Current Trends in Root Canal Irrigation

Efficacy of non -thermal pressure plasma versus other modalities for disinfection of primary root canals

BACKGROUND

Endodontic treatment aims in the preservation of extremely carious primary teeth. For root canal therapy to be successful, root canals must be properly prepared and effectively irrigated .Therefore, it is necessary to select the proper root canal disinfection method to preserve the primary tooth.

OBJECTIVE

This research was carried out to compare non-thermal pressure plasma (NTPP), diode laser, propolis, and chlorhexidine (CHX) efficacy for disinfection of deciduous anterior root canals contaminated with Enterococcus Faecalis (E. faecalis) after sterilization by gamma radiation.

METHODS

In this study, forty extracted single-rooted primary anterior teeth were used. All teeth were cleaned, disinfected, and stored till use. Gaining access was provided till reaching the orifices of canals, all pulp tissue debris was removed, and root canals of all teeth were prepared. Standardized 8 mm root length was obtained through crown decronation below the cemento-enamel junction. Samples were sterilized by gamma radiation then the bacterial suspension was inoculated inside root canals. Specimens divided into four main groups; ten samples each group. Group I: Samples irrigated with chlorhexidine. Group II: Samples treated with diode laser. Group III: Samples irrigated with Ethanolic extract of propolis. Group IV: Samples treated with NTPP.

RESULTS

A significant difference was found between values measured before and after four irrigation types (p < 0.001) for CHX, Diode Laser, NTPP and (P = 0.035) for Propolis. The highest values of colony reduction measured before and after irrigation were for NTPP (4.06 ± 0.88). Maximum reduction in colony-forming units was recorded in the NTPP group (98.79%), while the lowest reduction in colony-forming units was recorded in Propolis group (81.99%).

CONCLUSION

All tested methods (CHX, NTPP, Diode laser and Propolis) decreased colony count, with the highest reduction noted in group treated by NTPP and the least reduction noticed in Propolis treated group.

Possibilities of Application of Cold Atmospheric Pressure Plasmas in Dentistry—A Narrative Review

According to the World Human Organization (WHO), dental and periodontal diseases are common among the human population. Traditional dentistry offers a wide range of methods for treating oral diseases and performing esthetic procedures. In contrast, cold atmospheric pressure plasma (CAPP) has been found to be a promising technology in multiple fields, particularly in medical sciences such as dentistry. In this study, CAPP might be a promising adjunct to conventional dental treatments. A substantial number of studies have confirmed the effectiveness of both direct and indirect CAPP applications in dentistry. Because CAPP technology is fast, inexpensive, and noninvasive, we aim to review recent literature focused on the application of this methodology in dentistry.

Impact of different disinfection protocols on the bond strength of NeoMTA 2 bioceramic sealer used as a root canal apical plug (in vitro study)

INTRODUCTION

Treatment of an immature permanent tooth required a special disinfection protocol due to the presence of thin radicular walls, which are prone to fracture. Mineral Trioxide Aggregate (MTA) has been proposed as a root repair material for root canal treatment. The aim of this in vitro study was to compare the push-out bond strength of conventional White MTA cements and second generation NeoMTA 2 in imitated immature roots treated with different disinfection protocols, which are 5.25% sodium hypochlorite (NaOCl), followed by 17% ethylenediaminetetraacetic acid (EDTA), and NaOCl, followed by 20% etidronic acid (HEBP).

METHODS

The root canals of freshly extracted single-root teeth were manually prepared until 90 K-file to imitate immature roots. Roots were randomly divided into four groups (G) according to the disinfection protocol (n = 15 per group). where G1 (NaOCl + EDTA + White MTA) and G2 (NaOCl + EDTA + NeoMTA 2) While G3 (NaOCl + HEBP + White MTA) and G4 (NaOCl + HEBP + NeoMTA 2) All groups were activated with manual agitation. All specimens were incubated for 48 h. The apical third of each root was perpendicularly sectioned to attain a slice of 3 mm thickness. Push-out bond strength values were assessed using a two-way ANOVA and a Student's t test.

RESULTS

G3 and G4 that were treated with HEPB showed higher significant push-out bond strength mean values than G1 and G2 treated with an EDTA chelating agent. Irrespective of the chelating agent used, it was found that both NeoMTA 2 and White MTA had no significant influence on push-out bond strength mean values (p ≤ 0.05).

CONCLUSION

The combined use of 5.25% NaOCl and 20% HEBP increased the push-out strength values of both NeoMTA 2 and White MTA, rendering them suitable to be used as an alternative chelating agent to EDTA.

Quality of Root Canal Filling in Curved Canals Utilizing Warm Vertical Compaction and Two Different Single Cone Techniques: A Three-Dimensional Micro-Computed Tomography Study

Statement of the Problem

Successful endodontic treatment depends on three-dimensional (3D) root canal filling to prevent the leakage of residual bacteria. Different obturation techniques with different sealers should be compared by employing advanced assessment tools.

Purpose

This study compared the obturation quality of warm vertical compaction (WVC) and two different single-cone (SC) techniques using micro-computed tomography (micro-CT).

Materials and Method

Thirty-three extracted maxillary molars with mesial root canal curvature of 20‒40º were prepared in vitro with One-Curve files and randomly assigned to three groups (n=11) for root canal obturation with WVC, SC technique with AH Plus sealer (SC-AH), or SC technique with SureSeal bioceramic (BC) sealer (SC-Su). The root canals underwent micro-CT examinations before and after obturation to determine the volume percentages (VPs) of voids and gaps at different distances from the apex (coronal, middle, and apical thirds). Data were analyzed by Kruskal-Wallis and Mann-Whitney U tests.

Results

The highest VP of voids and gaps was recorded in the SC-Su group, with no significant difference from other groups (p> 0.05). There were significant differences in VP of gaps at different distances from the apex (p<0.05). The VPs of gaps in the apical third of all the samples were significantly higher than in the coronal and middle thirds. However, the difference in VP of voids was not significant at different distances from the apex (p>0.05).

Conclusion

None of the tested techniques could provide a void-free and gap-free filling. The apical third of the canals showed the highest VP of gaps in all obturation techniques.

Chitosan: A Versatile Biomaterial Revolutionizing Endodontic Therapy

Owing to their nanoscale dimensions, nanomaterials have special chemical and physical properties that set them apart from their bulk counterparts. The exterior dimensions of a minimum of half of the particles span several nanometers in their size distribution. Silver nanoparticles (AgNPs) are one type of nanomaterial that has been widely used because of their strong antibacterial properties, which can kill bacteria that are resistant to many drugs. Due to its potential for regulated release, localized retention, and safeguarding the active ingredients against environmental or enzymatic deterioration, nanoparticle technology has also emerged as a promising medication delivery method. The techniques for creating nanoparticles can be easily scaled up and used for a wide variety of medications. Since polymeric nanoparticles are biodegradable, biocompatible, and have more readily available formulation techniques than other nanoparticle drug delivery approaches, their range of applications has been expanding. Chitosan, also known as deacetylated polysaccharide, is a straight-chain cationic polymer that is typically a cationic copolymer. It can be generated naturally or by deacetylating chitin. Consequently, it contains an extensive array of biomedical applications, such as efficient healing of wounds, regeneration of tissues, regeneration of bone, and anti-infection. Because of its functional diversity, accessibility, and being both biodegradable and biocompatible, it has a wide spectrum of uses in dentistry. Recent research on chitosan-based nanoparticles is founded on the field's growing comprehension of the characteristics of chitosan and techniques for chemical or physical modification that are used to optimize the drug loading and release characteristics of the nanoparticles.

Root Canal Instrumentation: Current Trends and Future Perspectives

The evolution of root canal instrumentation techniques has significantly impacted the field of endodontics, enhancing both the efficiency and outcomes of treatments. This review outlines the transition from manual to mechanical and rotary instruments, highlighting the role of nickel-titanium (NiTi) alloys and smart technologies in advancing procedural precision and reducing patient discomfort. Key historical developments and technological innovations, such as digital imaging and navigation systems, are explored for their contributions to improved clinical outcomes and patient satisfaction. Additionally, the review addresses the challenges presented by the complex anatomy of the root canal system and the advent of current instrumentation techniques. The potential of emerging trends, including artificial intelligence and advances in materials science, is discussed in the context of future endodontic practices. Despite the progress, challenges related to using advanced instrumentation methods, ethical considerations, and the cost factor of new technologies persist. The present review underscores the ongoing need for research and development to further refine root canal instrumentation techniques, ensuring that advancements in endodontic care remain patient-centered and accessible.

Efficacy of calcium hypochlorite in disinfection of gutta-percha cones contaminated with Candida albicans

This study aimed to compare the efficacy of 2.5% sodium hypochlorite (NaOCl), 2.5% calcium hypochlorite [Ca(OCl)2], and 2% chlorhexidine (CHX) in the rapid disinfection of gutta-percha cones contaminated with Candida albicans. The minimum inhibitory and minimum fungicidal concentrations of each solution for C. albicans were determined and the ability of each solution to destroy and inhibit biofilm in culture wells was tested. In addition, ninety-eight gutta-percha cones contaminated with the fungal suspension were disinfected according to the type of solution (2.5% NaOCl, 2.5% Ca(OCl)2 or 2% CHX) in its different application methods (without agitation, ultrasonic agitation or agitation with Easy Clean), and regarding the exposure time to each irrigating solution (1 or 5 min). Next, the samples were checked for turbidity and evaluation of viable colonies. The compounds that showed the best performance in biofilm destruction were NaOCl and Ca(OCl)2 at a concentration of 2xMIC (p < 0.001). Regarding inhibited biofilm, the only compound that was effective at all MIC concentrations tested was 2.5% Ca(OCl)2 (p < 0.0001). Regarding the viable colonies, all solutions were effective concerning the control group, for all application methods, in 1 and 5 min (p < 0.05). The densitometer reading showed that CHX was the only effective solution in all application methods performed (p < 0.05). The results demonstrate that all tested solutions were effective in the rapid decontamination of cones contaminated with C. albicans.

Efficacy of a Novel Intracanal Medicament on Total Antioxidant Status in Patients With Apical Periodontitis: A Randomized Controlled Clinical Trial

Introduction Successful endodontic treatment relies upon the microbial debridement of the root canal system. This can be achieved to a great extent by using intracanal medicaments, which inhibit the microbes growing in the root canal. Evaluating the capacity of oxidants in the saliva is a crucial parameter for assessing the antioxidant capacity of any individual, which decreases in inflammatory conditions. An effective intracanal medicament can increase the total antioxidant capacity of saliva, which comes down because of inflammatory conditions. Aim To evaluate the effect of two intracanal medicaments on the antioxidant capacity of saliva. Materials and methods In a randomized prospective clinical trial, 42 patients with a mean age of 18-70 years were selected based on exclusion and inclusion criteria, and the baseline value of the total antioxidant capacity of saliva was recorded. The patients were categorized into two groups as per the block randomization method (Group I: calcium hydroxide (Maarc, New Delhi, India) intracanal medicament; Group II: Hekla lava (SBL Pvt. Ltd., Germany) intracanal medicament). Access opening, working length determination, and cleaning and shaping were conducted using hand K-files and ProTaper Gold rotary files. Intracanal medicaments were placed according to the groups assigned, and temporary restoration was placed. The patients were recalled after seven days. If the tooth was asymptomatic, obturation was completed, and a saliva sample was collected to assess the total antioxidant capacity. Results The total antioxidant capacity of saliva was increased after using intracanal medicaments and endodontic therapy, and there was a statistically significant difference before and after using both the medicaments (p=0.0005; i.e., calcium hydroxide and Hekla lava. When both medicaments were compared, there was no significant difference in the antioxidant capacity of saliva among medicaments (p=0.384). Conclusion The total antioxidant capacity of saliva was increased after using both the intracanal medicaments. Hence, Hekla lava can be potentially used as an alternative intracanal medicament.

[Effectiveness of an irrigant in the chronic periapical abscess management: a case report]

The endodontic environment has optimal conditions for the growth of microorganisms that can release by-products into the periapical region of the tooth and cause inflammatory lesions. Chemical disinfection using irritants solutions plays an clinical important role, as they are able to remove waste from contaminated organic and inorganic tissues, generating a residual antibacterial effect. The purpose of this study was to show the effectiveness of 2.5% and 5.25% sodium hypochlorite as an irrigating agent for the clinical management of a chronic periapical abscess in a tooth with apical resorption. Initially, 2.5% sodium hypochlorite was used, however, as it did not have an optimal abscess healing response after 3 days, it was decided to use a concentration of 5.25% to achieve a better bactericidal effect. After 5 days, the fistula healed, and endodontic treatment continued. One of the perspectives of this case report is to investigate more about the use of antibiotic therapy in conjunction with a good irrigation protocol.

Efficacy of Different Root Canal Irrigating Solutions in Removing Smear Layer: A Scanning Electron Microscopic Study

Background The aim of the present investigation was to evaluate and compare the efficacy of frequently used chemical agents in terms of their capacity to eliminate the smear layer after instrumentation, as observed via scanning electron microscopy (SEM). Materials and methods Sixty extracted single-rooted mandibular premolar teeth, each with roots 15 mm in length, were used in this study. The teeth were divided into one control group and four study groups, each containing 12 teeth. In Control Group 0, teeth were irrigated with 3 ml of saline only. In Group 1, teeth were irrigated initially with 3% sodium hypochlorite (NaOCl) and then given a final rinse with 3 ml of 17% ethylenediaminetetraacetic acid (EDTA) for one minute. In Group 2, teeth were irrigated with 3% NaOCl and given a final rinse with 3 ml of a mixture of tetracycline, acid, and detergent (MTAD, BIOPURE) for one minute. In Group 3, teeth were irrigated with saline and given a final rinse with 3 ml of 17% EDTA for one minute. In Group 4, teeth were irrigated with saline and given a final rinse with 3 ml of MTAD for one minute. One-half of each tooth was chosen and prepared for scanning electron microscopic (SEM) examination at the cervical, middle, and apical thirds. These were observed at magnifications of up to 1,000 times to check for the presence or absence of a smear layer. The data were analyzed using the Kruskal-Wallis test and post-hoc Dunn's test. Results All of the root canal irrigation protocols exhibited superior efficacy compared to the control group in the elimination of the smear layer. Group 2 (3% NaOCl with MTAD) showed the lowest mean scores, compared to all the groups, followed by Group 1 (3% NaOCl with 17% EDTA). MTAD was more effective than EDTA. The smear layer was effectively removed from the apical third, followed by the middle and coronal thirds of the root. Conclusion Initial irrigation with 3% NaOCl and one-minute final irrigation with 3 ml MTAD was the most effective root irrigant, and particularly indicated in teeth with infection of the apical third.

Beyond Tradition: Non-surgical Endodontics and Vital Pulp Therapy as a Dynamic Combination

Symptomatic irreversible pulpitis and apical periodontitis in mature permanent teeth present challenges in their management. Traditional treatment approaches, such as root canal therapy or tooth extraction, may compromise tooth structure and oral function. This review article explores the combination of non-surgical endodontic treatment and vital pulp therapy as an alternative approach for these conditions. The purpose is to examine this combined approach's effectiveness, benefits, challenges, and limitations. The objectives include reviewing the literature, evaluating clinical outcomes, discussing potential benefits, and providing recommendations for clinical practice. The combination approach aims to preserve tooth structure, promote healing, and reduce postoperative complications. The article discusses the rationale for combining the two techniques, presents evidence supporting their efficacy, and outlines the techniques and protocols involved. Clinical outcomes, case studies, potential challenges, and comparative analysis with traditional approaches are also explored. Future directions and research recommendations highlight areas for further investigation, innovations, and the development of clinical guidelines. In conclusion, the combination of non-surgical endodontic treatment and vital pulp therapy offers a valuable strategy for managing mature permanent mandibular molars with symptomatic irreversible pulpitis and apical periodontitis. Further research and advancements are needed to refine the treatment protocol and expand the evidence base, and clinicians should stay updated to provide optimal care and improve patient outcomes.

Life span of Neoendo Flex and ProTaper Next rotary files with reciprocating motion in single-rooted teeth

Background

Cleaning and shaping represent a vital step in the endodontic procedure. In routine endodontic therapy, the fracture of nickel-titanium (NiTi) instruments is a procedural problem creating a major obstacle to therapy.

Aim

This study examines the life span of one Neoendo Flex and ProTaper Next (PTN) rotary file using reciprocating motion and compares the time required by both file systems for canal preparation.

Materials and Methods

One hundred maxillary permanent central incisors were selected. In that, fifty teeth are utilized in a reciprocating motion (RM) with the PTN file (n = 25) and Neoendo Flex file (n = 25). To check fractured resistance and the overall root canal preparation time, fifty more teeth are employed in continuous motion (CM) with canals prepared using PTN (n = 25) and Neoendo Flex (n = 25). All canals are prepared following the sequence of respective files. Later, the fracture mechanism of the files was inspected using a scanning electron microscope.

Results

In an RM motion, both PTN and Neoendo Flex files can be used in a minimum of 25 canals in single-rooted teeth. Statistical analysis using the Mann-Whitney U-test showed no significant difference in total time taken by PTN and Neoendo Flex in both motions.

Conclusion

Within the limitation of this study, the RM was found to be better than CM with less incidence of instrument fracture.

Evaluation of apical extrusion of debris and centering ability in different nickel-titanium files during curved root canal preparation

BACKGROUND

Curved root canals lead to difficulties in cleaning, shaping and filling the root canal system. Apical extrusion of debris and root canal transportation are important factors causing postoperative complications. In clinical practice, commonly selected instruments include multifile NiTi systems, such as M3-Pro PLUS (M3-PRO), Orodeka Plex 2.0 (ODP), Rotate (ROT), and Protaper Gold (PTG), as well as single-file NiTi systems, such as M3-L Platinum 2019 (M3L), Waveone Gold (WOG), and Reciproc Blue (RCB). This study aimed to comprehensively evaluate the differences in the apical extrusion of debris and centering ability of the above NiTi files.

METHODS

Seventy 3D-printed resin teeth were used (n = 10). The apically extruded debris was collected in a preweighed centrifuge tube. The resin teeth with or without root canal preparation were cut into separate cross sections at 1 mm, 3 mm, 5 mm, and 7 mm away from the root apex, and then the root canal transportation and centering ratio of each cross section were calculated.

RESULTS

Apical extrusion of debris was highest in RCB but lowest in OD-P (P < 0.05). Root call deviation was lowest in ROT at the 3 mm level, in PTG at the 5 mm level, and in PTG and ROT at the 7 mm level (P < 0.05). The centering ratio of NiTi files was highest in the RCB group at the 3 mm level, in the PTG group at the 5 mm level, in the ROT group at the 7 mm level (P < 0.05).

CONCLUSIONS

For NiTi files with the same system, the cross-sectional design is the greatest factor affecting the extrusion of debris, and motion mode is the second. In addition, the multifile system could reduce the degree of root canal transportation.

Cauterization of Narrow Root Canals Untouched by Instruments by High-Frequency Current

The mechanical removal of bacteria is fundamental to the treatment of infected root canals, but complete sterilization of biofilms tends not to extend to uninstrumented areas. However, during electrical conduction to a root canal filled with a conductor, the higher impedance where the root canal is narrower generates Joule heat that may result in a large temperature increase and sterilization. The effect of a high-frequency electric current on the wall of a simulated narrow root canal was investigated by scanning electron microscopy (SEM) and energy dispersive X-ray spectrometry (EDS). Simulated root canals, 0.1 mm in diameter, were prepared in dentine blocks. The root canal wall was treated with Plank-Rychlo solution for 5 min to create a decalcified layer. The simulated root canal was filled with either saline or NaClO, and 150 or 225 V at 520 kHz was applied for 0 s, 1 s, or 5 s. As the conduction time increased, and when the saline was replaced with NaClO, the proportion with a flat decalcified surface decreased, dentinal tubules and a lava-like morphology were significantly more evident on SEM (p < 0.01), and EDS showed significant decreases in carbon and oxygen and increases in calcium (p < 0.01). It was concluded that filling uninstrumented root canals with NaClO and using electrical conduction for 5 s could incinerate and eliminate the organic material of the root canal wall. The application of high-frequency electric current may lead to the cure of many cases of persistent apical periodontitis.