Various researches are being conducted in a pursuit of a method which may increase the success rate of root canal therapy in non-vital primary teeth with no damage caused to permanent teeth. Elimination of these resistant types of bacteria from root canals is considered as a serious challenge in root canal therapy. Recently, lasers with different wavelengths have proved to be able to clear the canals in permanent and primary teeth. These lasers disinfect the canals from resistant bacteria such as E. faecalis.  High-power lasers are among the newly introduced techniques for root canal disinfection. Evidence shows that diode lasers (DLs) can decrease the intracanal bacterial count and penetrate 500 µm into the surface. Bacterial elimination by incorporating use of laser for pulpectomy in the canals of primary teeth can provide infection free periodontal structure and fast healing in abscessed teeth. DL has the advantage of penetrating into the anatomic irregularities of the root canal structure and application of a DL in conjunction with irrigants has shown more favorable results. The bacterial reduction depends on radiation energy, bacterial species, time of radiation, and radiation frequency.  Different studies have used laser for root canal disinfection with range of 810, 880, 940, 980 nm wavelength. The study conducted by AA, Mohammed, El-Bayoumy YS, Barakat FI, and Edrees FM. on primary molars with 980nm diode laser concluded that laser was found to be more effective than 2% CHX, another study showed that  810-nm DL obstructed the dentinal tubules and decreased the Escherichia coli and E. faecalis bacterial counts. Therefore, this study will focus on clinical, radiographical and microbiological efficacy of canal disinfectants which includes 2% CHX, MTAP and diode laser when used in pulpectomy procedure.

NEED OF THE STUDY:

Search for new methods to increase the success rate of root canal therapy in children to prevent damage to permanent teeth is still going on. Elimination of these resistant types of bacteria from root canals is considered as a serious challenge in root canal therapy. Lasers with various wavelengths have recently been shown to be capable of clearing the canals in both permanent and primary teeth. Various root canal disinfectants are used routinely in pediatric dentistry for pulpectomy procedures. CHX demonstrates a broad-spectrum antimicrobial action and thus helps in reducing bacterial load in canals.  MTAP helps in elimination of both aerobic and anaerobic bacteria. Lasers reduces inflammation, relieves pain and also accelerates tissue generation. Taking these advantages into consideration the present study will evaluate CHX, MTAP and Diode laser for disinfection of canals in primary teeth and clinical success with long term follow-up.

On searching the literature till 18 March 2024 with the keywords like Diode laser , pulpectomy, necrosed pulp, root canal disinfectant on search engines like Pubmed, Medline, Researchgate, Google Scholar gave scanty results and in their limitation of study it was suggested study to be done with larger sample size and long term follow up , thus the need of the study to assess efficacy of diode laser as root canal disinfectant in primary teeth as compared to CHX  and MTAP.

NULL HYPOTHESIS:

There is no difference between CHX, MTAP and diode laser as root canal disinfectants in pulpectomy procedures of primary teeth when compared clinically, radiographical and microbiologically 

RESULT:

The present randomized clinical trial evaluated the antimicrobial, clinical, and radiographic efficacy of Chlorhexidine (CHX), MTAP, and diode laser as root canal disinfectants in primary teeth undergoing pulpectomy. All three groups showed significant reduction in E. faecalis and S. mutans counts postoperatively (p<0.001). The diode laser demonstrated the greatest reduction in E. faecalis and showed significantly better antimicrobial efficacy than CHX. Clinically, all groups exhibited marked improvement in pain, tenderness, swelling, mobility, and abscess, with almost complete resolution by 6 and 12 months. Radiographically, progressive healing with reduction in periradicular and intraradicular radiolucencies was observed in all groups, with the laser group showing comparatively faster healing. No adverse effect on tooth bud development was noted. Nolla stage assessment demonstrated continuous and significant tooth development over the follow-up period in all groups. Overall, all three disinfectants were effective, while diode laser showed comparatively superior antimicrobial and early radiographic outcomes.

CONCLUSION:

Within the limitations of the present study, all three root canal disinfectants—Chlorhexidine, MTAP, and diode laser—were effective in reducing microbial load and achieving favorable clinical and radiographic outcomes in primary teeth undergoing pulpectomy. Significant reduction in E. faecalis and S. mutans counts, along with progressive healing and resolution of clinical symptoms, was observed in all groups over 12 months. However, the diode laser demonstrated comparatively superior antimicrobial efficacy and earlier radiographic healing, particularly against E. faecalis. None of the treatment modalities adversely affected the development of the permanent tooth bud. Thus, diode laser may be considered a promising adjunctive disinfectant in pediatric pulpectomy procedures.