The effect of single-file reciprocating systems on Substance P and Calcitonin gene-related peptide expression in human periodontal ligament

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.

In vitro evaluation of filling material removal and apical debris extrusion after retreatment using Reciproc blue, Hyflex EDM and ProTaper retreatment files

OBJECTIVES

To evaluate the amount of remaining filing material and apical debris extrusion after retreatment using Reciproc Blue, Hyflex EDM and ProTaper Retreatment Files.

MATERIALS AND METHODS

Thirty-six extracted permanent mandibular first molars with moderately curved mesial roots were selected. Mesiobuccal canals were prepared using the ProTaper Next system up to size X2 and filled using gutta-percha and Adseal sealer via cold lateral compaction. Teeth were randomly divided into three equal groups (n = 12): Group 1: Reciproc Blue (RB)(VDW, Germany), Group 2: Hyflex EDM (HEDM)(Coltene/Whaledent, Switzerland), Group 3: ProTaper Universal Retreatment file system + ProTaper Next file system (PTUR + PTN)( Dentsply Maillefer, Switzerland). Eppendorf tubes were used to collect the apically extruded debris. Cone-beam computed tomographic scans were taken prior to and after retreatment and the volume of remaining filling material was assessed at the coronal, middle and apical levels. Statistical analysis was performed using the Kruskal-Wallis test, Friedman's test and Wilcoxon Sign Rank test. Significance level was set at p value 0.05.

RESULTS

There were no statistically significant differences among the three groups in the reduction of the volume of the filling material or in the amount of apically extruded debris.

CONCLUSION

All the tested filing systems showed similar efficacy in removing the filling material, however, none of them could achieve its complete removal. Apical extrusion of debris occurred with all the systems used with no significant difference between the three groups.

A review of the latest developments in rotary NiTi technology and root canal preparation

The introduction of nickel-titanium (NiTi) mechanical instruments dramatically changed clinical endodontics over the last few decades. Before NiTi, it was necessary to use more instruments to create an ideal root canal shape, and many approaches, sequences and techniques were developed over the years. Recently, NiTi endodontic instruments have undergone a series of changes brought about by modifications in design, surface treatments, and thermal treatments to improve their root canal preparation outcomes and reduce associated canal preparation risks during root canal treatment. Heat treatment is one of the most fundamental approaches to improving the fatigue resistance and flexibility of NiTi endodontic instruments. In addition, new kinematics have been developed to offer greater safety and efficiency. This narrative review describes the general properties and manufacturing of NiTi instruments, and the mechanical system evolution of NiTi instruments.

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.

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.

The state of the art and future trends of root canal files from the perspective of patent analysis: a study design

The goal of this review is to present a detailed and comprehensive description of the published work from the past decade regarding methods of improved material, geometric design, and additional functions in root canal files. The main improved methods of files and the most common technologies were further addressed, underlining their advantages and main limitations. Online databases (the Derwent Innovations Index) were consulted on this topic. Published work from 2010 to 2022 was collected and analyzed the relevant papers were chosen for inclusion in this review. The patent map classified the latest phase of the root canal files based on the analysis of the number of patents. The performance of the root canal files, such as materials. Directly affects the quality of the root canal therapy. We provided a thorough review of advances in the field of root canal files. In particular, three categories of improved methods were examined and compared, including material-based methods, geometry-based methods, and those based on additional functions. To understand this state of the art of different improved methods of root canal files, we conducted a literature analysis and a series of comparisons between different methods. The features and limitations of each method of root canal files were further discussed. Finally, we identified promising research directions in advancing the methods for the improved performance of root canal files. There is no perfect technology for all material/geometric design/additional functions, capable alone of fulfilling all the specificity and necessities of every patient. Although it is very promising, the material of the files remains understudied, and further work is required to make material science a pervasive technology in root canal therapy, and contribute to endodontic and periapical diseases by assisting in the subsequent development of root canal files.

A single-file endodontic treatment: A promising endodontic concept

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A critical appraisal of research methods and experimental models for studies on root canal preparation

It is the aim of this review to present a critical overview and summary on the contemporary possibilities, limitations and challenges of research related to root canal preparation. Frequently used research tools and contemporary research designs will be presented and discussed critically focussing on shortcomings and benefits with special regard to clinical relevance and scientific evidence. A plethora of experimental set-ups for assessing the shaping of root canals have been described in the endodontic literature using a considerable number of techniques and instruments. Nevertheless, it can be stated that scientific evidence demonstrating the clinical impact of many investigated topics is questionable or even missing. Instead of technical, radiographic and geometrical parameters, further research should focus on biological aspects and clinical evidence of the impact of root canal preparation on the outcome of root canal treatment.

Apical Extrusion of Debris during Root Canal Preparation with ProTaper Next, WaveOne Gold and Twisted Files

(1) Background: Apical extrusion of debris is an example of a complication that may arise during root canal treatment, and it has been proven to be an unavoidable occurrence during endodontic treatment by numerous authors. Even though it may not hinder the long-term outcome of treatment, it may lead directly to increased levels of postoperative pain and, therefore, lower levels of patient acceptance and satisfaction. The aim of the study was to assess the weight of apically extruded debris during root canal preparation with instruments that use different movement kinematics (rotary, reciprocating, and adaptive motion); (2) Methods: The study was performed using the Myers and Montgomery model. Sixty human premolar teeth were inserted into preweighed Eppendorf tubes and randomly classified into three groups. After manual glide-path preparation, teeth in each group were instrumented to working length set 1 mm short of the anatomical apex using the standard sequence provided by the manufacturers (for Group 1: ProTaper Next X1 & X2; for Group 2: WaveOne Gold Primary, for Group 3: Twisted Files SM1-SM3). Root canals were irrigated with 1 mL of 0.9% NaCl solution between each file insertion. The tubes with collected debris were stored in an incubator at 70 °C for 5 days in order to evaporate the liquid component. Measurement of the weight of extruded debris was performed by subtracting the preinstrumentation from the postinstrumentation weight of the tubes. The results were analyzed with Kruskal-Wallis ANOVA, with significance level set at 0.05; (3) Results: The weight of extruded debris was 0.337 mg (SD = 0.148) for Group 1, 0.305 mg (SD = 0.201) for Group 2, and 0.348 mg (SD = 0.135) for Group 3. (4) Conclusions: Engine-driven root canal preparation with the use of instruments ProTaper Next, WaveOne Gold and Twisted Files that use different movement kinematics (rotary, reciprocating, and adaptive motion) was associated with apical extrusion of debris to a similar extent.

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.

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.

Influence of hand and rotary files for endodontic treatment of primary teeth on immediate outcomes: Secondary analysis of a randomized controlled trial

BACKGROUND

Endodontic treatment of primary teeth can be time-consuming.

AIM

To compare hand and rotary files regarding the time for root canal chemical-mechanical preparation, child's behavior, apical limit of the obturation, and post-operative pain.

DESIGN

This secondary data from a randomized clinical trial with two parallel arms evaluated endodontic instrumentation in 88 children aged 4-9 years. Stratified and block randomization was performed into two groups: K-file hand and ProDesign Logic rotary files. The evaluated outcomes were the chemical-mechanical preparation time, child's behavior using the Frankl scale, apical limit of the obturation, and post-operative pain using the Faces Pain Scale-Revised. One operator and all outcome appraisers were blinded to the chemical-mechanical technique. Multiple linear regression, chi-square, and Fisher's exact test were performed.

RESULTS

The mean time for chemical-mechanical preparation using hand files was 24.5 (SD 4.0) minutes, and using rotary files, it was 17.0 (SD 2.5) minutes (P < .001). No difference was found between the instrumentation methods in the child's behavior, apical limit of the obturation, or post-operative pain.

CONCLUSIONS

The ProDesign Logic file reduced the average procedure time but presented no difference in the other variables studied when compared to the K-file.

The effect of sonic activation of irrigant on postoperative pain after root canal treatment in primary molar teeth: a randomized, clinical study

PURPOSE

Postoperative pain following root canal treatment is a concern for pediatric patients and pediatric dentists. The purpose of this study was to evaluate the effect of using sonic activation (SA) on postoperative pain levels after root canal therapy of primary molars.

METHODS

A total of 110 patients aged 5-9 years with symptomatic irreversible pulpitis involving primary molars were included in the study and were randomly divided into two groups according to agitation methods: SA and no sonic activation (NSA). Root canal treatments were completed, and the teeth were restored permanently. Postoperative pain levels were evaluated using the five-face scale at 8, 24, 48, and 72 h and 1 week after treatment. Pain levels and frequency of analgesic intake were recorded and analyzed.

RESULTS

Postoperative pain values were lower in the SA group than in the NSA group at 8, 24, and 48 h after treatment (p < 0.05). No significant difference was observed between the groups in terms of postoperative pain values at 72 h and 1 week after treatment (p > 0.05).

CONCLUSIONS

It was determined that the use of SA reduces postoperative pain level significantly after root canal treatment in primary molar teeth.

CLINICAL RELEVANCE

The use of SA can be recommended to clinicians since it is effective in the successful management of postoperative pain of root canal treatment in primary molar teeth.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT04197531.

Effect of intracanal diode laser application and low-level laser therapy on CGRP change

The aim of this study was to investigate the effect of a placebo, intracanal diode laser application, and low-level laser therapy (LLLT) on the change of the total amount of calcitonin gene-related peptide (CGRP) in the gingival crevicular fluid (GCF) (split-mouth study design). GCF sampling was performed on a contralateral tooth and experimental tooth (root canal-treated tooth) of thirty-nine patients. The patients were divided into three groups (n = 13), as follows: placebo (mock laser application), intracanal laser application, and LLLT. GCF sampling was repeated at the same sites (experimental and control teeth) one week after root canal treatment. The data were analyzed using the Pearson's correlation analysis and the independent-samples t-tests (p=0.05). In the placebo group, the total CGRP level changes in the GCF before and after treatment was significantly higher for experimental teeth than for control teeth (p<0.05). However, there was no significant difference between experimental and control teeth in the intracanal laser application and LLLT groups (p > 0.05). Intracanal laser application and low-level laser therapy have immunomodulation effects linked to the modulation of the total amount of CGRP in the GCF.

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.

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.

The accuracy of the auto-stop function of different endodontic devices in detecting the apical constriction

Background

Electronic apex locators (EALs) are modern devices used to determine the working length during root canal preparation. The newest endodontic motors provide an integrated EAL with auto-stop function to prevent instrumentation beyond the predefined working length during rotary root canal preparation. The aim of this study was to compare the accuracy of the auto-stop function of the VDW.Gold RECIPROC motor (VDW, Munich, Germany), the EndoPilot motor (Schlumbohm, Brokstedt, Germany) and the manual measurement with Raypex 6 (VDW, Munich, Germany) to detect the apical constriction (AC).

Methods

Ninety human teeth were chosen and randomly assigned to three experimental groups (30 teeth each): VDW.Gold RECIPROC motor continuous measuring (RCM), EndoPilot continuous measuring (ECM) and Raypex 6 manual measuring (RMM). When the measurement file reached the AC, the file was fixed in the tooth. The tooth was embedded in acrylic resin and the root tip was exposed, so that the histologic structure of the root canal and the file tip was visible for microscopic analysis. Afterwards, the distance of the file tip to the AC (D_AC) was automatically computed with a specially developed software tool.

Results

The mean D_AC were −13.18 μm (SD 88.46 μm) for RMM, −22.70 μm (SD 91.57 μm) for RCM and 18.74 μm (SD 88.11 μm) for ECM. The differences were not statistically significant (P = 0.181). The rates for instrumentation beyond the AC were not statistically different (Chi² = 4.753, p = 0.096).

Conclusions

All measurement methods showed a high accuracy in detecting the AC. The auto-stop function of these endodontic motors is a reliable addition to the endodontic armamentarium.

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.

Post endodontic pain following single-visit root canal preparation with rotary vs reciprocating instruments: a meta-analysis of randomized clinical trials

Background

In endodontic therapy, continuous rotary instrumentation reduced debris compared to reciprocal instrumentation, which might affect the incidence of post-endodontic pain (PP). The aim of our study was to assess whether PP incidence and levels were influenced by the choice of rotary or reciprocal instruments.

Methods

In this meta-analysis the Pubmed and EM databases were searched for prospective clinical randomized trials published before April 20, 2016, using combinations of the keywords: root canal preparation/instrumentation/treatment/therapy; post-operative/endodontic pain; reciprocal and rotary instruments.

Results

Three studies were included, involving a total of 1,317 patients, 659 treated with reciprocating instruments and 658 treated with rotary instruments. PP was reported in 139 patients in the reciprocating group and 172 in the rotary group. The PP incidence odds ratio was 1.27 with 95% confidence interval (CI) (0.25, 6.52) favoring rotary instruments. The mild, moderate and severe PP levels odds ratios were 0.31 (0.11, 0.84), 2.24 (0.66, 7.59) and 11.71 (0.63, 218.15), respectively. No evidence of publication bias was found.

Conclusions

Rotary instrument choice in endodontic therapy is associated with a lower incidence of PP than reciprocating instruments, while reciprocating instruments are associated with less mild PP incidence.

Intraoperative discomfort associated with the use of a rotary or reciprocating system: a prospective randomized clinical trial

Objectives

The aim of this randomized, controlled, prospective clinical study was to evaluate patients' intraoperative discomfort during root canal preparations in which either multi-file rotary (Mtwo) or single-file reciprocating (Reciproc) systems were used.

Materials and Methods

Fifty-five adult patients, aged between 25 and 69 years old, with irreversible pulpitis or pulp necrosis participated in this study. Either the mesiobuccal or the distobuccal canals for maxillary molars and either the mesiobuccal or the mesiolingual canals for mandibular molars were randomly chosen to be instrumented with Mtwo multi-file rotary or Reciproc single-file reciprocating systems. Immediately after each canal instrumentation under anesthesia, patient discomfort was assessed using a 1 - 10 visual analog scale (VAS), ranging from ‘least possible discomfort’ (1) to ‘greatest possible discomfort’ (10). The Wilcoxon signed-rank test was used to determine significant differences at p< 0.05.

Results

Little intraoperative discomfort was found in all cases. No statistically significant differences in intraoperative discomfort between the 2 systems were found (p = 0.660).

Conclusions

Root canal preparation with multi-file rotary or single-file reciprocating systems had similar and minimal effects on patients' intraoperative discomfort.

Multiple-file vs. single-file endodontics in dental practice: a study in routine care

BACKGROUND

Little is known about the differences of rotary multiple file endodontic therapy and single-file reciprocating endodontic treatment under routine care conditions in dental practice. This multicenter study was performed to compare the outcome of multiple-file (MF) and single-file (SF) systems for primary root canal treatment under conditions of general dental practice regarding reduction of pain with a visual analogue scale (VAS 100), improvement of oral-health-related quality of life (OHRQoL) with the german short version of the oral health impact profile (OHIP-G-14) and the speed of root canal preparation.

MATERIALS AND METHODS

Ten general dental practitioners (GDPs) participated in the study as practitioner-investigators (PI). In the first five-month period of the study, the GDPs treated patients with MF systems. After that, the GDPs treated the patients in the second five-month period with a SF system (WaveOne). The GDPs documented the clinical findings at the beginning and on completion of treatment. The patients documented their pain and OHRQoL before the beginning and before completion of treatment.

RESULTS

A total of 599 patients were included in the evaluation. 280 patients were in the MF group, 319 were in the SF WaveOne group. In terms of pain reduction and improvement in OHIP-G-14, the improvement in both study groups (MF and SF) was very similar based on univariate analysis methods. Pain reduction was 34.4 (SD 33.7) VAS (MF) vs. 35.0 (SD 35.4) VAS (SF) (p = 0.840) and the improvement in OHIP-G-14 score was 9.4 (SD 10.3) (MF) vs. 8.5 (SD 10.2) (SF) (p = 0.365). The treatment time per root canal was 238.9 s (SD 206.2 s) (MF) vs. 146.8 sec. (SD 452.8 sec) (SF) (p = 0.003).

DISCUSSION

Regarding improvement of endodontic pain and OHRQoL measure with OHIP-G-14, there were no statistical significant differences between the SF und the MF systems. WaveOne-prepared root canals significantly faster than MF systems.

Reciproc vs. hand instrumentation in dental practice: a study in routine care

Background. Little is known about the clinical impact of new root canal preparation systems in general dental practice under routine care conditions. Therefore, we compared hand instrumentation (H) with Reciproc (R) (VDW, Munich, Germany) preparation. The outcomes were endodontic related pain and oral health related quality of life (OHRQoL), evaluation of the procedures by the patients and the strain felt by the dentists during root canal therapy. Methods. Six dentists participated in the trial as practitioner-investigators. In the first phase of the trial they prepared root canals with H and in the second phase with R. The patients documented their pain felt with a visual analogue scale (VAS 100) and OHRQoL with the German short version of the oral health impact profile (OHIP-G-14) before treatment and before the completion of therapy and answered questions about how they experienced the treatment. The dentists documented their physical strain during treatment. Results. A total of 137 patients were included in the evaluation. 66 patients were treated with H, 71 with R. Pain reduction was 32.6 (SD 32.9) VAS (H) vs. 29.4 (SD 26.9) VAS (R) (p = 0.550), and the improvement of the OHIP-14 score was 5.5 (SD 9.2) (H) vs. 6.7 (SD 7.4) (R) (p = 0.383). There were no statistical differences in both groups. Significantly fewer patients felt stressed by the duration of treatment with R as with H (p = 0.018). Significantly more dentists reported that their general physical strain and the strain on their fingers were less severe with R than with H (p = 0.013 and p < 0.001). Discussion. H as well as R effectively reduced endodontic related pain and OHRQoL without statistical differences. R has advantages in terms of how patients experience the treatment and regarding the physical strain felt by the dentists.

Postoperative Pain after Endodontic Treatment of Asymptomatic Teeth Using Rotary Instruments: A Randomized Clinical Trial

INTRODUCTION

The aim of the present study was to compare the effect of two different rotary instruments on postoperative pain in teeth with asymptomatic irreversible pulpitis.

METHODS AND MATERIALS

A total of 78 mandibular first and second molars were divided into two groups (n=39) and their root canal preparation was carried out with either RaCe or ProTaper rotary instruments. All the subjects underwent one-visit root canal treatment and the severity of postoperative pain was evaluated using visual analog scale (VAS) at 4-, 12-, 24-, 48- and 72-h and 1-week intervals. In addition, the need for taking analgesics was recorded. Data were analyzed with the repeated-measures ANOVA and the Mann-Whitney U test was used for two-by-two comparison. Statistical significance was set at 0.05.

RESULTS

Comparison of mean pain severity between the two groups at various postoperative intervals did not reveal any significant differences (P=0.10). The difference in amount of analgesics taken by each groups was not statistically significant (P=0.25).

CONCLUSION

There were no significant differences in the postoperative pain reported between the two groups; which indicates the clinical acceptability of both systems.

A review of instrumentation kinematics of engine-driven nickel-titanium instruments

Over the years, NiTi alloys have become indispensable materials in endodontic treatment. With technological advancements in metallurgy, manufacturers have attempted to produce instruments with enhanced features. In parallel with these developments, endodontic motors have undergone improvements in terms of torque control and kinematics that are adjustable in different directions. This review presents an overview of the advancements in instrumentation kinematics and the effect of instrumentation kinematics on root canal shaping procedures and instrument performance. The literature search for this narrative review was conducted in Google Scholar, Scopus, PubMed and Web of Science using the keywords 'kinematics and endodontics' and 'reciprocation and endodontics'. In addition, historical literature was searched using the keyword 'nickel-titanium and endodontics'. Overall, 143 articles were included up to 2015.