Effect of Calcium Hydroxide Alone or in Combination with Ibuprofen and Ciprofloxacin on Nuclear Factor Kappa B Ligand and Osteoprotegerin Level in Periapical Lesions: A Randomized Controlled Clinical Study.

Introduction: The aim of the present study was to evaluate the effects of calcium hydroxide (Ca[OH](2)), Ca(OH)(2) + ibuprofen, and Ca(OH)(2) + ciprofloxacin in terms of receptor activator of nuclear factor kappa B ligand (RANKL) and osteoprotegerin (OPG) levels in asymptomatic periapical lesions. Methods: Sixty-six patients were randomly divided into 3 groups using a Web program according to the medication selected: Ca(OH)(2), Ca(OH)(2) + ibuprofen, and Ca(OH)(2) + ciprofloxacin. After removing gutta-percha from the root canals, the RANKL and OPG samples were taken from the interstitial fluid of the apical tissues using 3 paper points. At the second appointment, medicaments were removed, and second sampling was performed using the same method. The RANKL and OPG levels were measured by the enzyme-linked immunosorbent assay, and the RANKL/OPG ratio was calculated. Results: According to the intragroup analysis, there were no statistically significant differences between the preoperative and postoperative levels of the RANKL/OPG ratio in any of the groups. Intergroup analyses showed that there were no statistically significant differences among the Ca(OH)(2), Ca(OH)(2) + ibuprofen, Ca(OH)(2) + ciprofloxacin groups in terms of the percentage change in RANKL/OPG levels before and after treatment. Conclusions: Within the limitations of the present study, it can be concluded that addition of ibuprofen or ciprofloxacin to Ca(OH)(2) paste does not provide any extra benefit in terms of lowering RANKL and OPG levels.