Confocal laser scanning microscopy evaluation of roots subjected to activation protocol in endodontic microsurgery

Comparative Evaluation of Sodium Hypochlorite Gel Penetration Using Er,Cr:YSGG Laser and Passive Ultrasonic Activation After Apicoectomy: An In Vitro Study with Confocal Laser Scanning Microscopy

Background: Lasers from the erbium family have been investigated to activate irrigation with sodium hypochlorite (NaOCl), improving the disinfection depth of the dentinal tubules of the root canal walls during root canal treatment. However, the possibility of laser-activated irrigation (LAI) in retro-cavity preparation has not been investigated to the date. The aim of our experimental study is to evaluate the efficacy of NaOCl gel penetration inside the dentinal tubules when activated during retro-cavity preparation, comparing passive ultrasonic activation (PUI) and Er,Cr:YSGG LAI. Materials and Methods: Fifty extracted mature single-root human teeth were divided into four groups (control, PUI, and two LAI groups with different NaOCl concentrations). After conventional endodontic treatment and root end resection, NaOCl gel (impregnated with rhodamine dye for confocal laser scanning microscopy (CLSM) analysis) was applied and activated according to the study group. The penetration index and mean penetration length were measured using computer software. Results: Both penetration index and mean penetration length were found to have increased in the PUI group compared to the control samples. However, LAI had a better penetration that was statistically significant compared to both the PUI and control groups. The difference in NaOCl concentration in the laser groups did not affect the penetration values. Conclusions: Within the limitations of our in vitro study using NaOCl gel activation in the retro-cavity after apicectomy, Er,Cr:YSGG LAI significantly enhanced NaOCl gel penetration capacity compared to PUI, regardless of its concentration. LAI can enhance its penetration in a safe way, avoiding its extrusion to the surrounding periapical tissues.

Histological Evaluation of Root Canals by Performing a New Cleaning Protocol “RUA” in Endodontic Surgery

Aim: To enhance cleaning during retro-preparation in endodontic microsurgery. Materials and Methods: Forty mandibular premolars were instrumented, filled with a single cone technique, and then retro-preparation was performed and assigned to experiment A. In group A1, the cavity created by the retro preparation was cleansed with 2 mL of normal sterile saline. In group A2, the retro cavity was cleaned with 2 mL of sterile saline after the retro preparation. All the irrigation solutions mentioned above were delivered using an endodontic needle with a lateral vent and a gauge of 30. Subsequently, in group A2, 17% EDTA gel and 5.25% gel were inserted into the cavity and activated using ultrasonic tips. After the irrigation protocols, the specimens were decalcified for histological evaluation. Results: In the experiment, the amount of hard tissue debris was significantly greater in group A1 compared to group A2 (p < 0.05). Conclusions: The samples in group A2, where the new protocol was performed, showed statistically significant results.

Post-Operative Endodontic Pain Management: An Overview of Systematic Reviews on Post-Operatively Administered Oral Medications and Integrated Evidence-Based Clinical Recommendations

Endodontic treatment comprises the overall management of pre-, intra- and post-operative symptoms, including post-operative endodontic pain, considered as a complication susceptible of chronicization. Post-operative pain is very common and highly unpreventable and has a multi-factorial etiology and a potential pathogenic link to the acute inflammation of the periapical area, secondary to localized chemical, mechanical, host and/or microbial damage occurring during endodontic treatment. Considering the multitude of heterogeneous technical and pharmacological approaches proposed to control post-operative endodontic pain, the present study primarily comprised an overview of systematic reviews of systematic reviews of randomized clinical trials, summarizing findings on post-operatively administered oral medications for post-operative endodontic pain control, in order to note the most effective type and dosage of such drugs. Secondarily, a narrative review of the current evidence on technical solutions to be observed during endodontic treatment procedures, to control post-operative pain, was conducted to provide integrated evidence-based clinical recommendations for optimal post-operative endodontic pain management.