Flare-ups in endodontics: I. Etiological factors

Effect of Curcuma longa (Turmeric), as an intra-canal medicament, on inter-appointment endodontic pain in patients with symptomatic irreversible pulpitis: A randomized controlled clinical trial

Inter-appointment pain (IAP) is a subtype of postoperative pain which occurs between endodontic appointments. It may begin within a few hours after the first appointment and may continue for several days. Apart from mechanical instrumentation and thorough irrigation, intracanal medicaments play a central role in the disinfection of root canals and thus decreasing IAP. The aim of this study was to evaluate the effect of Curcuma Longa as an intracanal medicament on IAP in patients with symptomatic irreversible pulpitis (SIP). One hundred healthy adult patients having SIP in one of their single-rooted maxillary or mandibular teeth participated in this randomized, parallel, single-blinded clinical trial. After thorough biomechanical preparation, the root canals were randomly medicated with one of the following medicaments, Control (no medicament), Calcium Hydroxide, triple antibiotic paste (TAP), and Curcuma Longa. The pain was recorded using Visual analog scale at 4 h, 24 h, and every day until the seventh day. Data were analyzed using Kruskal-Wallis, Mann-Whitney U, and Wilcoxon signed-rank tests. No statistical difference in pain scores was observed between Calcium Hydroxide, TAP or Curcuma Longa groups. It can be concluded that Curcuma Longa, Calcium hydroxide, and TAP are equally effective in controlling IAP.

Post-operative pain after root canal preparation with different apical finishing sizes a triple blinded split mouth clinical trial

BACKGROUND

This is a triple-blinded, prospective split-mouth clinical trial. It is important to shed light on the effect of different apical preparation sizes regarding postoperative pain within the same patient with the same pulpal histological status. The aim is to compare and evaluate the severity of postoperative pain following apical enlargement with two different sizes after the IBF using the visual analogue scale.

METHODS

Fifty "teeth" in 25 patients were assigned into two equal groups (25 per group) using E3 Azure rotary files; Group A was prepared two sizes greater than the Initial binding file (IBF) (the largest K file to bind at the actual working length) mesial canals, which were enlarged to 35#/0.04 and 40#/0.04 for the distal canals. Group B was prepared in three sizes larger than the IBF: 40#/0.04 for mesial canals and 45#/0.04 for the distal canals. On a modified VAS form, patients were questioned to indicate the degree of their pain and assisted in narrating their pain intensity during the following periods: 12, 24, and 72 h, and after a week. VAS data were non-parametric and analyzed using the signed-rank test for intergroup comparisons, Freidman's test, and the Nemenyi post hoc test for intragroup comparisons. The significance level was set at p < 0.05.

RESULTS

showed that regardless of measurement time, enlargement of apical preparation was significantly associated with higher pain scores (p < 0.001). Within both groups, there was a significant reduction of measured pain score with time, with values measured after 12 and 24 h being significantly higher than values measured at other intervals (p < 0.001) and with values measured after three days being significantly higher than 1-week value (p < 0.001).

CONCLUSION

The size of apical preparation had a significant effect on postoperative pain.

TRIAL REGISTRATION NUMBER & DATE

NCT05847738, 08/05/2023.

Comparative Assessment of Postoperative Pain After Three Irrigation Techniques in Single-Rooted Teeth With Symptomatic Irreversible Pulpitis and Symptomatic Apical Periodontitis: A Randomized Controlled Trial

Aim This study aimed to assess the impact of positive pressure, negative pressure (EndoVac), and sonic-activated irrigation (EndoActivator) on postoperative pain with symptomatic irreversible pulpitis and symptomatic apical periodontitis. The hypothesis tested the superiority of negative pressure irrigation in reducing pain and analgesic requirements. Methodology Forty-eight eligible patients meeting inclusion criteria were enrolled, ensuring comprehension through verbal and written patient information sheets. The sample size calculation, based on prior data, determined 14 teeth per group with consideration for potential dropouts, resulting in 16 teeth per group. Inclusion criteria included healthy individuals aged 16-65 years with single-rooted teeth diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis, while exclusion criteria comprised recent analgesic intake, pregnancy, lactation, and specific dental conditions. Participants were allocated to three groups using computer-generated block randomization with allocation concealment via sequentially numbered opaque sealed envelopes. While blinding of the operator was not feasible, patient and assessor blinding was ensured. Preoperative data collection included patient demographics, tooth details, and pain intensity assessed on a Visual Analogue Scale (VAS). Root canal therapy procedures, conducted in two visits, included instrumentation and irrigation using 3% NaOCl across three groups: positive pressure irrigation, negative pressure irrigation, and sonic activation. Postoperative pain and analgesic intake were evaluated using VAS at specific intervals. One assessor tabulated and analyzed all the information. Results Postoperative pain assessments revealed that the EV group experienced the lowest pain levels, followed by the EA and SVN groups, with significant differences observed at six and 24 hours postoperatively (p < 0.05). Analgesic requirements correlated with pain levels, with the SVN group requiring the most analgesics and the EV group the least, highlighting the efficacy of the interventions. Conclusions Negative pressure irrigation (EndoVac) significantly reduced postoperative pain compared to conventional side-vented needle irrigation. These findings enhance understanding and guide evidence-based recommendations for optimizing endodontic procedures and prioritizing patient comfort and outcomes.

Systemic Corticosteroid Uses in Endodontics-Part 1: Managing Postoperative Pain

INTRODUCTION

This study aimed to systematically search and review all available literature regarding systemic (oral or locally injected) corticosteroids in endodontics to assess their effect on postoperative pain.

METHODS

A search was conducted using PubMed, Cochrane Library, Embase, Scopus, Dentistry & Oral Science, and ProQuest. Randomized controlled trials enrolling participants undergoing endodontic treatment and assessing the presence of pain and pain scores at 6, 12, and 24 hours postoperatively were included. We synthesize the effect measures using risk ratios (RRs), standardized mean differences (SMDs), and their corresponding 95% confidence intervals (CIs). Meta-analysis was performed using the random-effects inverse variance method. The level of significance was set at P < .05. The certainty of the evidence was evaluated using Grading of Recommendations, Assessment, Development and Evaluation approach.

RESULTS

A total of 2303 participants from 29 trials were included. Patients who received corticosteroids were significantly less likely to report pain at 6 hours (RR = 2.5; 95% CI, 1.74-3.61; P < .00001), 12 hours (RR = 2.10; 95% CI, 1.53-2.90; P < .00001), and 24 hours (RR = 1.77; 95% CI, 1.38-2.28; P < .00001) postoperatively. Furthermore, they reported lower pain intensity at 6 hours (SMD = - 0.82; 95% CI, -1.17 to -0.48; P < .00001), 12 hours (SMD = - 0.63; 95% CI, -0.75 to -0.51; P < .00001), and 24 hours (SMD = - 0.68; 95% CI, -0.90 to -0.46; P < .00001) postoperatively.

CONCLUSIONS

Moderate certainty evidence indicates that the use of systemic corticosteroids likely results in a moderate to large reduction in postoperative endodontic pain.

Effect of treatment variables on apical extrusion of debris during root canal retreatment: A systematic review and meta-analysis of laboratory studies

Background

This study aimed to systematically and comprehensively review the effect of various treatment variables on apically extruded debris (AED) during non-surgical root canal retreatment (NSRCRT).

Methods

The study protocol is shared in the Open Science Framework database (https://osf.io/kjtdg/?view_only=17060180705745ec9dae9a01614f3880). An electronic search was conducted up to July 2022 to reveal related studies. Two reviewers critically assessed the studies for eligibility against inclusion and exclusion criteria and data extraction. Quantitative data synthesis was performed, and the risk of bias in the studies was also evaluated.

Results

Forty-six studies were included in the systematic review and 14 in the meta-analysis. Conflicting or limited evidence was found for the effect of sealer type, obturation technique, and solvent use. The manual instrumentation increased the amount of AED compared to rotary instrumentation during the removal of filling materials (P<0.001). There was no significant difference in the amount of AED between the use of rotary and reciprocating files during the removal of filling materials (P=0.181).

Conclusion

Rotary instruments can be recommended instead of manual instruments during the removal of filling materials to control the amount of AED. Further studies with a low risk of bias are needed to clarify the effect of other treatment variables on AED during NSRCRT.

To Evaluate Different Endodontic Instrumentation Systems Regarding Post-Operative Pain After Endodontic Therapy: A Clinical Study

BACKGROUND

Despite substantial breakthroughs in instrumentation systems and pharmaceutical interventions, pain following endodontic therapy remains a serious concern. The effect of the type of endodontic instrumentation system in post-operative pain after endodontic therapy has been a matter of debate.

AIM

To evaluate different endodontic instrumentation systems, namely Reciproc (GmbH, Munich), OneShape® (MicroMega, France), Protaper Gold (Dentsply Sirona, USA), and Hyflex® EDM (Coltène/Whaledent Inc., USA) file systems, regarding post-operative pain after endodontic therapy Methods and materials: The endodontic department treated healthy patients aged 20 to 50 years who were experiencing symptoms of irreparable pulpitis in one or more maxillary molars or mandibular molars. Five hundred was the determined size of the sample. The study participants were divided into five categories, each comprising 100 participants. These categories were: Category 1: Reciproc instrumentation system. Category 2: OneShape® instrumentation system. Category 3: ProtaperGold instrumentation system. Category 4: HyFlex® EDM instrumentation system. Category 5: Control (stainless steel K-files). Following endodontic therapy, these scores were recorded at 6 hours, 12 hours, 24 hours, 48 hours, and 72 hours using the VAS scale.

RESULTS

The visual analog scale (VAS) score (mean±SD) in the control group was 0.73± 0.40 (<0.001). The VAS score in the Reciproc group was 0.43± 0.05 (<0.001). The VAS score in the OneShape® group was 0.36±0.09 (<0.001). The VAS score in the Protaper Gold group was 0.41 ±0.08 (<0.001). The VAS score in the HyFlex® EDM group was 0.55 ±0.02 (<0.001). The VAS score in all instrumentation techniques at 72 hours follow-up was lesser in comparison to a control group with meaningful statistical significance (<0.001). However, the post-operative pain among the Reciproc, OneShape®, Protaper Gold, and HyFlex® EDM instrumentation systems was not different clinically when compared among themselves. However, VAS values were greater in OneShape® and HyFlex® EDM compared to Reciproc and Protaper Gold, showing increased post-operative pain in OneShape and HyFlex® EDM compared to Reciproc and Protaper Gold. It was also observed that there was a decline in the VAS score in all instrumentation systems as the follow-up period increased from 6 hours to 72 hours, with maximum post-operative pain at 6 hours of follow-up and minimum post-operative pain at 72 hours of follow-up. However, the decline was lesser in OneShape® and HyFlex® EDM in comparison to Reciproc and Protaper Gold, with increased post-operative pain in OneShape® and HyFlex® EDM in comparison to Reciproc and Protaper Gold.

CONCLUSION

Post-operative pain at all follow-ups of endodontic procedures was less in Reciproc, OneShape®, Protaper Gold, and HyFlex® EDM than in the control group. VAS scores were higher in the OneShape® and HyFlex® EDM groups compared to the Reciproc and Protaper Gold groups, indicating increased post-operative pain with OneShape® and HyFlex® EDM instruments in comparison to Reciproc and Protaper Gold.

Evaluation of Pain Following the Use of Different Single-file Glide Path Systems: A Randomized Clinical Trial

INTRODUCTION

This study aimed to evaluate postoperative pain intensity following glide-path preparation using the ProGlider (PG) and WaveOne Gold Glider (WOGG) systems in asymptomatic teeth with necrotic pulp and periapical lesions.

METHODS

In this randomized clinical trial (ClinicalTrials.gov ID: NCT05955742) maxillary and mandibular molars with asymptomatic apical periodontitis of 78 patients (age, 18-65 years) were included. The patients were randomly divided into 3 groups: control (n = 26), PG (n = 26), and WOGG (n = 26). All the systems were used according to the manufacturer's instructions, and all the root canal treatments were completed by a single operator within 2 sessions. Postoperative pain was assessed using a numerical rating scale at 6, 12, 18, 24, 48, and 72 hours. Analgesics administered and abscess formation were also recorded. Statistical analyses were performed using the Mann-Whitney U, Bonferroni Dunn, Friedman, Chi-square, and Fisher exact tests.

RESULTS

The postoperative pain at 12 and 18 hours was lower in the WOGG group than in the other groups (P < .05). The postoperative pain scores at 6 and 24 hours were higher among women than among men (P < .05). The highest postoperative pain scores were observed at 6 hours (P < .05).

CONCLUSIONS

The WOGG glide-path file system was associated with less postoperative pain than the other systems. Abscess formation and analgesic use were higher in the PG group than in the other groups. Postoperative pain was greater in women than in men.

Assessing the occurrence and severity of pre- and postendodontic pain in anemic and healthy female patients

OBJECTIVES

The objective of this current survey was to assess both the occurrence and severity of pre- and post-endodontic pain among female individuals, distinguishing between those with anemia and those without.

MATERIALS AND METHODS

In the current study, we included a total of 60 women with anemia (hemoglobin < 11) and those without anemia (hemoglobin > 13). We recorded the occurrence and severity of pain before and at 24, 48, and 72 h following root canal treatment using a visual analog scale (VAS) ranging from 0 to 10. Additionally, we collected data on patient age, tooth type, as well as pulpal and periapical conditions. Statistical analysis was carried out using two-way ANOVA, pairedt-tests, and Pearson correlation coefficient. The significance level for statistical tests was set at p ≤ .05.

RESULTS

The incidence of preoperative pain in both anemic and non-anemic patients was 80%. The total incidence of post-operative pain was recorded as 71.7% (82.2% in anemic and 61.1% in non-anemic women). Compared with the pretreatment pain incidence and intensity, the values increased in 24 h but declined in 48 h and 72 h after treatment. Considering the posttreatment pain intensity, the mean values were higher in the three time intervals (24, 48, and 72 h) in anemic patients. Pulpal and periapical status, in contrast to age and tooth type, significantly contributed to the intensity of posttreatment pain.

CONCLUSION

Regarding the importance of pain phenomenon in human life, it is recommended to consider anemia as an important risk factor for post-endodontic pain. Early diagnosis and analgesic treatment interventions in anemic females, alongside the pain control during root canal treatment, could promote the patient's satisfaction and quality of care.

The use of sodium hypochlorite mixed with etidronic acid during canal preparation increases debris extrusion

The purpose of this study was to compare the impact of different irrigation protocols on debris extrusion. Single-rooted teeth were distributed into groups based on the irrigation protocols (n = 40): 2.5% NaOCl (biomechanical preparation: 20 mL and final irrigation: 5 mL); 2.5% NaOCl (biomechanical preparation: 20 mL) + 17% EDTA (final irrigation: 2 mL) + 2.5% NaOCl (final irrigation: 3 mL); and a mixture of 5% NaOCl +18% HEDP (biomechanical preparation: 20 mL and final irrigation: 5 mL). The canals were prepared using a reciprocating instrument size 40/0.06. For final irrigation, the groups were reassigned based on the agitation methods (n = 10): (a) no agitation; (b) ultrasonic; (c) sonic; and (d) continuous rotation. The control group (n = 10) received saline solution without agitation. The amount of debris extruded was measured by weight and analysed using One-way ANOVA (α < 0.05). The subgroups treated with NaOCl + HEDP mixture showed a significantly higher amount of extruded debris (p < 0.05), while there was no difference among agitation methods in all groups (p > 0.05).

Comparative evaluation of apical debris extrusion during root canal preparation using three different rotary file systems

Background: Endodontic success depends on the complete cleaning and shaping of the root canal. In order to achieve this goal, debris removal is essential. Even with improvements in instrument design, apical debris extrusion continues to be a cause of periradicular inflammation. The current study aimed to compare the amount of apically extruded debris throughout the canal instrumentation with TruNatomy, ProTaper Next, 2Shape rotary systems. Methods: A total of 60 freshly extracted single‑rooted mandibular premolars were used. An access opening was made, and a working length was estimated. The samples were arbitrarily allocated into three groups i.e. Group I: TruNatomy (n = 20), Group II: ProTaper Next (n = 20), Group III: 2Shape (n = 20). During the canal instrumentation, the extruded debris were collected in preweighed Eppendorf tubes. Post-instrumentation, the tubes were placed in a hot air oven at 140°C for five hours. For calculating the dry debris weight, the tube's pre-instrumentation weight was deducted from the post-instrumentation weight. The data was analysed using one‑way analysis of variance and post hoc Tukey's test. Results: Extrusion of debris was noted in all the specimens. TruNatomy rotary system showed least debris extrusion in comparison to ProTaper Next and 2Shape (P < 0.05). However, the results were statistically non-significant between ProTaper Next and 2Shape (P > 0.05). Conclusions: It was noted that all instruments apically extruded debris, with TruNatomy system being related to minimum extrusion.

Comparison of the effect of different glide path files on amount of apically extruded debris in curved root canals

It is essential to create a glide path before root canal preparation with nickel-titanium rotary files to avoid file breakage and preserve the original canal structure. The aim of this study was to compare the amount of apically extruded debris after using different glide path files. A total of 96 first mandibular molars with curved mesial roots were randomly divided into six groups (n = 16) which are K-files, Proglider, R-Pilot, TruNatomy Glider, WaveOne Gold Glider and group without a glide path. Apically extruded debris was measured after glide path and canal preparation. The highest amount of debris was found in the control group without a glide path and using a glide path file caused less debris and significant differences were observed between R-Pilot, TruNatomy Glider, ProGlider, WaveOne Gold Glider and K-file groups. It may be recommended to create a glide path before root canal shaping to reduce the amount of extrusion debris from the apical. Especially in curved and narrow root canals, it is recommended to use an R-Pilot file before root canal shaping in order to reduce the amount of apically extruded debris.

Comparative Evaluation of Extrusion of Apical Debris and Irrigant using Three Different Rotary Systems with Conventional Irrigation Methods - An In vitro Study

Aim

The present study aimed to compare and evaluate debris and irrigant extrusion from curved root canals using different rotary systems.

Materials and Methods

30 single-rooted mandibular canines were used in this study. The crown was decoronated, working length and initial apical diameter were established. A 1.5% agar gel model was used in this study. Samples were assigned randomly into 3 groups (n = 10 teeth per group). Protaper Next, OneShape, and Hanudent files were used according to the manufacturers' instructions for canal instrumentation. Apically extruded debris and irrigant was were computed by deducting the initial weight of the test apparatus without a tooth from its weight after the biomechanical preparation. Comparative analysis of the amount of apically extruded debris and irrigant for each of the instruments and the experimental models was performed.

Results

The statistically significant difference was found between the three experimental groups. (P < .05). Among all the groups least extrusion was observed in the Protaper Next group when used in combination with conventional irrigation.

Conclusion

All the instruments produced apically extruded debris and irrigant, but the maximum was seen with OneShape among the experimental groups.

Factors that affect the outcomes of root canal treatment and retreatment-A reframing of the principles

This paper undertakes a broad and comprehensive synthesis of relevant clinical, biological, biomechanical, technical and healthcare services data to understand the factors affecting outcomes of periapical healing after root canal (re)treatment. The medical and dental evidence-based era (1980-present) is contextualized with the earlier evidence drive in endodontics (1911-1940) triggered by the focal infection era. The current evidence-based approach has a sharper focus on evidence quality and derivation of practice guidelines. Contrary views question whether guideline-driven, or expertise-development-driven endeavours would best serve outcome improvement in society. The endodontic discipline functions in a broad healthcare framework and sustains industrial, economic and trend pressures that may be deemed to influence outcomes. The nature of root canal treatment and the challenges in determining the factors that affect its outcomes is discussed. The factors potentially affecting periapical healing after root canal treatment are classified into pre-operative, intra-operative and postoperative groups. These categories subsume multiple elements with interactive influences, creating a complex picture, further confounded by some apparently surprising, counter-intuitive and contradictory findings. The technical versus biological conundrum in root canal treatment continues to cause cognitive dissonance. However, due reflection and cross-discipline-synthesis resolve the apparent data conflicts into a very simple, consistent and plausible picture of how root canal treatment works and the key factors that affect periapical healing. Root canal retreatment is considered mainly in the context of its differences from primary treatment as the majority of factors influencing outcomes are common to both. The exceptional difference is that retreatments have a proportionately reduced probability of healing by virtue of compromised apical root canal ramification access or modified host/infection interactions. Root canal (re)treatment outcomes are dominantly influenced by the nature of prior dynamic host/infection interaction (pre-operative patient factors) and how the direction of this dynamic is influenced by two factors: (1) the active efficacy of the operators' root canal treatment protocol to sustain a microbial ecological shift (intra-operative treatment factors) and dampen periapical inflammation; and (2) the passive ability of the functional tooth (and its restoration margin) to maintain its integrity to resist infection reversal (postoperative restorative factors).

Effect of different retreatment files using different kinematics on the release of inflammatory mediators in root canal retreatment of single-rooted teeth: a randomized clinical trial

OBJECTIVES

This randomized clinical trial aimed to evaluate the effect of two rotaries (ProTaper Universal Retreatment (PTUR)), D-Race (DR) + XP-Endo Finisher R (XPFR) and one reciprocating (Reciproc Blue (RB) retreatment techniques on the release of neuropeptides (Substance P, calcitonin gene-related peptide (CGRP)), and cytokines (IL-6 and IL-10) in periapical fluid in root canal retreatment of single-rooted teeth.

MATERIALS AND METHODS

In this randomized clinical trial (ClinicalTrials.gov ID: NCT05039502), seventy-five patients scheduled for retreatment were randomly divided into 3 groups according to the file system used to remove root canal filling materials (n = 25): PTUR, RB, and DR + XPFR. After reshaping and disinfection of the root canals, periapical fluid samples were taken, and the levels of Substance P, CGRP, IL-6, and IL-10 were measured by enzyme-linked immunosorbent assay (ELISA) test. Data were analyzed using the Kruskal-Wallis and chi-square tests. The level of significance was set as p = 0. 05.

RESULTS

All the allocated participants received the intervention and were analyzed. There was no statistically significant difference among groups in terms of gender, age, tooth localization, and the distribution of analgesic use after treatment (p values 0.799, 0.095, 0.637, 1.000, respectively). No statistically significant difference was found in terms of the levels of Substance P, CGRP, and IL-10 among groups (p > .05), except IL-6.

CONCLUSIONS

PTUR, RB, and DR + XPFR files have comparable results in the expression of inflammatory mediators.

CLINICAL RELEVANCE

Retreatment files powered with rotary or reciprocating motion produced similar neuropeptide and cytokine levels in patients.

Current Applications and Future Directions of Lasers in Endodontics: A Narrative Review

The utilization of lasers has been regarded as a novel technique for the purposes of clinical use in the dental field. Recently, numerous studies have been conducted on the potential applications of laser therapy in endodontics. Moreover, due to their ablation, penetrability, and disinfection capabilities, lasers have performed well with respect to endodontic treatments, including root canal treatment, vital pulp therapy (pulp capping and pulpotomy), dentinal hypersensitivity treatment, and management of dental pain related to pulp and periradicular disease. In particular, the superiorities of laser-aided pulp therapy are emphasized through condensed clinical controlled trials, and histological studies, in this review. Moreover, the ingenious use of laser applications with respect to aiding in the acceleration of root development and the extraction of foreign matters (i.e., broken files and fiber posts) in canals has quickly become the cutting-edge trend of current research. This review offers a summary and discussion of the current literature on all the aforementioned laser applications. Moreover, the characteristics of laser devices, including erbium lasers, neodymium-doped lasers, CO2 lasers, and diode lasers, are detailed and discussed here, providing useful references for laser application in endodontics. We also focus on the different wavelengths with respect to the lasers that are applied in endodontics. High-power lasers perform well as operative instruments; in addition, low-level lasers lead to the regulation of pulp inflammation, and the promotion of pulp healing. This narrative review provides a summary of the advanced applications of lasers in conjunction with various devices in the practice of endodontics, and aims to inspire innovative perspectives on lasers in the context of the treatment of dental diseases, especially pulp diseases, in the future.

Comparison of the incidence of postoperative pain in single sitting root canal treatment after using two reciprocating systems and two continuous rotary systems: An in vivo study

Aim

The aim of the present study was to compare the incidence of postoperative pain in single sitting root canal treatment after using two reciprocating and two continuous rotating file systems.

Methodology

One hundred and four permanent mandibular canine and first premolar teeth were selected for the study and were divided into two groups 1 and 2 comprising 52 teeth each. Group 1 was treated using reciprocating file systems and was subdivided into two subgroups A and B using WaveOne Gold (WOG) and Reciproc Blue (RB), respectively. Group 2 was treated using continuous rotating file systems and was divided into two subgroups A and B using One Curve (OC) and Vortex Blue (VB), respectively. Treatments were performed in a single sitting. After the visit, the patients were given a prescription for ibuprofen 400 mg to be taken every 6 h if they experience pain. Participants were asked to rate the intensity of the postoperative pain on a visual analog scale according to four classes (no pain, mild pain, moderate pain, and severe pain) after 24 h, 48 h, 72 h, and 7 days. Patients were also asked to record the number of prescribed analgesic medication tablets taken at these time points.

Results

There was a statistically significant difference (P = 0.00) among the reciprocating file systems and continuous file systems regarding the incidence of postoperative pain after 24, 48, and 72 h which signifies that pain incidence and duration is less with respect to reciprocation instrumentation as compared to continuous instrumentation.

Conclusion

The use of Reciproc instrumentation system (WOG and RB) showed significantly less intensity and duration of posttreatment pain compared to the single-file rotary system (OC and VB) in patients with symptomatic irreversible pulpitis with apical periodontitis.

Quantitative evaluation of apically extruded debris using TRUShape, TruNatomy, and WaveOne Gold in curved canals

Objective

This study compared the quantity of extruded debris after instrumentation with TRUShape 3D Conforming files, TruNatomy files, and the WaveOne Gold reciprocating system.

Materials and methods

Fifty-one mesiobuccal canals with severe curvatures (25–40°) were assigned to three equal groups according to the rotary system used for preparation, either TRUShape, TruNatomy, or WaveOne Gold files. The extruded debris was collected in pre-weighed glass vials. The data were statistically analyzed using a one-way ANOVA test and Tukey’s post hoc test.

Results

The least extruded debris was obtained with the WaveOne Gold instruments compared to the TRUShape and TruNatomy files (p < 0.001).

Conclusions

Debris extrusion occurs independently of the motion or design of the instrument. The WaveOne Gold system outperformed TRUShape and TruNatomy files in this study.

Comparison of apical debris extrusion of different generation nickel-titanium instrument systems

BACKGROUND AND AIM

The aim of this study is to evaluate the apical debris extrusion amounts and preparation times of four different nickel-titanium systems with a similar cross-section design-Mtwo, RECIPROC, RECIPROC blue, and VDW.ROTATE.

MATERIALS AND METHODS

Eighty human mandibular central incisors were divided into four equal groups (n = 20). The test apparatus was inserted into an assembly that provided root canal temperature. Preparation times were recorded using a stopwatch, and the amount of extruded debris was collected in pre-weighed Eppendorf tubes. After drying, the net amount was determined by subtracting the previously measured Eppendorf tube weights from the total weight.

RESULTS

The Mtwo had the largest amount of debris, but there was no significant difference among the other groups. The VDW.ROTATE completed the preparation in a significantly shorter time than the RECIPROC blue and Mtwo.

CONCLUSION

Compared to other files, the Mtwo sequence produced significantly more debris and required significantly more time to complete the whole root canal preparation.

The Effect of Passive Ultrasonic Irrigation and XP-Endo Finisher on Post-operative Pain after Endodontic Retreatment on Patients (Randomized Controlled Clinical Trial)

AIM: To evaluate the effect of passive ultrasonic irrigation or XP-Endo Finisher on postoperative pain in patients with underextended filling in previously endodontically treated mandibular first molar teeth requiring endodontic retreatment using visual analog scale (VAS) scale at 6, 12, 24, 48, 72 h, and 7 daytime intervals. METHODS: Seventy-eight patients with mandibular first molars which need endodontic retreatment were randomly allocated into one of three separate groups (n = 26); NaviTip group (control), XP-Endo Finisher group, or Ultra X group. Data were statistically analyzed with a significance level of p ≤ 0.05. RESULTS: XP-Endo Finisher agitation and ultrasonic agitation as a final irrigation protocol showed significantly lower pain values than the control group, but there was no significant difference in pain values between the experimental groups. CONCLUSION: Within the limitation of this study, it can be concluded that agitation techniques used during endodontic retreatment decreased the incidence and intensity of post-operative pain.

Cyclic Fatigue Resistance of Glide Path Rotary Files: A Systematic Review of in Vitro Studies

The aim of the present systematic review was to perform a qualitative synthesis of in vitro studies that assess the cyclic fatigue resistance of rotary glide path (GP) files of endodontic applications. Systematic electronic searches were performed in the Medline, Embase, Scopus, SciELO, and Web of Science databases on 15 February 2022, and were last updated on 1 April In vitro studies that evaluated and compared the cyclic fatigue resistance of at least one rotary GP file system with another rotary GP file system were included. A total of 25 studies were included in the qualitative synthesis. All studies assessing the difference in the cyclic fatigue resistance between continuous and reciprocating rotation in rotary glide path files found that the latter resulted in a significantly higher cyclic fatigue resistance, as evidenced by a higher number of cycles until fracture and/or time until fracture. Within the limitations of this review and the in vitro nature of the included studies, the results indicate that the cyclic fatigue resistance of rotary GP files may be influenced by several intrinsic factors of the files, such as their taper, cross-sectional design, alloy properties, kinematics, and external factors, such as the curvature and radius at which the file is activated, the irrigation or lubricant used, and the temperature.

Comparative Evaluation of Apically Extruded Debris during Pulpectomy Procedure in Primary Molar Teeth Using Two Different Rotary Systems and Hand Files: An In Vitro Study

Background

Successful outcome of endodontic treatment depends on chemomechanical preparation of the tooth. However, during canal preparation, debris may extrude through the apical foramen causing postoperative complications. The aim of this study is to evaluate and compare the amount of apically extruded debris during the pulpectomy procedure in primary molar teeth using two different rotary files and hand files.

Materials and Methods

Distal roots of sixty extracted primary molars were divided into three groups: group A: Prime Pedo™ pediatric rotary files, group B: DXL-Pro Pedo™ pediatric rotary files, and group C: hand files. Myers and Montgomery experimental model was used. Preweighed Eppendorf tubes were used to collect apically extruded debris. The tubes were then placed in an incubator at 70°C for 5 days. The weight of the debris attained was determined. The data were analyzed using ANOVA and post hoc Bonferroni test.

Results

Hand files produced more apical debris extrusion (P < 0.05). Prime Pedo™ pediatric rotary files produced the least debris (P < 0.05).

Conclusion

Prime Pedo™ and DXL-Pro Pedo™ pediatric rotary files extruded significantly lower amount of debris apically during pulpectomy as compared to hand files. Rotary files can be considered an alternative to hand files in pediatric endodontics.

Effect of Ultrasonic and Diode Laser Irrigation Activation on Post-operative Pain and Microbial Reduction in Single Visit Endodontic Treatment of Necrotic Mandibular Molars

Aim: To clinically evaluate the effect of continuous ultrasonic and diode laser 810 wave length irrigation activation techniques on postoperative pain and bacterial reduction in single visit endodontic treatment of mandibular molars. Material and methods: Forty patients requiring root canal treatment therapy for necrotic mandibular molars teeth were included in this study with age ranges between 20 and 45 years. In all cases, single visit endodontic treatment was carried out using Revo-S rotary file system in crown down sequence. NaOCl 2.5% irrigation solution was used during treatment. Patients were randomly and equally assigned into two groups according to irrigation technique. Group (1): conventional syringe irrigation and group (2): continuous ultrasonic irrigation. Each group was subdivided into two sub groups (n = 10); subgroup 1A (conventional syringe irrigation with no laser), subgroup 1B (conventional syringe irrigation with diode laser), subgroup 2A (continuous ultrasonic irrigation with no laser) and subgroup 2B (continuous ultrasonic irrigation with diode laser). Postoperative pain evaluation was done using Visual Analogue Scale (VAS) at 6, 12, 24, 36, 48 hours and 7 days postoperatively. Microbiological detection of bacterial reduction was done by taking Samples (S1 and S2) for bacterial cultures. S1 after finishing access cavity and before mechanical preparation and S2 after finishing mechanical preparation and irrigation activation and before obturation. Samples were cultured on blood agar and determined as colony forming units (CFU/mL). Microbiological bacterial reduction was calculated accordingly.  Statistical analyses were analyzed using the Mann-Whitney U test.  The significance level was set at p < 0.05. Results: In all sub groups, postoperative pain decreased by time in all time intervals but pain was significantly lower in subgroup (2B) (continuous ultrasonic irrigation with diode laser) than subgroup (1A) (conventional syringe irrigation with no laser) in all time interval. Microbiological results showed the highest bacterial reduction was in subgroup (2B) (continuous ultrasonic irrigation with diode laser) and least bacterial reduction was in subgroup (1A) (conventional syringe irrigation with no laser). Conclusion: Using diode laser and continuous ultrasonic irrigation activation techniques as adjunctive methods showed improvement in postoperative pain records and enhanced bacterial reduction in root canal therapy. Keywords: Continuous ultrasonic irrigation, diode laser 810, post-operative pain, bacterial reduction, single visit endodontic treatment.

The Effect of Passive Ultrasonic Irrigation or XP-Endo Finisher on Post-Operative Pain in Patients with Necrotic Teeth with Apical Periodontitis (Randomized Controlled Clinical Trial)

Objective To evaluate the effect of passive ultrasonic irrigation or XP-Endo Finisher on post-operative pain in patients with necrotic teeth with apical periodontitis using (VAS) scale at 6, 12, 24, 48, 72 hours, and 7 day time intervals. Methods Seventy-eight patients diagnosed with necrotic mandibular first molar with symptomatic apical periodontitis were randomly allocated into 1 of 3 separate groups (n=26); Navitip group (control), XP-Endo Finisher group, or Ultra X group. After a single visit root canal treatment and a specific method of agitation, depending on each group, the patients were given a questionnaire on which the patient would mark the degree of pain in a scale from 0 to 10 at 6, 12, 24, 48, 72 hours and 7 days post-obturation. Data were statistically analyzed with a significance level of P ≤ 0.05. Results Ultrasonic agitation and XP-Endo Finisher agitation as a final irrigation protocol showed significantly lower pain values than the control group, but there was no significant difference in pain values between the experimental groups. Conclusion There was significantly less pain associated with ultrasonic and XP-Endo Finisher agitation compared to Navitip irrigation.

Effect of mode of rotation on apical extrusion of debris with four different single-file endodontic instrumentation systems: Systematic review and meta-analysis

This systematic review and meta-analysis evaluated whether single-file endodontic instrumentation systems with the reciprocating type of motion are responsible for more debris extrusion than single-file endodontic instrumentation systems with the full rotational type of motion. Electronic and manual searches were performed following the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analysis - PRISMA. We included studies comparing rotary (Neoniti and/ OneShape) versus reciprocating (WaveOne and/ Reciproc) systems. We evaluated the quality of studies and performed statistical analysis using R-Project software. Eight studies of high quality were included to perform the meta-analysis. Subgroup analysis was also done. The overall risk of bias was too low. In conclusion, single-file reciprocating systems tend to generate more extrusion of debris than single-file rotary systems.

Quantitative evaluation of apically extruded debris during biomechanical preparation using hand K-file, protaper next, and waveone – An In Vitro study

Background:

The instrumentation technique which produces least amount of apically extruded debris is desirable to use in biomechanical preparation of root canal.

Aim:

To quantitatively evaluate apically extruded debris during instrumentation with hand K-file, ProTaper Next, and WaveOne.

Materials and Methods:

Forty-five extracted human single-rooted mandibular premolars with straight, single canal and single apical foramen were selected after radiographic evaluation and divided equally into three groups. Cleaning and shaping was done using hand K-files in step-back technique, ProTaper Next, and WaveOne single-file system. Debris extruded apically was collected into Eppendorf tubes and stored in an incubator at 37°C temperature for 5 days for drying. Weight of dry debris was measured using electronic microbalance with an accuracy of 10⁻⁵ g.

Statistical Analysis:

Student's t-test, with P value < 0.05 is statistically significant.

Results:

Statistically significant (P < 0.05) amount of debris was extruded by all three instrumentation systems: hand K-file- 1.9220 mg, ProTaper Next- 1.4940 mg, and WaveOne- 0.9940 mg. Least amount of debris produced by WaveOne was statistically significant (P < 0.05) when compared with the other two systems.

Conclusion:

The WaveOne reciprocating system extruded least amount of debris in comparison to hand K-file and ProTaper Next.

Effect of guided conservative endodontic access and different file kinematics on debris extrusion in mesial root of the mandibular molars: An in vitro study

Background

Guided conservative endodontic access is a novel technique and the influence of such access cavities on apical debris extrusion (ADE) can have a significant effect on postoperative pain.

Objective

This study compared ADE and preparation time (PT) in the mesial canals of the mandibular first permanent molars in different access cavity designs and the amount of sodium hypochlorite in the extruded debris using attenuated total reflection-Fourier transform infrared spectrometer (ATR-FTIR).

Materials and Methods

Human mandibular first permanent molars (N = 72) were selected and randomly divided into six groups (n = 12) based on type of cavity design and files used: Group 1, Conservative Access Cavity [ConsAC])-WaveOne Gold; Group 2, ConsAC-Mtwo; Group 3, ConsAC-XP-endo shaper; Group 4, Traditional Access Cavity [TradAC])-WaveOne; Group 5, TradAC-Mtwo; and Group 6, TradAC-XP-endo shaper. All the ConsAC were prepared with a customized template fabricated using cone beam computed tomography. ADE evaluation was done using the Myers and Montgomery set up. All the instruments were used according to the manufacturers' instructions, followed by a final irrigation using Endoactivator. The time taken for preparation was calculated using a digital watch. Five samples in each group was taken and subjected to ATR-FTIR analysis.

Results

There was no significant difference between the groups with respect to ADE (P > 0.05). Whereas, a statistically significant difference was seen in PT between the TradAC and ConsAC (P < 0.05). Using ATR-FTIR, it was found that all the samples of extruded debris had the presence of sodium hypochlorite.

Conclusions

All instrumentation systems produced ADE irrespective of access cavity design. The time taken for preparation of canals in ConsAC was significantly longer compared to TradAC.

Clinical Relevance

ADE can translate clinically as postoperative pain. Assessing the ADE in ConsAC could shed light on the type of file systems that can be used in such cavities in order to minimize postoperative pain clinically.

Comparison of Apical Extrusion of Bacteria After Glide Path Preparation Between Manual K File, One G Rotary, and WaveOne Gold Glider Reciprocation Preparations

Objective:

To compare the amount of apically extruded bacteria between hand-filed preparations, rotary and reciprocation glide path preparations in curved canals of extracted teeth infected with Enterococcus faecalis.

Methods:

Forty mandibular first molar teeth were decoronated, fitted into rubber stoppers and fixed onto glass vials. The mesiobuccal canals from mandibular first molar teeth were infected with Enterococcus faecalis, then randomly assigned to one of five groups for glide path preparation: manual stainless-steel file (K-files), rotary file (One G), reciprocating file (WaveOne Gold Glider) and two control groups. After glide path preparation, 0.01 mL of saline was taken from the experimental vials. The solution was plated on tryptic soy agar and colonies of bacteria were counted as colony-forming units. The results were analysed statistically using Kruskal-Wallis and post hoc Mann-Whitney U tests.

Results:

The manual K-file group was associated with significantly more bacteria extrusion compared to the rotary and reciprocating groups (P<0.05). However, no significant difference occurred between rotary and reciprocation instruments.

Conclusion:

All instrumentation techniques resulted in a measurable amount of apical extrusion of bacteria. Manual K-files extruded the highest quantity of bacteria compared to One G rotary file and WaveOne Gold Glider reciprocation file during glide path preparation.

Apical debris extrusion of full-sequenced rotary systems in narrow ribbon-shaped canals

The apically extruded debris caused by TruNatomy System (TRN), RACE EVO system (RE) and VDW Rotate (VR) systems in mandibular anterior teeth with ribbon-shaped root canals were compared. The root canals (n = 20 in each group) were irrigated with NaOCl 2.5%, and the extruded debris was collected at pre-weighted Eppendorf tubes. The amount of apically extruded debris (mg) and the treatment time (s) were recorded. Tukey pairwise comparisons were performed to compare groups with a 95% confidence level. VR had significantly less debris extrusion values and treatment time than RE and TRN (P < 0.05). Although no difference was observed between RE and TRN in terms of apically extruded debris (P > 0.05), a significant difference in favour of RE was observed in terms of treatment time (P < 0.05). All the instruments extruded debris at varying weights.

Apically extruded debris associated with ProTaper Next, ProTaper Gold and TruNatomy systems: An in vitro study

Background. This research aimed to investigate and compare the amount of apically extruded debris after root canal preparation using ProTaper Next, ProTaper Gold, and TruNatomy systems. Methods. Forty-five extracted mandibular premolar teeth with single canals with similar lengths were used. The root canals were prepared using ProTaper Next (Dentsply Maillefer, Ballaigues, Switzerland), ProTaper Gold (Dentsply Maillefer, Ballaigues, Switzerland), or TruNatomy (Dentsply Maillefer, Ballaigues, Switzerland) files. Apically extruded debris during preparation was gathered into preweighed Eppendorf tubes. Then the Eppendorf tubes were incubated at 70°C for five days. The Eppendorf tubes were weighed again to determine their final weight plus the extruded debris. Results. The TRN system resulted in significantly less debris extrusion than the PTN system (P <0.05). There was no significant difference between the PTN and PTG groups and between the PTG and TRN groups (P >0.05). Conclusion. All the instrumentation systems caused apical extrusion of debris. However, the TRN system resulted in significantly less debris extrusion than the other systems.

Evaluating In Vitro Performance of Novel Nickel-Titanium Rotary System (TruNatomy) Based on Debris Extrusion and Preparation Time from Severely Curved Canals

INTRODUCTION

This laboratory-based study aimed to investigate the quantitative amount of apically extruded debris from severely curved root canals and the preparation time for the novel rotary system TruNatomy (TN; Dentsply Sirona, Charlotte, NC) compared with Reciproc Blue (RCB; VDW Dental, Munich, Germany), HyFlex (HyFlex Controlled Memory [HCM; Coltene/Whaledent, Altstatten, Switzerland] and HyFlex EDM [HEDM, Coltene/Whaledent]), and ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland) rotary systems.

METHODS

One hundred mandibular molar human teeth with severe curvature of the mesiobuccal canal (25°-45°) were included in the present study. The specimens were randomly distributed into 5 balanced groups (n = 20): TN, RCB, HCM, PTN, and HEDM. The amount of extruded debris for each group during instrumentation at body temperature was collected in an Eppendorf tube. After desiccation, the mean debris weights for each group were calculated. The total preparation time for each group was also recorded. Data were statistically analyzed using the Kruskal-Wallis test at a significance level of P < .05.

RESULTS

The HCM and HEDM groups extruded a significantly higher amount of debris than the other tested groups (P < .001). TN extruded the least amount of debris, but it was not significantly different compared with the RCB and PTN groups (P > .05). In terms of preparation time, the TN group did not show any significant difference compared with the other groups.

CONCLUSIONS

All instrumentation systems extruded debris. TN was among the groups that produced the lowest amount of apically extruded debris that is clinically acceptable. The amount of apically extruded debris using the TN system was equal to 2 popular systems and statistically significantly less than 2 other popular systems studied.

Postoperative pain after ultrasonically and laser-activated irrigation during root canal treatment: a randomized clinical trial

AIM

To compare the intensity of postoperative pain after primary root canal treatment of asymptomatic teeth when using ultrasonically (UAI) or laser-activated irrigation (LAI).

METHODOLOGY

In this superiority randomized clinical trial (ClinicalTrials.gov ID: NCT03981237) with parallel design, fifty-six patients with an asymptomatic tooth in need of primary root canal treatment were enrolled. After chemo-mechanical canal preparation using rotary instruments and NaOCl irrigation, teeth were randomly assigned to two groups and patients were blinded to the final irrigation protocol. In the UAI group (n = 28), 60s activation with an Irrisafe tip was done per canal. In the LAI group (n = 28), NaOCl was activated with a pulsed Er:YAG (2940 nm) laser, equipped with a conical tip, with settings of 50 µs, 20 mJ at 15 Hz for 60 s. Patients recorded their pain intensity 6, 24, 48 and 72 h after treatment on a 100 mm visual analogue scale (VAS), as well as their analgesic consumption. Pain levels and incidence were compared across groups using the Mann-Whitney U-test and chi-square test.

RESULTS

Overall, mean postoperative pain intensity was low, with the majority of patients having no or minimal pain 24 h postoperatively. At 6 h postoperatively, pain intensity and incidence were significantly higher in the UAI group compared to the LAI group (P < 0.05). For the other time intervals, no significant differences in postoperative pain incidence or intensity were found. The frequency of analgesic intake did not differ significantly between the two groups. Neither of the activation methods resulted in any adverse effects.

CONCLUSIONS

Ultrasonically and laser-activated irrigation resulted in low and comparable levels of postoperative pain in asymptomatic patients receiving primary root canal treatment.

Association between polymorphisms in catechol-O-methyl transferase, opioid receptor Mu 1 and serotonin receptor genes with postoperative pain following root canal treatment

AIM

To evaluate the effect of single nucleotide polymorphisms in the COMT, OPRM1, 5HT1A, 5HT2A and 5HTR3B genes on the intensity of postoperative pain following root canal treatment.

METHODOLOGY

Ninety-five patients with mandibular and maxillary molar teeth diagnosed with symptomatic apical periodontitis and a level of preoperative pain greater than 50 on a 100 mm visual analogue scale (VAS) were included. Salivary DNA was collected from the participants and stored in Eppendorf tubes at -80 °C. Preoperative percussion pain values were recorded before the root canal treatment procedures. After completion of root canal treatment, the participants were given instructions to record their postoperative pain intensity levels at 24, 48 and 72 h, 5 days and 1 week after treatment, using the VAS. A second visit for the patients after seven days was planned to record their intensity levels of percussion pain on VAS. The percussion test was performed by tapping on the occlusal surface of the tooth with a blunt instrument. A QIAamp DNA Mini Kit was used to isolate DNA from saliva, and SNP Genotyping Analysis software version 1 was used to analyse the genotypes by calculating FAM and HEX signals. The Kruskal-Wallis and Mann-Whitney U-tests were used to evaluate pain intensity values amongst the genotypes, alleles, haplotypes and allele combinations. Nominal data (gender, intake and tooth number) were analysed using a Chi-square test. Bonferroni correction was performed. Thus, the significance level was set at 1.6% (P = 0.016), 2.5% (P = 0.025) and 1.25% (P = 0.0125) for genotype, allele and haplotype comparisons, respectively.

RESULTS

There was no significant difference amongst the genotypes and alleles in terms of pre- and postoperative pain intensity. There was no significant difference amongst the haplotypes formed for the COMT gene in terms of pain intensity. Additionally, there was no significant association between the allelic combination formed for 5HT1A + 5HT2A genes and the intensity of postoperative pain.

CONCLUSION

The findings indicate that none of the evaluated SNPs for COMT, OPRM1, 5HT1A, 5HT2A and 5HTR3B genes were associated with the intensity of postoperative pain.

Shaping ability and apical debris extrusion after root canal preparation with rotary or reciprocating instruments: a micro-CT study

Objectives

The aim of this study was to evaluate the shaping ability of the TruShape and Reciproc Blue systems and the apical extrusion of debris after root canal instrumentation. The ProTaper Universal system was used as a reference for comparison.

Materials and Methods

Thirty-three mandibular premolars with a single canal were scanned using micro-computed tomography and were matched into 3 groups (n = 11) according to the instrumentation system: TruShape, Reciproc Blue and ProTaper Universal. The teeth were accessed and mounted in an apparatus with agarose gel, which simulated apical resistance provided by the periapical tissue and enabled the collection of apically extruded debris. During root canal preparation, 2.5% sodium hypochlorite was used as an irrigant. The samples were scanned again after instrumentation. The percentage of unprepared area, removed dentin, and volume of apically extruded debris were analyzed. The data were analyzed using 1-way analysis of variance and the Tukey test for multiple comparisons at a 5% significance level.

Results

No significant differences in the percentage of unprepared area were observed among the systems (p > 0.05). ProTaper Universal presented a higher percentage of dentin removal than the TruShape and Reciproc Blue systems (p < 0.05). The systems produced similar volumes of apically extruded debris (p > 0.05).

Conclusions

All systems caused apically extruded debris, without any significant differences among them. TruShape, Reciproc Blue, and ProTaper Universal presented similar percentages of unprepared area after root canal instrumentation; however, ProTaper Universal was associated with higher dentin removal than the other systems.

Effect of Rotary and Reciprocating Instrumentation Motions on Postoperative Pain Incidence in Non-Surgical Endodontic Treatments: A Systematic Review and Meta-Analysis

OBJECTIVE

A systematic review and meta-analysis were conducted to determine whether there are postoperative pain differences resulting from rotary and reciprocation engine-driven instrumentation motions in non-surgical endodontic treatment or retreatment at 12, 24, and 48 hours.

METHODS

Four electronic databases (PubMed, Embase, Cochrane Library, and Scopus) were searched to identify randomised controlled trials that compared the effects of rotary and reciprocating instrumentation motions on postoperative pain. Two authors independently screened the search results, extracted the data, and assessed the quality using the Cochrane risk of bias tool. Due to numerous variables across studies, the random effect inverse variance method for meta-analysis was applied. When significant heterogeneity among studies was present, the random effects multi-variable meta-regression analysis was performed to determine the source of heterogeneity.

RESULTS

At all time intervals, the incidence of postoperative pain was higher in the reciprocating instrumentation group, but was not statistically significant. There was no significant difference in the analgesic intake between groups. Meta-regression analysis determined study population sizes as a significant heterogeneous factor, while significance was not observed for preoperative pain or the pulpal diagnosis.

CONCLUSION

There was no difference in postoperative pain at 12, 24, and 48 hours after non-surgical root canal treatment and retreatment, using reciprocating or rotary instrumentation motions.

Comparative evaluation of apical extrusion of intracanal bacteria using ProTaper Next, Mtwo, and ProTaper rotary systems: An in vitro study

Aim:

The aim of this study was to evaluate the number of intracanal bacteria extruded apically after instrumentation with three different nickel–titanium rotary instruments.

Materials and Methodology:

Forty freshly extracted mandibular premolars were selected, access cavities were prepared, and the teeth were mounted in the bacterial collection apparatus. Root canals were contaminated with a suspension of Enterococcus faecalis and incubated for 24 h at 37°C. The contaminated teeth were divided into four groups of 10 teeth each according to the rotary system used for instrumentation: Group 1: ProTaper universal files, Group 2: MTwo files, Group 3: ProTaper Next files, and Group 4: Control group (no instrumentation). Bacteria extruded after preparations were collected into vials. The number of colony-forming units (CFUs) was determined for each sample.

Statistical Analysis:

The data obtained were analyzed using the one-way analysis of variance followed by post hoc Tukey’s test with a P = 0.05 as the level for statistical significance.

Results:

The results suggested a statistically significant difference in the number of CFUs between four experimental groups (P < 0.001).

Conclusion:

Least amount of bacterial extrusion was seen in ProTaper Next Group while more bacterial extrusion was seen in MTwo Group.

Postoperative Pain After the use of Sodium Hypochlorite gel and Solution Forms: A Randomized Clinical Study

OBJECTIVE

The present study aimed to compare the effect of sodium hypochlorite (NaOCl) gel and solution forms on postoperative pain level.

METHODS

Fifty-two patients were divided into two groups according to the root canal irrigation solution. In the NaOCl solution group, the root canals were irrigated with 2 mL of 5.25% NaOCl between each pecking motion. In the NaOCl gel group, 5.25% NaOCl gel was used according to the manufacturer's instructions. The root canal treatments were completed and the participants were given instructions to record postoperative pain levels on 24, 48, and 72 hours and 1 week after treatment using VAS.

RESULTS

Intergroup analyses revealed that the NaOCl gel group resulted in significantly less postoperative pain than the NaOCl solution group on day 1.

CONCLUSION

It can be concluded that using NaOCl gel during root canal preparation results in less postoperative on day 1 when compared with the NaOCl solution.

Assessment of various endodontic instrumentation systems on the amount of apically extruded bacteria - An in vitro study

Aim:

The objective of this in vitro study was to assess the effect of different endodontic instrumentation systems on the amount of apically extruded bacteria.

Materials and Methods:

One hundred and twenty freshly extracted human mandibular premolars with single canal were collected. Endodontic access cavities were prepared and then contaminated with an Enterococcus faecalis suspension (ATCC 29212). After incubation at 37°C for 24 h, the root canals were instrumented with K flare files, F360 Single file system, K3XF files, Heroshaper files, Protaper Next files, and Hyflex EDM Single file system. During instrumentation, apically extruded bacteria were collected in the vials containing 0.9% NaCl. Samples were taken from the vials and incubated in brain–heart infusion agar medium for 24 h.

Statistical Analysis:

The number of colony-forming units was determined, and data were statistically analyzed using one-way analysis of variance and post hoc Tukey test.

Conclusions:

Both rotary and hand instrumentation systems extruded intracanal bacteria through the apical foramen, Group 1 (Hand K Flare files) showed maximum, whereas, Group 5 (Protaper Next) and Group 6 (Hyflex EDM) showed the least extrusion.

Can kinematics, file diameter, and PUI influence the intracanal decontamination and apical bacterial extrusion?

The present study investigated the intracanal decontamination and apical extrusion of bacteria and debris from root canals instrumented with rotary and reciprocating systems (ProDesign Logic or ProDesign R), with different file diameters and using conventional syringe irrigation (CSI) or passive ultrasonic irrigation (PUI). Eighty extracted mandibular premolars were contaminated with Enterococcus faecalis and randomly assigned to eight experimental groups according to the root canal instrumentation and irrigation technique employed (n = 10): G1: Prodesign Logic 25.06; G2: Prodesign R 25.06; G3 and G4 were instrumented with the same single-file systems, respectively, using 35.05 diameters and CSI. G5, G6, G7, and G8 were instrumented like the previous groups, but with PUI. Apically extruded debris during instrumentation was collected into pre-weighed microtubes. The weight of the empty microtube was subtracted from the final weight to establish the amount of extruded debris. Bacteria from root canals and extruded debris were collected for a microbiological evaluation of colony forming units (CFU/mL). For statistical analyses, the Mann-Whitney and Kruskal-Wallis followed by the Dunn's tests were used (α = 0.05). All instruments caused extrusion of debris. For irrigation techniques, PUI promoted greater debris and bacterial extrusion (p < 0.05). The CFU/mL count indicated that the instrumentation of the experimental groups were equally effective in the decontamination of the root canal (p > 0.05). The systems tested (regarding file diameter and kinematics) were associated with similar amounts of apically extruded debris and root canal decontamination. PUI was associated with greater debris and bacterial extrusion.

Effect of preoperative oral administration of steroids in comparison to an anti-inflammatory drug on postoperative pain following single-visit root canal treatment - a double-blind, randomized clinical trial

AIM

This randomized, double-blinded, clinical trial evaluated the effect of oral premedication of piroxicam, prednisolone, dexamethasone or placebo on postoperative pain after single-visit root canal treatment in teeth with symptomatic irreversible pulpitis and symptomatic apical periodontitis.

METHODOLOGY

The trial is reported according to the Preferred Reporting Items for RAndomized Trials in Endodontics (PRIRATE) 2020 guidelines. The protocol was registered at the clinical trial registry (India) (CTRI/2019/06/019818). In total, 160 patients, assigned to four groups, received orally either 20 mg piroxicam, 20 mg prednisolone, 4 mg dexamethasone or a placebo 60 min before root canal treatment. Patients recorded their postoperative pain intensity at 6, 12, 24, 48 and 72 h using a 10-cm visual analogue scale. Intergroup comparison was performed using Kruskal-Wallis tests with post hoc analysis using Dunns test. Incidence of pain was analysed using chi-square tests. A P value < 0.05 was considered to be statistically significant. Binary logistic regression was used to determine the odds of postoperative pain, with incidence of pain as the dependent variable and intervention groups, gender, age and type of tooth as independent variables.

RESULTS

In total, 156 patients were analysed in the trial, since four patients dropped out during follow-up. All drugs were associated with a significantly lower incidence of postoperative pain compared to the placebo at 6 h (P = 0.009), 12 h (P = 0.003) and 24 h (P = 0.008). Mean intensity of pain was significantly more intense at 6, 12 and 24 h with the use of placebo in comparison to the other three intervention groups (P < 0.05). Intensity of pain was not significantly different between the premedications used (P > 0.05). One patient in the piroxicam group reported gastritis, whereas no adverse effects were recorded in other groups.

CONCLUSION

Preoperative oral administration of a single dose of 4 mg dexamethasone, 20 mg piroxicam or 20 mg prednisolone reduced the incidence and severity of postoperative pain following single-visit root canal treatment compared to a placebo in patients with symptomatic irreversible pulpitis and symptomatic apical periodontitis up to 24 h. The odds of postoperative pain at 24 h for patients premedicated with 4 mg dexamethasone or 20 mg piroxicam or 20 mg prednisolone were 5.3 times, 3.4 times and 2.5 times less compared to the placebo, respectively.

Effects of antibiotic administration on post-operative endodontic symptoms in patients with pulpal necrosis: A systematic review and meta-analysis

OBJECTIVES

The current systematic review and meta-analysis aimed to assess the efficacy of prophylactic oral antibiotics in the management of post-operative endodontic symptoms in adults with necrotic pulp.

MATERIALS AND METHODS

A systematic search up to April 2020 was performed to find all randomised controlled trials (RTCs) comparing oral antibiotics with placebo to manage post-endodontic symptoms. The outcome measures were post-operative pain, swelling and/or the combined pain and swelling at different follow-ups. Standardised mean differences (SMDs) and 95% confidence intervals (CIs) were estimated using random-effect inverse-variance method. Additional analysis was performed if heterogeneity existed (P < .05).

RESULTS

For post-endodontic pain, 8 RCTs (n = 690) were included. Antibiotic prescription had no significant effect on endodontic pain at 6 (SMD = -0.008, 95% CI -0.279 - 0.264, P = .95), 12 (SMD = -0.080, 95% CI -1.39 - 1.23, P = .90), 24 (SMD = -0.044, 95% CI -0.29 - 0.20, P = .72), 48 (SMD = 0.18, 95% CI -0.26 - 0.62, P = .42) and 72 h (SMD= -0.050, 95% CI -0.33 - 0.23, P = .723) post-operatively. For post-endodontic swelling, 4 RCTs (n = 149) were included. Antibiotic prescription had no significant effect on endodontic swelling at 24 (SMD = 0.29, 95% CI -0.72 - 1.32, P = .56), 48 (SMD = -0.23, 95% CI -0.98 - 0.51, P = .54) and 72 hours (SMD= -0.03, 95% CI -1.25 - 1.33, P = .96), post-operatively. For combined pain and swelling, no meta-analysis was performed.

CONCLUSION

The administration of prophylactic antibiotics to prevent post-operative endodontic symptoms is not supported by the current evidence.

Apical extrusion of debris with different rotary and reciprocating single-file endodontic instrumentation systems: a systematic review and meta-analysis protocol

INTRODUCTION

Root canal treatment is one of the oldest dental procedures for the treatment of endodontic infection. Extrusion of debris beyond the root apex during root canal instrumentation and subsequent persistence of pain are common complications. A systematic review of the evidence on reciprocating single-file instrumentation systems and their comparison with rotary single-file systems, with apical extrusion of debris as primary outcome, will be done through this study.

METHODS AND ANALYSIS

Published ex vivo and in vitro studies with no language restriction will be included. We will search MEDLINE (Ovid), EMBASE (Ovid), Web of Science, Cochrane and Google Scholar. Strategies will be incorporated to search grey literature also. Thorough evaluation of search results, completion of data abstraction and assessment of quality will be done by two reviewers independent from each other. Assessment of included studies will be done by utilising an evidence model developed on the basis of standards of quality reported in guidelines to document ex vivo and in vitro studies regarding dental materials and pertained for extrusion of debris apically and has been already used in quality assessment of studies involving quantification of debris extrusion apically. We will calculate the standardised mean differences for apically extruded debris, with congruent 95% CIs. We will measure the statistical heterogeneity by applying the Cochrane Q test and quantify using the I² statistic. Existence of covariates and any potential heterogeneity will be explored through prespecified subgroup and sensitivity analyses.

ETHICS AND DISSEMINATION

Approval from an ethical research committee is not required because it will be done using data that have been already published and have no concerns related to the privacy of patients. Extensive dissemination of results from this review will be done through submission to a peer-reviewed journal for publication and conferences.

PROSPERO REGISTRATION NUMBER

CRD42019151804.

Effects of the endodontic access cavity on apical debris extrusion during root canal preparation using different single-file systems

Objectives

This study was conducted to evaluate the effects of traditional and contracted endodontic cavity (TEC and CEC) preparation with the use of Reciproc Blue (RPC B) and One Curve (OC) single-file systems on the amount of apical debris extrusion in mandibular first molar root canals.

Materials and Methods

Eighty extracted mandibular first molar teeth were randomly assigned to 4 groups (n = 20) according to the endodontic access cavity shape and the single file system used for root canal preparation (reciprocating motion with the RCP B and rotary motion with the OC): TEC-RPC B, TEC-OC, CEC-RPC B, and CEC-OC. The apically extruded debris during preparation was collected in Eppendorf tubes. The amount of extruded debris was quantified by subtracting the weight of the empty tubes from the weight of the Eppendorf tubes containing the debris. Data were analyzed using 1-way analysis of variance with the Tukey post hoc test. The level of significance was set at p < 0.05.

Results

The CEC-RPC B group showed more apical debris extrusion than the TEC-OC and CEC-OC groups (p < 0.05). There were no statistically significant differences in the amount of apical debris extrusion among the TEC-OC, CEC-OC, and TEC-RPC B groups.

Conclusions

RPC B caused more apical debris extrusion in the CEC groups than did the OC single-file system. Therefore, it is suggested that the RPC B file should be used carefully in teeth with a CEC.