Apical extrusion of debris and irrigants using two hand and three engine-driven instrumentation techniques

Assessment of apical extrusion in regenerative endodontics: a comparative study of different irrigation methods using three-dimensional immature tooth models

To investigate the apical extrusion of sodium hypochlorite in immature permanent teeth caused by conventional syringe irrigation (CSI), EDDY, XP-endo Finisher file (XP-F), and a new laser irrigation activation system [shock-wave-enhanced-emission-photo-acoustic-streaming (SWEEPS)]. Three-dimensionally printed forty-nine teeth with immature central incisor morphology were randomly assigned to seven experimental groups, based on the irrigation activation methods and insertion depths (1 mm and 2 mm short of the working length) as follows: CSI-1, CSI-2, EDDY-1, EDDY-2, XP-1, XP-2, and SWEEPS. Prior to the irrigation activation process, samples were placed in metacresol mixed agar gel in Eppendorf tubes. To evaluate NaOCI extrusion into the gel, each sample was digitally photographed, and the area of apical extrusion was analyzed using ImageJ software. To examine potential significant differences between the continuous variables, the Mann-Whitney U test and Kruskal-Wallis H test, were applied (P = .05). The SWEEPS resulted in a greater amount of apical extrusion compared to the CSI method, regardless of the insertion depth (P < 0.001). The SWEEPS resulted in greater apical extrusion scores compared to EDDY-2 (P < 0.001). The EDDY-1 resulted in greater amount of apical extrusion scores compared to EDDY-2 (P < 0.001). This study, the first to show the effect of the novel SWEEPS technology on NaOCI extrusion, found that irrigation activation can cause different levels of apical extrusion depending on the method and distance from the working length. It is crucial to consider the potential occurrence of apical extrusion when applying activation methods to immature teeth.

Substance P/calcitonin gene-related peptide and their receptors expression in human periodontal ligament after root canal preparation with five different systems

AIM

The purpose of this study was to quantify the effect of five different root canal preparation instruments on Substance P (SP), Calcitonin gene-related peptide (CGRP) and their receptors expression in healthy human periodontal ligament.

METHODOLOGY

STROBE guidelines were used to design a study using 60 periodontal ligament samples obtained from healthy lower premolars where extraction was indicated for orthodontic reasons. Prior to extraction 40 of these premolars were equally divided into four groups and root canals were prepared using different systems: Mtwo, Reciproc Blue, HyFlex EDM and Plex-V. Ten premolars were prepared with hand files and served as a positive control group. The remaining 10 premolars where extracted without treatment and served as a negative control group. All periodontal ligament samples were processed to measure the expression of SP, CGRP and their receptors by radioimmunoassay. Kruskal-Wallis and Duncan tests were performed to determine statistically significant differences between the groups for each variable.

RESULTS

Greater expression of all the peptides measured were found in the hand-file preparation group, followed by the Reciproc Blue, Mtwo, HyFlex EDM and Plex-V groups. The lower SP, CGRP and their receptors values were for the intact teeth control group. Kruskal-Wallis test showed statistically significant differences amongst groups (p < .001). Dunn post-hoc tests showed statistically significant differences in SP, CGRP and their receptors expression between the intact teeth and the hand-file and Reciproc Blue groups. Hand-file group showed significant differences with the other groups, except with Reciproc Blue, where no differences were observed in any of the peptides measured. Finally, no differences were observed between Plex-V and HyFlex in any of the peptides measured.

CONCLUSIONS

Root canal preparation with hand files and Reciproc Blue generates the highest expression of SP, CGRP, NK1 and CGRP1R in human periodontal ligament, whilst Plex-V and HyFlex maintain the basal expression of neuropeptides and their receptors. Mtwo showed intermediate results between Reciproc Blue and HyFlex.

Assessment of Bacterial Load and Post-Endodontic Pain after One-Visit Root Canal Treatment Using Two Types of Endodontic Access Openings: A Randomized Controlled Clinical Trial

The need for controlling bacteria and pain during root canal therapy is undeniable. This clinical trial aimed to assess whether there is a difference in colony-forming unit (CFU) reduction after instrumentation and post-endodontic pain after root canal treatment (RCT) using a traditional endodontic cavity (TEC) versus a conservative endodontic cavity (CEC). This clinical study was conducted on 89 patients designated for a single-visit RCT. Patients were allocated randomly (TEC n = 45 and CEC n = 44). The access opening was gained accordingly in each group by a single operator. A pre-instrumentation sample of root canal dentin was collected using an endodontic file; the second sample was collected similarly, right after shaping and cleaning the root canal. The CFU was calculated based on the samples collected. The pain level was recorded preoperatively and at 1, 7, and 21 days postoperatively utilizing a visual analog scale (VAS). There were no statistically significant differences in the CFU reduction between the TEC and CEC groups (p > 0.05). Additionally, there were no statistically significant differences found in postoperative pain levels between the TEC and CEC at 1, 7, and 21 days (p > 0.05). Despite the limitations of this study, both the CEC and TEC demonstrate a decrease in bacteria within the root canals and alleviate postoperative pain with no difference between them.

Microscopic Evaluation of Dentinal Defects after Root Canal Preparation with Different Hand and Nickel-Titanium Files; An In Vitro Study

Background

Effective endodontic instrumentation aims to remove microorganisms, debris, and tissue from the root canal while maintaining dentinal integrity. This study compares dentinal defect incidence following canal preparation with different hand files, nickel-titanium rotary files, and reciprocating files.

Materials and Methods

Eighty single-rooted mandibular premolars with mature apices were collected. Four groups (n = 20) were established based on canal patency establishment, canal preparation technique, irrigation solution, and final irrigation. After root sectioning at 3 mm, 6 mm, and 9 mm from the apex, slices were examined under a stereomicroscope, and dentinal defects were recorded. A second examiner reviewed the images.

Results

The results showed significant difference of P = 0.031 among Hand files vs. Rotary ProTaper files: In Hand files vs. Reciprocating WaveOne files significant difference was P = 0.048, and for rotary ProTaper files vs. Reciprocating WaveOne files: No significant difference (P = 0.643). Dentinal defect counts were similar at 3 mm, 6 mm, and 9 mm. Statistically significant variation was observed between hand files and rotary files, as well as hand files and reciprocating files.

Conclusion

Both rotary and reciprocating files showed a statistically significant increase in dentinal defect incidence compared to hand files. However, clinical implications should be considered cautiously. Instrumentation technique selection should be based on clinical context, operator experience, and patient factors. Further clinical studies are needed for validation.

Influence of endodontic motors on the behaviour of root canal shaping instruments: an in vitro comparative study

AIMS

The endodontic literature reports a lot of comparative study on endodontic instruments, concerning as well their geometry, instrumental dynamics, material, mechanical behavior or heat treatment. However, to our knowledge, no study has focused on the influence of endodontic motors on the shaping abilities of endodontic instruments. Thus, the aim of this study was to analyze the influence of the endodontic motors on root canal shaping instruments.

METHOD

Dual Move (MICRO-MEGA, Besançon, France), Canal Pro CL2i (COLTENE, Alstätten, Suisse), Canal Pro Jeni Motor (COLTENE, Alstätten, Suisse), Ai Motor (WOODPECKER, Guilin, China), Wave One motor (VDW, Postfach, Munich) and Smart A (WOODPECKER, Guilin, China) were pre-clinically compared in continuous rotation and reciprocating motion on a traction/compression bench using resin blocks. Canal shaping in continuous rotation and reciprocating motion were performed with One Curve and One RECI instruments (MICRO-MEGA, Besançon, France), respectively. The penetration/removal forces, making it possible to objectify the cutting effect and screwing effect of the instruments during root canal shaping, were analyzed.

RESULTS

The results showed (i) that endodontic motors influence the mechanical behavior of endodontic instruments, (ii) that the influence of the motors is essentially felt during reciprocating motion and (iii) that the reciprocating angles influence the mechanical behavior of endodontic instruments.

CONCLUSION

Only endodontic instruments are widely studied in literature while endodontic motors have a direct influence on root canal treatment. This study analyzes the influence of the endodontic motors on root canal shaping instruments. This study tends to demonstrate that Jeni Motor could optimize the mechanical behavior of endodontic instruments.

In vitro apical extrusion of debris and instrumentation time following root canal instrumentation with Reciproc and Reciproc Blue instruments and a novel stainless steel rotary system (Gentlefile) versus manual instrumentation

Background

This study compared apical extrusion of debris and instrumentation time following root canal instrumentation with Reciproc, Reciproc Blue, and Gentlefile (GF) rotary instruments versus the manual step-back technique.

Methods

This in vitro study was conducted on 80 extracted mandibular premolars with mature apices and a root curvature of<10°. The teeth were randomly assigned to 4 groups (n=20), standardized regarding working length, and placed in pre-weighed vials. The root canals were instrumented with Reciproc, Reciproc Blue, and GF systems and the manual step-back technique in the four groups. The vials containing the collected debris were then dried and weighed. The instrumentation time was also recorded for each group. Data were analyzed with one-way ANOVA and post hoc Games-Howell test (α=0.05).

Results

Minimum apical debris extrusion was noted in Reciproc, followed by Reciproc Blue, GF, and manual technique (P<0.05). Pairwise comparisons showed significantly lower apical extrusion of debris in the Reciproc compared with GF (P=0.015) and manual instrumentation (P=0.011) groups. The Reciproc system also had the shortest instrumentation time, followed by Reciproc Blue, GF, and manual instrumentation (P<0.05). Pairwise comparisons showed significant differences between all the systems (P<0.05) except between Reciproc and Reciproc Blue (P>0.05) in this respect.

Conclusion

Although all systems caused apical extrusion of debris, manual instrumentation caused maximum extrusion of debris. In contrast, the Reciproc system was superior to others regarding minimal apical extrusion of debris and the shortest instrumentation time.

The effect of different kinematics on apical debris extrusion with a single-file system

To compare the amount of extruded debris caused by different motions using a single-file system. Fifty mandibular first molar teeth were randomized into 5 groups (n = 10) according to the motion tested: Optimize Torque Reverse (OTR), TF Adaptive Motion (TFA), continuous rotation (CR), reciprocation motion (+ 150°, -30°) (REC), and Jeni motion (Jeni). One Curve single file 25/06 (Micro-Mega, Besançon, France) was used in all experimental groups. The root canals were irrigated with 2.5% NaOCl, and the extruded debris were collected at pre-weighted glass vials. The glass vials were kept inside an incubator for one week at 70 °C to dry out the irrigating solution. The extruded debris was quantified by subtracting the pre-instrumentation from the post-instrumentation weight of the glass vials. The time required for each instrumentation procedure was digitally recorded. All data were analyzed statistically with one way ANOVA and post hoc Tukey test (P < 0.05). All the motions extruded apically debris with Jeni mode caused significantly less debris extrusion than TFA, REC, and CR (P < 0.05) while no significant difference emerged with OTR. Preparation time was not significantly different in all groups. Within the limits of the present study, all the kinematics produced apically debris extrusion, with Jeni reporting a similar amount of debris compared with OTR and significantly less than TFA, REC, and CR. Preparation time was similar among the tested kinematics.

Apically extruded debris of different file systems used with various kinematic movements during retreatment: An in vitro study

This study aimed to examine the amount of apically extruded debris and time during retreatment with five current file systems, which exhibit various kinematic movements. One hundred upper central incisors were shaped with manual files and filled using the thermoplastic injection method. The root canal fillings in each group (n = 20) were removed using the Genius (GN), ProTaper Next (PTN), Reciproc (RCP) Blue, Tango-Endo (TE) and Twisted File Adaptive (TFA) file systems. The apically extruded debris was collected in preweighed Eppendorf tubes. Time to reach working length and total time were also recorded. The PTN, RCP Blue and TFA instruments caused significantly less apically extruded debris and shorter total retreatment time than the GN and TE file systems (p < 0.05). The time to reach the working length was the shortest in the PTN group compared to the other groups (p < 0.05). All file systems extruded debris while removing the root canal filling.

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.

Postoperative Pain Following Root Canal Instrumentation Using ProTaper Next or Reciproc in Asymptomatic Molars: A Randomized Controlled Single-Blind Clinical Trial

Aim: The development of postoperative pain following root canal instrumentation may impair patient’s comfort and undermine their trust in the dentist. This study assessed the effect of root canal instrumentation techniques (rotary (PTN; ProTaper Next®) and reciprocating (R; Reciproc®)) on the postoperative pain intensity (primary outcome) and tenderness on biting (secondary outcome) of patients’ asymptomatic molars. Methodology: This study protocol was registered with ReBec-WHO (U1111-1182-2800). From a pool of 112 patients evaluated for eligibility (healthy adults (≤18 years old)), with a single asymptomatic molar (maxillary or mandibular) indicated for root canal treatment, diagnosed with asymptomatic irreversible pulpitis (including chronic hyperplastic pulpitis), 75 were randomly allocated in similar proportions to receive the intervention (two-appointment root canal therapy) in either the PTN or R group. The allocated procedures were performed using standardized protocols. Participants (blinded to the instrumentation technique) rated their pain intensity at 6, 12 and 24 h and from day 2 to day 7 following the root canal instrumentation appointment using a VAS and an NRS; the ibuprofen tablets taken and the presence of tenderness on biting were recorded. The instrumentation time was registered. Univariate and multivariate statistics measured the effect of independent variables on the outcomes. Results: From the 75 patients allocated, 8 patients (4 from each group) were lost; in total, 33 patients were analyzed in the PTN group and 34 in the R group. The frequencies of postoperative pain (p > 0.05) and tenderness on biting (p > 0.05) were similar between groups. The medication intake (mean of 1.31 tablets) and the time of instrumentation (approximately 11 min) were similar between groups. Conclusion: ProTaper Next and Reciproc® caused a slight risk of tenderness on biting and contributed to similar self-reported postoperative pain (low intensity) up to 7 days following root canal shaping.

COMPARATIVE EVALUATION OF THE EFFECT OF DIFFERENT ROTARY INSTRUMENT SYSTEMS ON THE AMOUNT OF APICALLY EXTRUDED DEBRIS

Objectives: The purpose of our study is to examine in vitro the amount of debris extrusion from the apical after root canal preparation with different rotary instruments. Materials and Methods: In present study, 60 single root single-canal lower premolar human teeth were used. The teeth were randomly selected and divided into 4 main groups (n=15). Root canals are shaped by using 2Shape, One Curve and XP-3DEndo Shaper working in rotational motion and WaveOne Gold working reciprocal motion. Later, the weight of each eppendorf tube was weighed on a precision scale and the amount of debris extrusion from the apical was determined with 10ˉ4 precision by subtracting the empty weight of the tube. Since the parametric test assumptions were fulfilled in the evaluation of the data obtained regarding the amount of debris extrusion from the apical of file systems by loading them into the SPSS 22.0 program, One-Way Variance analysis was used and the level of error was taken as 0.05. Results: When the amount of debris extrusion from the apical is ordered from high to low, it was seen that there are 2Shape, One Curve, XP-Endo Shaper, WaveOne Gold. However, the difference between study groups was not statistically significant (p> 0.05). Conclusions: Considering the results obtained in terms of debris extrusion from the apical about the new generation files with different metallurgy, kinematics, structural features, designs and different configurations that we used ın present study, it was seen that these systems would not show any difference in terms of the effect of debris on the success of endodontic treatment.

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.

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 intracanal cryotherapy on postoperative pain after endodontic treatment: systematic review with meta-analysis

Objectives

This study aimed to evaluate the effectiveness of final irrigation with cold saline solution after endodontic treatment compared with saline solution at room temperature against postoperative pain following endodontic treatment.

Materials and Methods

A broad search was performed in the PubMed, Web of Science, Scopus, Cochrane Library, Virtual Health Library (LILACS), and Grey Literature databases. Two independent reviewers performed data extraction, risk of bias using the Cochrane methodology, and certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.

Results

Eight studies were included in qualitative synthesis. Intracanal cryotherapy favored the reduction of postoperative pain in the systematic review. Four studies were included in meta-analyses. The meta-analysis showed that intracanal cryotherapy reduced postoperative pain in teeth with symptomatic apical periodontitis (SAP) at 24 hours. There was no association between intracanal cryotherapy and control (room temperature) groups in teeth with normal periapical tissue with respect to postoperative pain at 24 hours and 48 hours.

Conclusions

Intracanal cryotherapy was effective in reducing postoperative pain after endodontic treatment in teeth with SAP.

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.

Comparative Evaluation of Hand K-flex Files, Pediatric Rotary Files, and Reciprocating Files on Instrumentation Time, Postoperative Pain, and Child's Behavior in 4-8-year-old Children

Background

A pulpectomy is regarded as the choice modality of treatment for necrotic teeth. The use of hand files, though popular traditionally as a gold standard, may be challenging due to increased chairside time. Postoperative pain is one of the most common complications of pulpectomy and may be unpleasant for a child/pedodontist. Rotary files were found to reduce instrumentation time, reduce apical extrusion, and in turn reduce pain but there is a lack of studies in primary teeth particularly for pediatric and reciprocating file systems. The increased number of options available today makes it a dilemma for the operator to choose a suitable file system.

Aim and objective

The study aimed to evaluate and compare the instrumentation time, postoperative pain, and effect on child's behavior among three groups, i.e., hand K-flex files (group I), pediatric rotary files (group II), and reciprocating files (group III).

Materials and methods

A total of 75 primary molar teeth after meeting inclusion criteria were randomly allocated into three groups. During the procedure, step-wise instrumentation time was recorded using a stopwatch. The child's behavior pre- and postoperatively was assessed by an evaluator. The postoperative pain (up to 1 week) was assessed by a questionnaire.

Results

The mean age of children taken for the study was 6.03 ± 1.2 years with 46 males and 29 females. The mean biomechanical preparation time was observed to be significantly shorter in the pediatric rotary and reciprocating file groups vs hand K-flex files (p < 0.001**). The postoperative pain after 6 hours had a mean value of 0.88 + 0.9 for the hand K-flex file group which was significantly higher than both rotary file groups (p < 0.05*). The pre- and postoperative behavior revealed no significant difference.

Conclusion

The clinical performance of pediatric and reciprocating files was superior, but the choice of file system did not significantly alter behavior.

How to cite this article

Tyagi R, Khatri A, Kalra N, et al. Comparative Evaluation of Hand K-flex Files, Pediatric Rotary Files, and Reciprocating Files on Instrumentation Time, Postoperative Pain, and Child's Behavior in 4–8-year-old Children. Int J Clin Pediatr Dent 2021;14(2):201–206.

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.

Comparison of canal transportation and centering ability of manual K-files and reciprocating files in glide path preparation: a micro-computed tomography study of constricted canals

Background

Optimum Glide Path (OGP) is a new reciprocating motion aiming to perform efficient glide path preparation in constricted canals. The aim of this study was to investigate and compare manual and OGP movement in terms of canal transportation and centering ability in glide path preparation of constricted canals.

Methods

Thirty constricted mesial root canals of mandibular molars, with initial apical size no larger than ISO#8, were selected and negotiated with #6–#8 K-files under the microscope. Canals were randomly divided into two experimental groups: Group 1 (MAN, n = 15): Glide path was established by using #10-#15 stainless steel K-files manually; Group 2 (OGP, n = 15): #10-#15 Mechanical Glide Path super-files were used with OGP motion (OGP 90°, 300 rpm). Each instrument was used to prepare only 2 canals (as in one mesial root). Canals were scanned before and after glide path preparation with micro-computed tomography (micro-CT) to evaluate root canal transportation and centering ratio at 1, 3 and 5 mm levels from the root apex. File distortions and separations were recorded. Paired t-test was used to statistically evaluate the data (P < .05).

Results

Group 2 showed a significantly lower transportation value than group 1 at 1-mm and 3-mm levels (P < .05), however the difference at 5-mm level was not significant. There was no significant difference regarding the centering ratio between the groups. Six #10 K-files were severely distorted in group 1, while no file separation or distortion was found in group 2.

Conclusions

OGP motion performed significantly less canal transportation (apical 3 mm) and file distortion during glide path establishment in constricted canals comparing to manual motion, while the centering ability between the two was similar.

Clinical relevance

OGP reciprocating motion provides a safer and efficient clinical approach compared to traditional manual motion in glide path establishment with small files in constricted canals.

Comparative evaluation of dentinal crack formation after root canal preparation with Neoendo Flex and Mani Silk files: An in vitro study

Context:

Neoendo Flex and Mani Silk are recently launched nickel–titanium (NiTi) rotary files. Dentinal cracks and file separation remain a critical problem in the endodontic domain.

Aim:

The aim was to evaluate and compare the incidence of dentinal crack formation after root canal preparation with Neoendo flex and Mani silk files.

Materials and Methods:

Thirty-six extracted single-rooted premolars with straight, single root canals were selected for the study. The specimens were randomly assigned to three groups, with 12 samples in each group. The root canal preparation for the three groups was done with hand K-file, Mani Silk, and Neoendo Flex files, respectively, following which the specimens were horizontally sectioned at 3, 6, and 9 mm from the apex. Sectioned samples were viewed under a stereomicroscope to determine the presence or absence of dentinal cracks. The data were analyzed using one-way ANOVA and Chi-square test.

Results:

Hand K-files and Mani Silk files produced a lesser number of cracks than Neoendo Flex files; however, the difference was not statistically significant among the three file groups at 3 mm and 6 mm (P > 0.05). A statistically significant difference between the groups was seen at 9 mm, where Mani Silk files produced fewer cracks than K files and Neoendo Flex files (P = 0.007). Overall, Neoendo Flex significantly produced more cracks than Mani Silk and hand K-files (P = 0.0029).

Conclusions:

Both hand K files and NiTi rotary instruments may cause dentinal cracks. Neoendo Flex files tend to produce more dentinal cracks than Mani silk and K-file.

Impact on Quality of Life of Patients Treated by Different File Systems for Root Canal Treatment

Introduction The outcomes of oral health conditions and therapy for those conditions are described by the term “oral health-related quality of life.” Oral health-related quality of life is recognized by the World Health Organization as an important part of the Global Oral Health Program. The study aims to compare the impact of three root canal preparation systems on patients’ quality of life and correlate postoperative pain with the impact on the quality of life.

Materials and Methods A survey was performed in which 90 patients were randomly assigned to three groups based on the root canal preparation system: (1) ProTaper Gold (Dentsply, Tulsa Dental Specialties, Tulsa, Oklahoma, United States), (2) Neoendo flex (Neoendo, India), and (3) Hyflex EDM/CM (Coltene Whaledent) that included 30 participants in each group. Data collection included the implementation of a demographic data questionnaire, Oral Health Impact Profile 14 (quality of life), and visual analogue scale(pain). The questionnaire was given after root canal treatment in the first 24 hours. The data obtained were statistically analyzed.

Results No significant differences were found in the quality of life among study groups. Group 1 demonstrated a highly significant difference in the postoperative pain with p value of 2.67.

Conclusion Within the limitations of the present study, Protaper Gold showed a highly significant difference in postoperative pain when compared with other file systems. No significant differences were found in the quality of life among the study groups.

An Arithmetic Crown-down Dynamic Tactile Instrumentation Technique: A Case Report of an S-shaped Root Canal

The preparation of severely curved S-shaped double-curved root canals can be technically challenging. A novel root canal instrumentation technique is proposed, which modifies 2 techniques: the McSpadden crown-down technique and the tactile controlled activation technique. In the McSpadden crown-down technique, the root canal is divided into 2 portions: the coronal zone and the apical zone. However, rather than focusing on the length of file engagement, a formula is proposed to calculate the maximum insertion depths of higher tapered instruments to prevent overflaring of the canal and preserve pericervical dentin. Tactile-controlled activation involves activating martensitic nickel-titanium rotary files upon engagement and then immediately withdrawing the files. The proposed technique recommends 3 apical strokes after the initial engagement before withdrawal to minimize instrumentation time. This novel technique is described in a case report involving the management of an S-shaped double-curved maxillary lateral incisor. The technique presents a new method of crown-down instrumentation that prevents overflaring and avoids instrument separation.

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.

Detection of Dentinal Microcracks in Radicular Dentin after Shaping with XP-endo Shaper, Neoendo Flex Files, and Hero Shaper Using Scanning Electron Microscope: An In Vitro Study

The study aimed to compare the extent of dentinal microcracks in the radicular dentin using hand K files and various types of rotary nickel-titanium (NiTi) file systems. Forty mandibular incisor teeth (human) were grouped for the study. The root apices were closed, and the canals were straight (<5°). The samples were divided into four groups (n = 10). Group 1-Hand K file system (SybronEndo, SA), Group 2-XP-endo Shaper (FKG Dentaire, La Chaux-de-Fonds, Switzerland), Groups 3-Neoendoflex file (Neoendo, Orikam, India), and Group 4-Hero Shaper files (Micro-Mega, Becacon, France). Sectioning was done at 3, 6, and 9 mm from the apex, perpendicular to the long axis using a diamond disc under water coolant. The cut samples were then observed through a scanning electron microscope at ×50 enlargement. The control group showed no microcracks except one sample in the coronal third, which was less significant. The difference in the amount of crack detected on comparing the different groups was significant. In the experimental groups, XP-endo Shaper group showed significantly less number of cracks than the Neoendo flex, and Hero Shaper groups. Within the limitations of this study, all the system, except hand K files, produced remarkable dentinal microcracks. Least cracks were seen in canals instrumented with XP-endo Shaper. It can also be noted that single file system causes less number of microcracks.

Apically extruded debris produced during glide path preparation using R-Pilot, WaveOne Gold Glider and ProGlider in curved root canals

The present study aimed to compare the apically extruded debris produced during glide path preparation using R-Pilot (RP), WaveOne Gold Glider (WGG) and ProGlider (PG) with the subsequent preparation using Reciproc Blue in curved root canals. Mesial roots of mandibular molars with angle of curvature between 25° and 35° were selected (n = 20). The Myers and Montgomery method was used to collect and assess apically extruded debris. The glide path was prepared either manually with K-file, ProGlider, R-Pilot or WaveOne Gold Glider. Manual preparation group produced the highest amount of apically extruded debris (P < 0.05), while all groups caused debris extrusion. There were no significant differences among the extruded debris caused by RP, PG and WGG groups (P > 0.05). Apically extruded debris produced by engine-driven reciprocational or continuous rotational single file glide path instruments was similar, whereas manual glide path preparation was associated with the greatest amount of extruded debris.

Effect of Gravity on Periapical Extrusion of Irrigating Solution With Different Irrigation Protocols in Immature Anterior Teeth

Objective:

Periapical extrusion is frequently observed during endodontic therapy. It can lead to acute injury of periapical tissues, resulting in interappointment pain or swelling. The effect is pronounced in teeth with immature teeth which are more susceptible to the extrusion of irrigant. The aim of this study was to evaluate the effect of gravity on apical extrusion of irrigating solution with different irrigation protocols in immature anterior teeth.

Methods:

An extracted maxillary central incisor was modified to simulate an open apex with an apical diameter of 1.3 mm and parallel canal walls. The tooth was subjected to a cone-beam computed tomographic scan, and the image data set was utilized to prepare 30 resin tooth models with a 3D printer. These resin teeth were used to form an open-ended Myers and Montgomery extrusion models. These were then randomly divided into two groups to simulate their orientation in the jaw during endodontic therapy, i.e., group I (maxillary arch, n=15) models fixed at 45° inclined plane and group II (mandibular arch, n=15) models placed at a plane parallel to the floor. Five models from each group (n=5) were tested by three different irrigation protocols: positive pressure (PP) Irrigation, passive ultrasonic irrigation (PUI), and negative pressure (NP) irrigation. The extruded irrigating solution was collected in glass vials, and the volume was measured.

Results:

The volume of extruded irrigating solution in groups I and II was compared using Mann–Whitney U-test. The median values for PP, PUI, and NP irrigation protocols were 0.6, 1, and 0 ml and 10, 10, and 0.5 ml for groups I and II, respectively. PP and PUI protocols were associated with significantly less extrusion in group I when compared to group II (P=0.004). There was no statistically significant difference in the volume of irrigating solution extruded in groups I and II (P=0.007) for NP irrigation protocol.

Conclusion:

Gravitation force has an influence on periapical extrusion of irrigant in immature permanent teeth irrespective of the irrigant system used. NP performed better when compared to PP or PUI irrigation protocol irrespective of the tooth orientation.

Dental care for patients taking antiresorptive drugs: a literature review

Antiresorptive drugs (ARDs), such as bisphosphonates or denosumab, that prevent bone resorption are widely used in patients with osteoporosis or with cancer that has metastasized to the bones. Although osteonecrosis of the jaw (ONJ) is a well-documented complication of ARD use, the benefits ARDs outweigh the complication. Thus, research has focused on finding ways to prevent or reduce the risk of developing ONJ. Dentists, as part of a multi-professional team, have a critical role in preventing ONJ. However, many dentists tend to hesitate to provide dental care to patients with ONJ, or tend to think that it is a problem to be dealt with by oral surgeons. This review gives an overview of ARD-related ONJ and provides the guidelines for dental care in patients taking ARDs to lower the risk of developing ONJ.

Endodontic Treatment in Artificial Deciduous Teeth through Manual and Mechanical Instrumentation: A Pilot Study

“In vitro” studies seek to simulate actual biological conditions in the laboratory providing principles to be studied later. To facilitate the development of new techniques of root instrumentation in primary teeth and to ensure the integrity and function of the element, this study aimed to demonstrate the technological advances in endodontics through endodontic treatment performed on artificial primary teeth using a rotary instrumentation system and reciprocation. Instrumentation of the root canal was performed via a manual, rotary, and Reciproc system. Results showed that current systems can facilitate endodontic treatment in one session. These procedures become increasingly easy with the help of technological advances in dentistry.

Endodontic Treatment in Artificial Deciduous Teeth by Manual and Mechanical Instrumentation: A Pilot Study

Introduction

“In vitro” studies seek to simulate actual biological conditions in the laboratory and providing principles to be studied later, to facilitate the development of new techniques of root instrumentation in primary teeth and to ensure the integrity and function of the element.

Aim

This study aimed to demonstrate the technological advances in endodontics by endodontic treatment performed on artificial primary teeth using a rotary instrumentation system and reciprocation.

Materials and methods

Instrumentation of the root canal was performed via a manual, rotatory and Reciproc system.

Results

The rotatory systems can facilitate endodontic treatment in one session.

Conclusion

These procedures become increasingly easy and rapid with the help of technological advances in dentistry.

How to cite this article

Hecksher F, Vidigal B, Coelho P, Otoni D, Alvarenga C, Nunes E. Endodontic Treatment in Artificial Deciduous Teeth by Manual and Mechanical Instrumentation: A Pilot Study. Int J Clin Pediatr Dent, 2018;11(6):510-512

Apically Extruded Debris Using Passive Ultrasonic Irrigation Associated with Different Root Canal Irrigants

Abstract The present study evaluated the amount of apically extruded debris after chemo-mechanical preparation (CMP) associated with passive ultrasonic irrigation (PUI) using four different root canal irrigants, namely, 6% sodium hypochlorite (NaOCl), 2% chlorhexidine gel + saline solution (2% CHXg+SS), 2% chlorhexidine solution (2% CHXs) and SS alone. Sixty mandibular premolars with single straight root canals were selected and randomly assigned into 4 groups (n=15) according to the root canal irrigant used as follows: G1 (PUI + NaOCl), G2 (PUI + CHXg+SS), G3 (PUI+CHXs) and G4 (PUI+SS). Reciproc® R25 files (25/.08) were used during CMP and the debris extruded from each tooth were collected in pre-weighted Eppendorf tubes and dried. The average weight of debris was assessed by using an analytical microbalance. Data were statistically analysed by using ANOVA and post-hoc Tukey’s test (a=0.05). Debris extrusion was observed in all groups, irrespective of the root canal irrigating, with 2% CHXg + SS being associated with lower debris extrusion compared to other irrigants (p<0.05). No significant differences were observed between 6% NaOCl, 2% CHXs and SS. In conclusion, passive ultrasonic irrigation did not completely prevent apically extrusion of debris. PUI performed with 2% chlorhexidine gel + saline solution significantly minimized debris extrusion compared to 6% sodium hypochlorite, chlorhexidine solution and saline solution.

Evaluation of Apically Extruded Debris Using Positive and Negative Pressure Irrigation Systems in Association with Different Irrigants

This study evaluated the amount of apically extruded debris after chemo-mechanical preparation (CMP) using positive and negative pressure irrigation systems [Conventional irrigation (CI) and EndoVac (EV)] in association with different irrigants [6% Sodium Hypochlorite (NaOCl), 2% Chlorhexidine gel + saline solution (CHXg + SS), 2% Chlorhexidine solution (CHXs) or Saline solution (SS)]. Eighty mandibular premolars with single root canals were selected and randomly assigned into 8 groups (n = 10) according to the irrigation system and the irrigant used during CMP: G1 (EV + NaOCl), G2 (EV + CHXg + SS), G3 (EV + CHXs), G4 (EV + SS), G5 (CI + NaOCl), G6 (CI + CHXg + SS), G7 (CI + CHXs) and G8 (CI + SS). Reciproc® R25 files (25/.08) were used during the CMP and the extruded debris from each tooth was collected in pre-weighted Eppendorf tubes and dried. The average weight of debris was assessed using a microbalance, and the data were statistically analyzed using ANOVA and the post hoc Tukey's test (a = 0.05). All groups were associated with debris extrusion. EV was the irrigation system with less extruded debris (p < 0.05). No differences were observed regarding the irrigant when EV was used. When CI was used, CHXg + SS were associated with lower debris extrusion (p < 0.05). It was concluded that no irrigation protocol succeeded in preventing debris extrusion. EV resulted in lower levels of debris extrusion than CI. The use of CHXg + SS resulted in lower debris extrusion.

Separation of Nickel-Titanium Rotary and Reciprocating Instruments: A Mini-Review of Clinical Studies

Objective:

This review aimed to evaluate clinical studies that assessed separated NiTi rotary and reciprocating instruments.

Design and Methods:

This review assessed clinical studies involving treatments performed by undergraduate students, graduate students, and endodontic specialists. This review evaluated studies using rotary instruments, reciprocating instruments, and hybrid techniques. The number of uses of the different NiTi rotary and reciprocating systems was also assessed.

Results:

The incidence of separation for rotary instruments ranged from 0% to 23%. Rotary instruments were used from 1 to 50 times depending on the instrument and tooth type. The lowest rate of incidence separation for rotary instruments was obtained by undergraduate students, using a hybrid technique. The separation incidence for reciprocating instruments ranged from 0% to 1.71%. Reciprocating instruments were mostly single-used; one study reported their use up to 3 times. Separation rate in reciprocating instruments was similar in single-use or in multiple uses 0.2%.

Conclusions:

Separation of instruments has dropped recently and seems to be a minor problem in current Endodontics. Multiple uses of NiTi rotary instruments are a possibility without significantly increasing the risk of instrument separation. Single and multiple uses of NiTi reciprocating instruments are also associated with low incidence of separation. Attempting to remove separated instruments should be carefully evaluated.

Quantitative analysis of apically extruded bacteria following preparation of curved canals with three systems

This study compared the amount of apically extruded bacteria following preparation of curved root canals using two continuously rotating multifile and one reciprocating single-file systems. Mesiobuccal canals from maxillary molars were contaminated with Enterococcus faecalis and divided into three groups according to the instrumentation system: Reciproc (R25 instrument, 25/.08), BT-RaCe (10/.06, 35/.00 and 35/.04), and Mtwo (25/.06, 30/.05 and 35/.04). Apically extruded material was collected by a customized apparatus with 1.5% agarose gel covering the root apex to simulate the periradicular tissues. The extruded material was extracted from the gel and subjected to bacteriological culture for bacterial quantification. The three systems showed a high frequency of bacterial extrusion (>70%). There were no statistically significant differences in the counts of extruded bacteria between groups (P > 0.05). The incidence and amount of apical bacterial extrusion were similar between the three systems. The customized apparatus was effective in collecting apically extruded bacteria.

Impact of root canal preparation performed by ProTaper Next or Reciproc on the quality of life of patients: a randomized clinical trial

AIM

To compare the impact of the two different root canal preparation systems on the quality of life of patients and correlate postoperative pain with the impact on quality of life.

METHODOLOGY

A randomized clinical trial was conducted with 58 patients allocated into two groups based on the root canal preparation system employed: ProTaper Next (PN) or Reciproc (R). Data collection involved the administration of a questionnaire addressing demographic and clinical characteristics, the OHIP-14 (quality of life) and a visual analog scale (pain). The latter two were the outcomes of interest and were administered in the first 24 h after root canal treatment. The data were submitted to descriptive analysis, bivariate analysis, Poisson univariate and multiple regression, and Spearman's correlation test, with a 5% significance level.

RESULTS

A greater frequency of impact after treatment was found for the items 'uncomfortable to eat food' and 'felt self-conscious'. No significant difference between groups was found regarding the severity of impact for total OHIP-14 score or any of the domain scores.

CONCLUSIONS

The two root canal preparation systems exerted a similar impact on quality of life. Postoperative pain was correlated with impact on quality of life, affecting chewing function, self-consciousness and stress. Thus, it is important for dentists to provide care capable of preventing or treating the negative consequences of such therapy.

Comparison of apical transportation and centering ability of Mtwo and Reciproc R25 in severely curved canals using cone-beam computed tomography

Background:

Apical transportation (AT) of the root canal moves the physiologic canal terminus to a new location on the external root surface and results in the accumulation of debris and residual microorganisms due to inadequate cleaning and shaping of the canal end. This study aimed to assess the prevalence of AT following canal preparation with Mtwo and Reciproc R25 using cone-beam computed tomographic (CBCT).

Materials and Methods:

In this in vitro study, 40 mesiobuccal root canals of the maxillary molars with 19–22 mm length and (>40°) taper were prepared in two groups using Mtwo and Reciproc R25 rotary systems along with irrigation with 2.5% NaOCl. CBCT scans were obtained of the canals before and after preparation under similar conditions, and the values were measured using the device software. The amount of AT was measured according to Gambill et al. Data were analyzed using SPSS 17 and Chi-square and t-tests. P < 0.05 was considered significant.

Results:

Both systems caused some degrees of AT. No significant difference was found between the two systems in terms of the amount and direction of AT (P > 0.05); overall, the frequency of AT toward the mesial wall was greater than that toward the distal direction. However, this difference was not statistically significant.

Conclusion:

The mean amount of AT and the ability to keep the instruments in severely curved canals were not significantly different in canals prepared by Mtwo and Reciproc rotary systems. Thus, these systems can be used in the clinical setting with the lowest risk of AT.

Apical extrusion of debris during root canal preparation using a novel nickel-titanium file system: WaveOne gold

Aim:

This study was intended to evaluate the amount of apically extruded debris following root canal preparation with three different instrumentation systems.

Materials and Methods:

Sixty mandibular incisor teeth were selected and randomly divided into three groups (n = 20/group) according to the instrumentation system used: the ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland), the Twisted File Adaptive (TFA; SybronEndo, Orange, CA, USA), and the WaveOne Gold (WOG; Dentsply Maillefer, Ballaigues, Switzerland). All apically extruded debris was collected and dried in preweighed glass vials. The mean weight of the apically extruded debris was obtained using a microbalance. The time for root canal preparation was also recorded. The data were analyzed using a one-way analysis of variance.

Results:

The mean weights of apically extruded debris were 0.00035 ± 0.00014 g (PTN); 0.00023 ± 0.0001 g (TFA); and 0.00019 ± 0.0001 g (WOG) (P < 0.01). The mean preparation time value was 301,13 ± 62.14 s (PTN); 234.27 ± 34.88 s (TFA); and 239.8 ± 58.6 s (WOG) (P < 0.05).

Conclusions:

The PTN system extruded more debris than the TFA and WOG systems. The TFA and WOG systems were faster than the PTN system.

Physico-chemical and Biological Properties of a New Portland Cement-based Root Repair Material

OBJECTIVE

To propose bismuth carbonate, a radiopacifying agent, as a new endodontic root repair material that was added to Portland cement (PC) at 2 wt%, 5 wt%, 10 wt% and 15 wt%, and physicochemical and biological properties of each formulation were evaluated in comparison to MTA-Angelus.

METHODS

Mixed and powder samples were analysed by scanning electron microscopy (SEM) and X-ray power diffraction (XRD), and the semiquantitative constitution of the powder was determined by energy-dispersive spectrometer (EDS). Setting time was evaluated by Vicat needle and radiopacity analysed with digital X-ray. The pH of all tested materials was observed after immersion in water for 3, 24, 48, 72 and 168 h (or 7 days). Solubility and calcium release were measured after immersion in water for 24 h. A multiparametric assay XTT-NR-CVDE was used to evaluate the cytotoxicity of the materials in human periodontal ligament (HPDL) fibroblasts. HPDL fibroblasts were exposed to PC 15% and mineral trioxide aggregate (MTA), and the expression of proinflammatory cytokines (IL1A, IL6, IL8, TNF) and bone formation genes (ALP, COL1, RUNX2) was evaluated by real-time PCR. Mineralisation of HPDL fibroblasts cocultured with PC, PC 15% and MTA was evaluated with Von Kossa staining.

RESULTS

PC-based groups presented more irregular and larger particles than MTA. PC and MTA showed similarities as observed by XRD and EDS. Setting time of PC-based groups was increased with the addition of bismuth carbonate. All tested materials were alkaline, and pH tended to reduce over time. All cements had solubility lower than recommended, with no difference between them (P>0.05) and showed calcium release. PC 15% had similar radiopacity when compared with MTA (P>0.05). Cell viability was higher for the tested materials than the positive control (P<0.001), but there was no difference when they were compared with negative control (P>0.05). Gene expression levels were similar for all tested groups (P>0.05). Analysed cements had positive Von Kossa staining.

CONCLUSION

Overall, the addition of 15% of bismuth carbonate did not result in significant changes to its physicochemical and biological properties when compared with MTA, except for the setting time, and may be considered a potential substitute for MTA.

Comparison of apical extrusion of intracanal bacteria by various glide-path establishing systems: an in vitro study

OBJECTIVES

This study compared the amount of apically extruded bacteria during the glide-path preparation by using multi-file and single-file glide-path establishing nickel-titanium (NiTi) rotary systems.

MATERIALS AND METHODS

Sixty mandibular first molar teeth were used to prepare the test apparatus. They were decoronated, blocked into glass vials, sterilized in ethylene oxide gas, infected with a pure culture of Enterococcus faecalis, randomly assigned to 5 experimental groups, and then prepared using manual stainless-steel files (group KF) and glide-path establishing NiTi rotary files (group PF with PathFiles, group GF with G-Files, group PG with ProGlider, and group OG with One G). At the end of canal preparation, 0.01 mL NaCl solution was taken from the experimental vials. The suspension was plated on brain heart infusion agar and colonies of bacteria were counted, and the results were given as number of colony-forming units (CFU).

RESULTS

The manual instrumentation technique tested in group KF extruded the highest number of bacteria compared to the other 4 groups (p < 0.05). The 4 groups using rotary glide-path establishing instruments extruded similar amounts of bacteria.

CONCLUSIONS

All glide-path establishment instrument systems tested caused a measurable apical extrusion of bacteria. The manual glide-path preparation showed the highest number of bacteria extruded compared to the other NiTi glide-path establishing instruments.

The Effect of Root Canal Preparation Using Single Versus Multiple Endodontic Rotary Files on Post-operative Pain, a Randomised Clinical Trial

Objective:

The purpose of this randomised clinical trial study was to compare the incidence and intensity of post-operative pain following the use of single-file and multi-file rotary instruments with continuous rotational motion for root canal preparation in asymptomatic permanent human teeth.

Methods:

A total of 105 healthy consenting patients who fulfilled specific inclusion criteria and had premolar or molar teeth diagnosed with asymptomatic irreversible pulpitis without periapical pathosis requiring endodontic treatment participated in this study. The patients were randomly allocated by stratification into five groups of 21 according to the instruments and systems used for root canal preparation: (a) Neoniti A1 (#25) single file, (b) RaCe #25/.06 single file, (c) Mtwo #25/.06 single file, (d) Easy RaCe, (e) and Mtwo multifile. Endodontic treatment was carried out in a single appointment. The severity of post-operative pain was assessed by numerical rating scale scores until complete pain relief was achieved. Analgesic consumption and the incidence of pain were also evaluated. Data were analysed by one-way ANOVA and Tukey HSD tests.

Results:

When comparing different instruments and systems for canal preparation, the analgesic consumption, incidence and intensity of post-operative pain did not differ (p>0.05). The highest levels of post-operative pain were experienced after 6 h in all groups.

Conclusion:

The post-operative pain did not differ between the single and multi-file root canal preparation techniques evaluated in this study.

Apical Extrusion of Intracanal Bacteria with Single File and Multifile Rotary Instrumentation Systems

Aims and Objectives:

Instrumentation techniques may cause extrusion of microorganisms and their products into the periapical region resulting inflammation and treatment failure. The aim of this ex vivo study was comparing the apical bacterial extrusion in canals prepared with single file versus multiple file rotary systems.

Materials and Methods:

Ninety-two human single-rooted mandibular first premolars were used. Endodontic access cavities were prepared, and root canals were contaminated with an Enterococcus faecalis (E. faecalis) suspension. The samples were incubated at 37°C for 30 days; the contaminated teeth were divided into four groups of 20 specimens each (1: Reciproc, 2: Mtwo, 3: Neoniti A1, 4: Safesider). Six teeth were not infected and each were prepared with one of the above instruments were considered as negative and six teeth which had been previously infected, were used as positive control groups. Extruded bacteria from the apical foramen during instrumentation were collected into vials containing 0.9% NaCl. The microbial samples were taken from the vials and incubated in brain heart agar medium for 24 h. The resulting bacterial titer, in colony-forming units per mL, was determined. The data entered into SPSS 18 software and were analyzed by Kruskal–Wallis and Mann–Whitney U-tests at 0.05 significance level.

Results:

Mtwo multifile system showed significantly less bacterial extrusion than Safesider (P = 0.015) and Neoniti A1 (P = 0.042) but did not show significant difference with Reciproc system (P = 0.25).

Conclusions:

All instrumentation systems extruded bacteria beyond the apical foramen. However, this study showed that Mtwo multifile rotary system extruded fewer bacteria.

In Vivo and In Vitro Effectiveness of Rotary Nickel-Titanium vs Manual Stainless Steel Instruments for Root Canal Therapy: Systematic Review and Meta-analysis

INTRODUCTION

This systematic review evaluated the effectiveness of nickel-titanium (NiTi) rotary files compared to stainless-steel (SST) hand files.

METHODS

An electronic search was performed on Medline, EMBASE, CENTRAL and Scopus databases up to February 2016. An additional hand searching was performed in 13 journals. The studies were classified according to study type and the outcome variables. Two reviewers independently applied eligibility criteria, extracted data, and three reviewers independently assessed the quality of the evidence of each included study according to The Cochrane Collaboration's procedures. A meta-analysis was performed whenever it was possible.

RESULTS

The electronic and hand search strategies yielded 1155 references of studies after removal of duplicates. Four clinical studies (two prospective and two retrospective studies) and 18 in vitro studies (on extracted teeth) were included for the qualitative synthesis after full-text evaluation of the eligible studies. The overall level of methodological quality of the studies included can be considered inadequate. Only one clinical study was judged at low risk of bias, whereas most non-clinical studies had a low risk of bias. Three meta-analyses, based on a very limited number of studies, could be performed. Each meta-analysis contained two studies. Of these, one meta-analysis was based on clinical studies.

CONCLUSIONS

The results of this systematic review suggested that NiTi rotary instruments were associated with lower canal transportation and apical extrusion when compared to SST hand files, whereas both groups had similar outcomes in terms of success of therapy, amount of residual bacteria, and cleansing ability after treatment. However, due to the limited evidence available, these results should be interpreted with caution. Consequently, more randomized control trials using standardized protocols are needed in order to provide more solid recommendations.

Healing of Apical Periodontitis after Nonsurgical Treatment in Patients with Type 2 Diabetes

INTRODUCTION

The purpose of this prospective study was to compare the success of primary root canal treatment between type 2 diabetic and nondiabetic patients and to investigate the effect of periapical healing on glycated hemoglobin (HbA1c) in type 2 diabetic patients with apical periodontitis.

METHODS

Sixty mandibular molars with necrotic pulps and apical radiolucency (size ≥ 2 mm × 2 mm) were included in the study. Based on the HbA1c levels, patients were divided into 2 groups: type 2 diabetic (HbA1c ≥6.5%) and nondiabetic (HbA1c <6.5%). Forty-six teeth were evaluated at the 12-month follow-up time period. The primary outcome measure was the change in apical bone density as determined by the periapical index.

RESULTS

Both the diabetic and nondiabetic group depicted a significant reduction in the periapical score after endodontic treatment at the 12-month follow-up (P < .05). Significantly less periapical healing was observed in the diabetic group (43%) compared with the nondiabetic group (80%) at the 12-month follow-up (P < .05). HbA1c levels in the diabetic group increased at each follow-up after endodontic treatment.

CONCLUSIONS

Diabetes mellitus may have a negative impact on the outcome of endodontic treatment in terms of periapical healing. Nonsurgical endodontic treatment did not improve HbA1c levels in patients with type 2 diabetes.

Efficacy of photon-initiated photoacoustic streaming on apically extruded debris with different preparation systems in curved canals

AIM

To determine the effect of photon-initiated photoacoustic streaming (PIPS) on the extrusion of debris using multiple-file (ProTaper Next-PTN) and single-file (One Shape-OS) continuous rotary systems in curved canals in human molar teeth.

METHODOLOGY

Sixty extracted maxillary first molar teeth with curved mesial roots, mature apices and of similar lengths were selected. Teeth having canals with apical diameters larger than size 15 were discarded. The teeth were randomly divided into four experimental groups (n = 15 teeth per group) according to the file used and irrigation systems: (i) OS with PIPS with a 2940 nm Er:YAG laser (0.3 W, 15 Hz, and 20 mJ), (ii) OS with conventional needle irrigation (CNI) with a 27-G needle, (iii) PTN with PIPS and (iv) PTN with CNI. The PIPS and CNI was applied during each file change for 20 s. Total irrigation and activation time was 1 min, and a total volume of 7.5 mL of bidistilled water was used as the irrigant. The apically extruded debris was collected into pre-weighed Eppendorf tubes. The tubes were then stored in an incubator at 70 °C for 5 days. The weight of dry extruded debris was assessed by subtracting the initial weight of the tube from the final weight. The results were analysed statistically using one-way analysis of variance and Tukey's post hoc tests. Bonferroni correction was used to compare the groups.

RESULTS

The PIPS irrigation technique was associated with significantly more debris extrusion than the CNI system (P < 0.05). The single-file (One Shape-OS) rotary system was associated with more debris than the multiple-file (ProTaper Next-PTN) rotary systems when the same irrigation system was used (P > 0.05). The total amount of debris extruded apically by PIPS activation was significantly greater than that by CNI (P < 0.05).

CONCLUSIONS

All file and irrigation systems extruded debris apically. PIPS activation was associated with significantly more extrusion debris in curved canals compared with no activation.