Owing to anti-inflammatory, anti-oedematous, fibrinolytic, anti-infective, and analgesic effects, trypsin:
chymotrypsin oral combination has emerged as a promising treatment of mandibular molars with chronic apical abscess. Trypsin chymotrypsin combination always showed a significant reduction in swelling and pain postoperatively.
Study procedures:
- According to inclusion and exclusion criteria; patients will be subjected to complete history taking, general and local "dental" examinations.
- Important dental symptoms will be assessed include bleeding, pain, malocclusion, new growths, numbness or paresthesias, and chewing problems.
- General information will be reported including use of alcohol or tobacco and systemic symptoms, such as fever and weight loss.
- A thorough inspection with good illumination, a tongue blade, gloves, and a gauze pad will be performed.
- Complete or partial dentures will be removed so that underlying soft tissues can be seen.
- A head-mounted light will be used. However, because the light cannot be precisely aligned on the axis of vision, it is difficult to avoid shadowing in narrow areas.
- Better illumination results will be performed with a head-mounted convex mirror.
- The temporomandibular joint (TMJ) will be assessed by looking for jaw deviation on opening and by palpating the head of the condyle anterior to the external auditory meatus.
- Examiner then place his little fingers into the external ear canals with the pads of the fingertips lightly pushing anteriorly while patients repeatedly open widely and then close.
- Preoperative preapical X-ray and CBCT will be done.
- Cases will be randomly divided into 3 groups; Group A will receive (Alphintern®, tablet, Amoun, Egypt), Group B will receive (Limitless Allzyme Max®, tablet, Eva, Egypt) Group C will not receive medication
- Medications will be taken three times daily for 7 days postoperative, after that all cases will be reexamined regarding healing rate, adverse effect and failure rate of medical treatment.
- Randomization, allocation and concealment: It will be done using computer generated randomization sheet. Sealed opaque packages will be given to a third person (nurse) who will assign the packages to study groups. Each patient will be invited to pull out a package. According to the number inside package, cases will be allocated to either group A, B or C according to a computer- generated random list.
- Postoperative preapical X-ray will be done at the end of the root canal treatment.
- Patient will be recalled after three months for preapical X-ray assessment.
- After six months patient will be recalled for preapical X-ray and CBCT to be done.