Effect of XP-endo Shaper versus conventional rotary files on postoperative pain and bacterial reduction in oval canals with necrotic pulps: a randomized clinical study

Postoperative pain following the use of the TruNatomy and XP-endo Shaper systems: A randomized clinical study

INTRODUCTION

The present study aimed to clinically compare the incidence of postoperative pain after endodontic treatment of posterior teeth using XP-endo Shaper (XPES; FKG Dentaire, La Chaux-de-Fons, Switzerland) and TruNatomy (TNY; Dentsply Sirona, Ballaigues, Switzerland) systems.

METHODS

In a single-blind randomized clinical trial, 104 vital teeth with an indication for conventional endodontic treatment for prosthetic purposes were treated by a single specialist following a pre-established protocol. All participants were unaware of the treatment they received. The teeth were randomly divided into 2 groups (n = 52) according to the instrumentation system used (TNY group and XPES group). The treatments were performed in a single visit. The participants were asked to rate the intensity of postoperative pain on a numeric rating scale and a visual analogue scale (no pain, mild pain, moderate pain, and severe pain) after 24, 48, 72 hours and after 7 days.

RESULTS

The incidence of postoperative pain was zero in both groups at 48 h, 72 h, and 7 days. At 24 h, most patients in the XPES and TNY groups had no pain, while the remaining participants in either group experienced mild pain (1 to 3), with no significant difference between groups (p > .05, Mann-Whitney test).

CONCLUSIONS

The instruments used in this study are associated with minimal postoperative pain, which only occurred in the first 24 h. Based on the parameters analyzed, we conclude that the systems tested cause mild postoperative pain over a short period of time.

The XP-endo Shaper and Its Impact on Posttreatment Discomfort: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

INTRODUCTION

This systematic review and meta-analysis assess the impact of the XP-endo Shaper (XPS) on postoperative pain following root canal treatment and compare its efficacy with other endodontic systems.

METHODS

A comprehensive literature search was conducted in MEDLINE, Web of Science, Embase, and the Cochrane Library from January 2000-August 2024. Randomized controlled trials using XPS and reporting postoperative pain were included. Pain levels were measured using the Visual Analog Scale at multiple postoperative time points. Data were pooled and analyzed using a random effects model, revealing significant heterogeneity.

RESULTS

Six randomized controlled trials involving 731 patients met the inclusion criteria. The pooled analysis revealed that XPS significantly reduced pain scores at the 6, 12, and 24-hour time points (standardized mean difference [SMD] -1.30, 95% confidence interval [CI] [-2.36, -0.24], P = .016; SMD -3.00, 95% CI [-3.54, -2.46], P < .001; SMD -0.91, 95% CI [-1.53, -0.28], P = .005, respectively) compared to other systems, including WaveOne Gold and HyFlex EDM. Pain scores beyond 48 hours were comparable between XPS and other file systems.

CONCLUSIONS

XPS shows substantial short-term efficacy in reducing postoperative pain following root canal treatments, likely due to its flexible design and reduced debris extrusion. The findings suggest that XPS can potentially improve patient comfort, though long-term pain outcomes remain similar to other systems.

Characteristics and Effectiveness of XP-Endo Files and Systems: A Narrative Review

Background: XP-endo files are composed of Max-Wire alloy, which was developed by FKG Dentaire (La Chaux-de-Fonds, Switzerland). This alloy, known as Martensite-Austenite Electropolish Flex, is the first NiTi alloy used in endodontics to combine the shape memory effect with superelasticity for use in clinical practice. Objective: This article aims to provide a comprehensive overview of the existing knowledge and evidence regarding different XP-endo files and systems, XP-endo Finisher (XPEF), XP-endo Shaper (XPES), XP-endo Retreatment (XPER), XP-endo Rise (XPE-Rise), and XPE-Rise Retreatment (XPE-Rise-R), to help clinicians understand their different properties and recommended clinical uses. Moreover, this review aims to identify future research opportunities in this field. Materials and Methods: A search was performed in the PubMed database using the keywords "XP endo" or "XP-endo". A total of 309 studies were identified during the initial search, and then initial abstract screening was conducted. The inclusion criteria included any study that aimed to evaluate XP endo files and systems on permanent teeth, either in vivo or in vitro. We excluded studies that were unrelated to the subject, literature reviews, case studies, and studies that employed deciduous teeth. Finally, we performed an extensive review of the selected 130 studies, which we assessed, summarized, and classified based on the specific XP-endo file used. Conclusion: Overall, XP-endo files offer significant improvements in endodontic treatment. XPEF excels in irrigation activation and medicament removal, and XPES succeeds in canal cleaning, shaping, and retreatment. The XPER system, which incorporates the XPEF-R file, shows promise in removing root-filling materials, but its performance is inconsistent compared to other retreatment systems. We have found limited information regarding the latest XPE-Rise and XPE-Rise-R systems, additional research is required to fully determine their comparative effectiveness and optimize their clinical application.

Evaluation of apically extruded debris from root canal filling removal of the mesiobuccal canal of maxillary molars using XP shaper and protaper with two different irrigation

Background

Periapical extrusion of debris for root retreatment will effectively improve the posttreatment inflammation and pain. The aim of this study was to investigate the extruded debris for root retreatment using XP shaper and ProTaper files.

Materials and Methods

In his experimental laboratory study, 40 extracted human maxillary molars were used in this laboratory study. After disinfection and equalization of length, the samples were treated with a passive step-back technique and dressed. The samples placed in the tubes for retreatment were divided into four groups: (1) XP shaper file and hypochlorite, (2) XP shaper file and ethylenediaminetetraacetic acid (EDTA), (3) ProTaper file and hypochlorite, and (4) ProTaper file and EDTA. Then, the teeth were taken out of the tubes, and cleaned to collect the remaining apical debris. The weight of the tube and the extruded debris was measured again. Data were analyzed using the Kruskal-Wallis test (α =0.05).

Results

The highest average of extruded debris was related to the XP shaper file with EDTA solution, and the lowest average was related to the ProTaper file with hypochlorite solution. Between the two files used with EDTA and hypochlorite solution, the average debris extrusion of the XP shaper file with EDTA solution was significantly higher (P < 0.05) compared to the ProTaper and XP shaper files with hypochlorite solution (P < 0.05).

Conclusion

Regardless of the type of irrigant material, the ProTaper file can be a more suitable option than the XP shaper file for retreatment of the tooth root canal with minimal debris extrusion.

Postoperative pain in patients following endodontic treatment by XP-endo Shaper files: A systematic review and meta-analysis

Context

Postoperative pain occurs in 25%-60% of patients following endodontic treatment. It can significantly impact a patient's quality of life and requires timely management or, preferably, prevention.

Aims

The present systematic review was conducted aiming to analyze randomized controlled trials that compared postoperative pain in patients whose canals were shaped by XPS versus other endodontic file systems.

Materials and Methods

A systematic search was performed using key terms "postoperative pain" AND "XP-endo Shaper" across multiple databases to identify relevant randomized controlled trials. Details concerning the study design, endodontic preparation, XP-endo Shaper-related factors, and pain assessment were recorded. The risk of bias was calculated using the RevMan 5.3 software. Meta-analysis done using the random effects model which was represented using forest plots.

Results

Six studies evaluating a total of n = 290 samples of XP-endo Shaper file and other file systems each, respectively, were included in the final review and meta-analysis. The standard mean difference ranged from 0.8 to 2.88 with a mean of 1.04 (0.80-2.88) favoring other file systems. This signifies that the postoperative pain is on average 1.04 times more by other file systems as compared to XP-endo Shapers file although the difference was statistically nonsignificant (P > 0.05).

Conclusions

XP-endo Shaper has proven to be a relatively more efficient file system that effectively cleans and shapes the root canals, including those with difficult anatomy.

Postoperative pain of minimally invasive root canal treatment:a randomized clinical trial

This randomized clinical trial compared postoperative pain between a minimally invasive (MP) and conventional root canal treatment protocol (CP). A total of 170 mature permanent teeth (either with vital or necrotic pulp), were randomly assigned into two groups. In the CP group, ProTaper Gold (Dentsply Sirona, Ballaigues, Switzerland) and a continuous wave of condensation technique were used, whereas, in the MP group, TruNatomy (Dentsply Sirona), ultrasonic-assisted irrigation (UI), calcium hydroxide, and a sealer-based obturation technique were used. Patients recorded preoperative and postoperative pain using a 0-10 numerical rating scale (NRS) at 4 h, 1, 2, 3, 4, 5, 6, and 7 days after instrumentation and 1 day after canal obturation, respectively. There were no significant differences in pain intensity at any time points assessed between the two groups (p > 0.05). The occurrence of moderate/intense pain after instrumentation was significantly associated with preoperative periapical index (PAI) (p = 0.017) and NRS scores (p < 0.001). Preoperative pulp status (p = 0.009) and NRS score (p = 0.006) were identified as significant factors in the occurrence of moderate/intense pain after obturation. Instrumentation unequivocally reduced pain severity for both groups. The post-endodontic pain associated with the use of MP, combined with UI, Ca(OH)2, and calcium-silicate cement, did not differ from that of CP. Preoperative pain score, PAI, and preoperative pulp status were determined to be prognostic factors for postoperative pain.

The effect of ibuprofen sustained release oral premedication on intraoperative and postoperative pain: A randomised clinical trial

The aim of this study was to assess the effect of ibuprofen sustained release (SR) oral premedication on the efficacy of buccal infiltration (BI) with intraoperative and postoperative pain after single-visit root canal treatment. Sixty patients diagnosed with symptomatic irreversible pulpitis and apical periodontitis in mandibular molar were divided into two groups. Group SR received ibuprofen SR 800 mg and group PL received placebo capsule 1 h before 3.6 mL articaine BI injection. Pain was recorded using a modified visual analogue scale and postoperatively at intervals 6, 24 and 48 h. Group SR showed a significantly higher anaesthetic success rate (73.3%) compared to group PL (46.7%) (p < 0.05). Intraoperative and postoperative pain was significantly higher in group PL compared to group SR (p < 0.05). Premedication of ibuprofen SR improved the efficacy of primary BI in mandibular molars with symptomatic irreversible pulpitis and decreased postoperative pain at 6 and 48 h.

Centric versus eccentric engine-driven endodontic instrument design for microbial load reduction-A systematic review and meta-analysis of randomised clinical trials

This systematic review assessed the clinical influence of centric and eccentric engine-driven instrument design for reduction in microbial load in infected root canal system. The literature search was conducted in electronic databases (PubMed, Cochrane Library, Scopus, Lilacs and Google Scholar) and grey literature till June 2022. The search strategy followed the PRISMA 2020 guidelines. Qualitative and quantitative synthesis was conducted based on the guidelines of the Cochrane Handbook. The risk of bias was assessed using the revised Cochrane criteria and quality of evidence was conducted using the Grading of Recommendation Assessment, Development and Evaluation tool. Out of 28 papers, only five papers met the inclusion criteria of this review. Studies showed reduction in microbial load after instrumentation using centric or eccentric instruments with no statistically significant difference in the meta-analysis. In conclusion, there is low-grade evidence suggesting that microbial reduction is similar using centric and eccentric instruments.

A micro-computed tomographic analysis of the root canal systems in the permanent mandibular incisors in a Chinese population

BACKGROUND

Comprehensive understanding of the root canal system complexity is critical important for successful root canal therapy. A double root canal system may be present in permanent mandibular incisors with a variable incidence in different ethnic populations. Ignorance or improper management of this canal variation can lead to treatment failure. This in vitro study aimed to identify the anatomic features of root canal systems in the mandibular incisors in a Chinese population by using micro-CT.

METHODS

A total of 106 permanent mandibular incisors (53 central incisors and 53 lateral incisors) were collected from a native Chinese population. The teeth were scanned by a micro-CT scanner and then reconstructed three-dimensionally. The canal configurations were detected by Vertucci's classification, and the number and location of the accessory canals were also identified. The long (D) and short diameters (d) of the main and accessory canals were measured and D/d ratio was calculated at different root levels (cemento-enamel junction [CEJ] level, mid-root level and 1, 2, 3 and 4 mm from the apex). The root canal curvatures in the double-canaled mandibular incisors were measured at the proximal view by using modified Schneider's method. Chi-square test or Fisher's exact test was used for comparison of occurrence rates. Comparison of means from multiple groups was performed by using one-way ANOVA and LSD post-hoc test.

RESULTS

In regard to the occurrence of double root canals, gender difference was neither detected in the mandibular central (16.0% [male] vs 14.3% [female]; p = 0.862), nor in the mandibular lateral incisors (26.9% [male] vs 33.3% [female]; p = 0.611). Age group difference was also not detected in the mandibular central (p = 0.717) and lateral incisors (p = 0.521). The incidence of double root canals was 15.1% (8/53) in the central incisors, and 30.2% (16/53) in the lateral incisors, but the difference did not reach statistical significance (p = 0.063). The most frequent non-single canal type was the type III (1-2-1) (18.9% [20/106]), and the other types identified included 1 case of type II (2-1) and 3 cases of type V (1-2). The incidence of accessory canals was 17.9% (19/106), with a mean level of 1.92 ± 1.19 mm from the apex. The frequency of long-oval (2 ≤ D/d < 4) and flattened canals (D/d ≥ 4), as well as the mean value of D, d and D/d ratio increased from the apical 1 mm to the apical 4 mm level (the D/d ratio increased from 1.9 to 2.9 for the single canals, from 1.4 to 3.3 for the buccal canals and from 1.2 to 2.3 for the lingual canals), and the D/d ratio reached the peak at the mid-root level. Double curvatures were detected in 33.3% (8/24) of the buccal canals and 37.5% (9/24) of the lingual canals, and the difference has no statistical significance (p = 0.063). The degrees of the primary curvatures were 21.5 ± 7.1 degrees for the buccal and 30.1 ± 9.2 degrees for the lingual canals, and the degrees of secondary curvatures were 27.0 ± 11.4 degrees for the buccal and 30.5 ± 12.5 degrees for the lingual canals in the double curvatures. The degrees of the single curvatures were 14.2 ± 6.3 degrees for the buccal and 15.6 ± 6.0 degrees for the lingual canals. Significant difference was detected among above 6 groups of canal curvatures (p = 0.000), and severe curvatures (≥ 20 degrees) were more frequently detected in the double curved canals.

CONCLUSIONS

Double-canaled mandibular incisors were not uncommon in the Chinese population, and type 1-2-1 was the most frequent non-single canal type. Gender and age did not significantly impact the occurrence of a second canal in mandibular incisors. Long-oval and flattened canals were very common at different root levels and their incidence increased from apex to the mid-root level. Severe curvatures were frequently detected in the double canal systems, especially in those canals with double curvatures.

Severity of Post-Operative Pain after Instrumentation of Root Canals by XP-Endo and SAF Full Sequences Compared to Manual Instrumentation: A Randomized Clinical Trial

This investigation aimed to examine the post-operative pain experienced following single-visit root canal treatment using the XP-endo shaper sequence (XPS), full-sequence self-adjusting file (SAF), and manual K-files (HKF). A randomized equivalence parallel design, double-blinded clinical study was conducted on 120 patients with symptomatic irreversible pulpitis, with or without clinical signs of apical periodontitis. Only teeth with fully formed roots and no periapical lesions were incorporated in the study. Patients were apportioned to one of three groups (n = 40) randomly: Group 1-XPS, Group 2-SAF, and Group 3-HKF. Pre- and post-instrumentation pain was rated utilizing Visual Analog Scale (VAS) with a spectrum of 0-100 mm. The descriptive statistics and one-way ANOVA with 95% confidence intervals were used for statistical analysis. The mean VAS scores before instrumentation were consistent in all three groups. At 6, 24, 48, and 72 h, patients with root canals instrumented by SAF had the lowest post-instrumentation mean VAS score, followed by XPS. For all time intervals, the patients in the HKF group had the highest VAS score. The full-sequence SAF instrumentation resulted in less post-operative pain than the XP-endo plus protocol, while manual instrumentation with K-files resulted in the highest post-operative pain.

Influence of Sodium Hypochlorite and Chlorhexidine on the Dynamic Cyclic Fatigue Resistance of XP Endo Shaper Instruments

OBJECTIVE

 This study evaluated the dynamic cyclic fatigue resistance of the XP-Endo Shaper (XPS), associated with chlorhexidine digluconate (CHX) or sodium hypochlorite (NaOCl) in two different formulations: gel (G) or liquid (L).

MATERIALS AND METHODS

 Sixty XPS were used in an artificial stainless-steel canal, and the files were fully immersed in the irrigating solution throughout the experiment until the fracture. The files were divided into six groups (n = 10) based on the irrigation solution used: NaOCl(L), NaOCl(G), CHX(L), CHX(G), natrosol gel (NAT) (control), and lubricating oil (LO) (control). The artificial canal was manufactured 1.5 mm wide, 20 mm long, and, 3.5 mm deep with a straight cervical segment measuring 14.29 mm; an apical segment of 4.71 mm with 3 mm radius; and 90 degrees of curvature apical 1 mm long straight segment. Resistance to cyclic fatigue was determined by recording the number of cycles to fracture (NCF).

RESULTS

 The CHX(G), CHX(L), and OIL (LO) groups showed no significant difference between them and presented longer time to fracture (p > 0.05). NaOCl(L) shows the lowest NCF without significant differences between NaOCl(G) and NAT. The NCF of the NaOCl(G) was statistically similar to the CHX(L) and statistically lower than the CHX(G) and OIL groups. NAT did not present a statistical difference of the NaOCl(L), NaOCl(G), and presented a significantly lower NCF than the CHX(G) (p < 0.01).

CONCLUSION

 The use of CHX(G) resulted in increased cyclic fatigue resistance of the XPS instruments compared to NaOCl or LO.

Evaluation of rotary instruments with whipping motion in the biomechanical preparation of large root canals of young permanent teeth

Shaping ability evaluation of taper ./01 instruments in large root canals, by microcomputed tomography (micro-CT) and scanning electron microscopy (SEM). Maxillary central incisors with large diameter root canals were divided into two groups (n = 10): XP-Endo Shaper (FKG-Dentaire, Switzerland) and manual instrumentation (FKG-Dentaire). Two- and three-dimensional parameters from cervical to apical root thirds were evaluated by micro-CT. Apical stop was evaluated by SEM images. Data were analysed by ANOVA and Tukey tests (α = 5%). XP-Endo Shaper allowed a regular biomechanical preparation with less dentinal wear compared with manual instrumentation, which showed excessive wear of the thin root canal walls (p < 0.05). Roundness and SMI showed similarity between both protocols (p > 0.05). XP-Endo Shaper SEM showed a regular and well-defined shape of the apical foramen suggesting the formation of the apical stop. Reduced diameter and taper instruments promoted a conservative wear and a well-defined apical stop formation in large root canals.

Pain and Avoidance during and after Endodontic Therapy: The Role of Pain Anticipation and Self-Efficacy

Background: Pain anticipation has been identified as a predictor of pain and avoidance with respect to endodontic therapy. Self-efficacy is also key to the development and maintenance of health behaviors and achieve patient adherence to treatment. However, the role of self-efficacy has not been studied yet in endodontic treatment. Methods: This study was conducted on 101 patients who needed root canal therapy. They had to fill a questionnaire before treatment registered pain anticipation and self-efficacy; during and after treatment were registered pain intensity and avoidance. Results: Pain anticipation explained pain during (Beta = 0.51, t = 5.82, p ≤ 0.001, [0.34, 0.69]) and after treatment (Beta = 0.38, t = 4.35, p ≤ 0.001, [0.21, 0.55]). Self-efficacy did not have an influence in pain values. Pain anticipation explained avoidance during (Beta = 0.51, t = 3.60, p ≤ 0.001, [0.23, 0.80]) and after treatment (Beta = 0.62, t = 4.29, p ≤ 0.001, [0.33, 0.91]). Self-efficacy had a significant role in avoidance during treatment (Beta = 0.12, t = 2.19, p ≤ 0.03, [0.01, 0.23]) with a strong moderation relationship between pain anticipation and avoidance when self-efficacy was medium (Beta = 0.44, t = 3.24, p = 0.002, [0.17, 0.72]) or high (Beta = 0.84, t = 3.5, p ≤ 0.001, [0.37, 1.33]). Self-efficacy was not significant respect to avoidance after treatment. Conclusions: Self-efficacy is an important variable in endodontic therapy due to their moderating effect between pain anticipation and avoidance behavior during the procedure. It is necessary to improve the results of root canal therapy and reduce patient’s avoidance in order to take into account this variable.

The antibacterial effect and the incidence of post-operative pain after the application of nano-based intracanal medications during endodontic retreatment: a randomized controlled clinical trial

OBJECTIVE

This clinical trial aimed to evaluate the effect of nano-silver and nano-calcium hydroxide intracanal medicaments (ICM) during retreatment regarding their antibacterial effect and their effect on post-operative pain and flare-ups.

MATERIALS AND METHODS

Sixty-nine patients scheduled for endodontic retreatment were included in this randomized clinical trial and randomly allocated to 3 equal groups (n = 23) according to the type of ICM used. The first microbial sampling (S1) representing the original microbiota was obtained after the removal of the old canal filling. After chemo-mechanical debridement, another sample (S2) was obtained representing the microbial state before ICM application. Patients were randomly allocated to receive either nano-silver (nano-Ag), nano-calcium hydroxide (nano-CH), or calcium hydroxide (CH) as ICM. Patients rated their pain pre-operatively and then after 6, 12, 24, 48, and 72 h. During the second visit (7 days later), the last microbial sample (S3) was obtained after removal of the ICM. Reduction of total bacterial and total E. faecalis counts and the biofilm-forming capability of the existing microbiota were determined.

RESULTS

Results showed reduction in total bacterial count, total E. faecalis count and the biofilm-forming,capability of the existing microbiota after chemo-mechanical debridement (S1-S2) and after the application of ICM (S3-S2). However, the reduction after cleaning and shaping was significantly more pronounced (p < 0.001) compared to the effect of ICM application, with no difference between the 3 ICM (p > 0.05). Post-operative pain was significantly reduced at the 48- and 72-h intervals after the application of nano-Ag and nano-CH only (p < 0.001), with no significant difference between these two ICM (p > 0.05). The incidence of flare-ups in all groups was similar (p > 0.05).

CONCLUSIONS

The antibacterial effect of the nano-Ag and nano-CH was equivalent to that of CH, but they contributed to better pain control.

CLINICAL RELEVANCE

Nanoparticles may have a positive impact on post-endodontic pain.