Samanta, Akhil Changanath, Anwesha Pradhan, Govind Shashirekha, Vinay Shivagange
European Endodontic Journal - 2025;10(6):506-513
ABSTRACT Karthikeyan ANBALAGAN,1 Amit JENA,1 Luna SAMANTA,2 Akhil CHANGANATH,3 Anwesha PRADHAN,2 Govind SHASHIREKHA,4 Vinay SHIVAGANGE5Efficacy of Continuous Chelation with Etidronate and Sequential Chelation with Chitosan on Bacterial Reduction in Teeth with Pulp Necrosis: A Double-blind, Randomized Clinical Trial This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.1Department of Conservative Dentistry and Endodontics, Sriram Chandra Bhanja Dental College and Hospital, Utkal University, Odisha, India 2Department of Zoology, Redox Biology and Proteomics Laboratory, Ravenshaw University, Odisha, India 3Department of Public Health Dentistry, Sriram Chandra Bhanja Dental College and Hospital, Utkal University, Cuttack, Odisha, India 4Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to be) University, Odisha, India 5Department of Endodontology, Oman Dental College, Muscat, Oman 507 Anbalagan et al. Etidronate and Chitosan on Bacterial Reduction in Pulp Necrosis EUR Endod J 2025; 10: 506-513 HIGHLIGHTSObjective: This study compared the efficacy of continuous chelation with etidronate and sequential chela- tion with chitosan to traditional chelation with EDTA in reducing bacterial levels in teeth with necrotic pulp. Methods: Sixty patients with single-rooted and single-canal teeth with pulp necrosis were randomly di- vided into three groups based on the irrigation protocol with passive ultrasonic activation (PUI). G1 (Control): NaOCl/EDTA+PUI, G2: NaOCl/etidronate+PUI, and G3: NaOCl/chitosan+PUI. Microbiological samples were taken before (S1) and after the root canal preparation and irrigation protocol (S2). Total bacterial counts were measured using 16S ribosomal RNA gene-based real-time quantitative polymerase chain reaction. Statistical analysis was performed using the Wilcoxon signed rank test and the Kruskal-Wallis test (p<0.05). Results: All S1 samples tested positive for bacteria, and total bacterial counts from S1 to S2 were significantly reduced across all three groups (p<0.001), with a mean reduction of 97.7% in G1, 96.3% in G2, and 96.8% in G3. No significant differences were observed among the groups (p=0.345). Bivariate and multivariate analy- ses revealed that none of the patient-related or tooth-related variables had a significant effect on bacterial reduction (p>0.5). Conclusion: All three irrigation protocols, including continuous chelation with etidronate, sequential chela- tion with chitosan, and traditional chelation with EDTA, significantly reduced bacterial levels in teeth with primary endodontic infections. Etidronate and chitosan may serve as alternatives to EDTA; however, further prospective clinical studies are required to validate and recommend their use in clinical practice.
