Post-endodontic pain in curved canals prepared with different rotary instrumentation techniques: A randomized controlled trial.

BACKGROUND: Curved root canals are associated with the highest number of procedural errors during endodontic instrumentation. Recently, numerous rotary instruments have been developed, with both manual and automated mechanisms, to facilitate endodontic treatment and manage the complications related to it. OBJECTIVES: The aim of the study was to assess post-endodontic pain after using the HyFlex® EDM OneFile (HEDM), WaveOne® Gold (WOG) and XP-endo® Shaper (XPS) systems in the preparation of curved canals in patients with asymptomatic irreversible pulpitis. MATERIAL AND METHODS: A total of 45 molars with curved canals and asymptomatic irreversible pulpitis were randomly divided into 3 equal groups based on the instrumentation used: HEDM (group A); WOG (group B); and XPS (group C). All teeth were prepared according to the manufacturers' instructions. Postendodontic pain was assessed using the visual analog scale (VAS) at 6, 12, 18, 24, 48, and 72 h after root canal instrumentation. The data was analyzed using the one-way analysis of variance (ANOVA) and the paired-samples t test with the Bonferroni correction, with a p-value of 0.05 set for statistical significance. RESULTS: The highest levels of post-endodontic pain were recorded at 6 h after treatment. Then, the values gradually decreased until the pain nearly vanished after 72 h. No statistically significant differences were observed in the VAS scores between groups A and B. At the same time, group C showed the lowest VAS scores at all follow-up time points. CONCLUSIONS: The use of the XPS system resulted in the lowest pain scores at all follow-ups. The HEDM and WOG groups showed no differences in the pain scores throughout the whole follow-up period.

Can diode laser 810 nm decrease post endodontic pain in patients with asymptomatic necrotic maxillary incisors? A four-arm randomized controlled trial.

AIM: To find the best method for applying the diode laser 810 nm to relieve post-endodontic pain on necrotic maxillary incisors with periapical lesions within a single-visit treatment. METHODS: Eighty patients with a necrotic incisor, diagnosed with asymptomatic apical periodontitis, received standardized cleaning and shaping procedures, then divided randomly with a 1:1:1:1 allocation ratio into four groups: Group 1: control group with no laser application, Group 2: applying the diode laser as an irrigation activation system (IAS), Group 3: applying the diode laser from the buccal and palatal mucosa, Group 4: applying the diode laser as an IAS and from buccal and palatal mucosa. The postoperative pain was assessed using the visual analog scale (VAS) 1, 3, 7, and 14 days after the treatment. The mean values of the VAS score were statistically analyzed used Kruskal-Walis and Mann-Whitney U tests. The level of significance was set at a = 0.05. RESULTS: During 14 days after treatment, there was a statistically significant difference between mean values of VAS scores in the four groups (P value < 0.05); Group 1 scored the highest score, whereas Group 4 showed the lowest one. Moreover, Group 4 showed favorable outcomes compared with Group 2 and Group 3 during the first three days after treatment. CONCLUSION: Diode laser reduced postoperative pain after necrotic teeth with large-sized apical lesion treatment, whereas using diode laser either as an IAS or LLLT reduced the postoperative pain compared with the control group. Moreover, the usage of a diode laser in both previous techniques represents the best protocol for postoperative pain relief during 14 days of treatment. CLINICAL RELEVANCE: The clinical significance of this study is to investigate the best method to reduce postoperative pain using diode lasers 810 nm; where the results of this study indicated that the more diode laser exposer in LLLT and IAS, the less postoperative pain after endodontic procedures.

The effect of the irrigant activation protocol on postoperative pain in maxillary incisors with asymptomatic apical periodontitis: A three-arm randomized clinical trial.

OBJECTIVES: This study aimed to compare the effects of three irrigation activation systems (IAS) on postoperative pain (PP) in activating three final irrigants: sodium hypochlorite 5.25%, ethylenediaminetetraacetic acid 17%, and chlorhexidine 2%. MATERIALS AND METHODS: This parallel randomized clinical trial included referred patients with asymptomatic large-sized apical lesion incisors. A standard method was followed in the canal cleaning and shaping for all included patients in the study. Then, the patients were randomly assigned (1:1 allocation) into three groups: G1 (n = 20) with passive ultrasonic irrigation activation; G2 (n = 20) with XP-Endo Finisher file activation; and G3 (n = 20) with diode laser (810 nm) activation. PP was estimated in all groups using a visual analog scale after 1, 3, 7, and 14 days of treatment. Comparisons between the groups were made using the Kruskal-Wallis test, whereas the Mann-Whitney U test was used in the pairwise comparisons. RESULTS: Sixty patients were followed-up in this trial. There were significant differences between the groups in terms of PP After 1, 3, and 7 days of treatment (p = 0.002, p = 0.017, and p = 0.006, respectively). On the first day of treatment, G3 showed the lowest PP compared with G1 and G2 (p = 0.007 and p = 0.001, respectively). On the third day of treatment, G3 showed less PP compared with G2 (p = 0.005). On the seventh day of treatment, G2 showed the highest PP compared with G1 and G3 (p = 0.012 and p = 0.003, respectively). CONCLUSIONS: The XP-Endo Finisher file caused the highest PP level especially in the next day and 3 days of the treatment, whereas the diode laser had the lowest PP level during the first week of treatment. It is noteworthy that PP disappeared completely after 2 weeks of treatment with all three IASs. TRIAL REGISTRATION: The trial was registered in the ISRCTN registry (Trial ID: SRCTN99457940).

Partial Pulpotomy in Mature Permanent Molars with Symptoms Indicated Irreversible Pulpitis Using MTA: A Study of Three Case Reports over Four-Year Follow-Up.

VPT is vital pulp therapy, a biologically based procedure that combines several therapeutic techniques to maintain the entire or a portion of the dental pulp. Interest in VPT has grown due to recent developments in bioactive materials and an understanding of biological pulp reparative responses. This case report is aimed at evaluating the success rate of partial pulpotomy in permanent molars with symptoms indicating irreversible pulpitis using MTA and presenting with extremely deep carious lesions over four years of follow-up. All patients came with spontaneous and severe pain. Each tooth was isolated with a rubber dam and disinfected with 5.25% NaOCl before caries excavation. After caries removal, a partial pulpotomy was performed on 2-3 mm of the exposed pulp. Bleeding time was recorded after hemostasis was achieved, and then MTA was placed over the exposed pulp. The permanent restoration was placed after pulp capping, and postoperative periapical radiographs were taken. Patients were scheduled for clinical and radiological examinations for four years based on 6-month intervals. All teeth revealed a successful outcome throughout the follow-up periods (clinically and radiographically) with complete resolution of clinical signs and symptoms. Partial pulpotomy using MTA might be an effective long-term management strategy for permanent molars clinically diagnosed with irreversible pulpitis.

Antimicrobial Efficacy of Two Different Calcium Hydroxide Endodontic Dressings on the Eradication of Enterococcus faecalis in Single-Rooted Canals: An In Vitro Study.

INTRODUCTION: Bacterial pulp infections are considered the most common cause of endodontic treatment failure. Enterococcus faecalis was isolated from most cases of failure of endodontic treatment. Therefore, using the appropriate intra-canal dressing is essential for successful treatment. The improved formula used in calcium hydroxide PLUS points ensures more calcium hydroxide is released over a longer period and more space to release calcium hydration. This in vitro research aimed to evaluate the differences in the efficacy between Ca(OH)2 paste and PLUS points as an endodontic dressing in eradicating E. faecalis growth inside infected single-rooted canals. MATERIALS AND METHODS: Thirty mandibular first premolars with single canals were extracted for orthodontic reasons and were prepared after cutting their crowns to standardize the length of the roots to 17 mm, root preparation, and isolating E. faecalis. The infected sample root canals were contaminated with the prepared bacterial suspension, and the sample was incubated in the incubator under air conditions at 37°C for seven days, counting the bacteria colonies. Then, the bacterial units were counted before applying the drug, applying Ca(OH)2 paste in the first group and Ca(OH)2 PLUS points in the second group. The bacterial units were counted, and the number of bacteria was compared between the two substances applied to the samples, measuring the intracanal dressings' effectiveness. Wilcoxon signed-rank tests were used to detect significant differences.  Results: The results showed a statistically significant difference in the bacterial count of E. faecalis before and after applying the dressing of Ca(OH)2 paste from a mean of 11.89 to a mean of 3.18 (p=0.003) and no statistical difference in applying Ca(OH)2 PLUS points from mean 11.98 to mean 10.50 (p>0.05). CONCLUSION: Within the limits of the current in vitro study, the Ca(OH)2 paste cones were more effective than Ca(OH)2 PLUS points in eradicating E. faecalis growth inside the infected single-rooted canals.

Heterotopic gastrointestinal cyst in the mandible of a young adult: A rare case-report from Syria.

Heterotopic gastrointestinal cyst (HGC) is a rare entity in the head and neck region. The dorsal surface of tongue and the floor of the mouth is the most commonly affected sites and rarely affects bone. Histologic examination reveals a lesion resembling any part in the gastric tract; colonic, intestinal or gastric mucosa. We report a HGC presenting in a twenty-one-year-old Syrian female patient.

The Effect of Bioceramic HiFlow and EndoSequence Bioceramic Sealers on Increasing the Fracture Resistance of Endodontically Treated Teeth: An In Vitro Study.

Background/purpose Root fractures after endodontic treatment are a serious complication, and it often causes tooth loss, several studies have found a correlation between root canal preparation and filling, and the possibility of root fracture. Therefore, this study aimed to evaluate the root fracture resistance of the endodontically treated mandibular premolars after preparing and filling by EndoSequence Bioceramic (BC), EndoSequence BC HiFlow, and AH Plus (AHP). Materials and methods The study sample consisted of 75 single-rooted and single-canal mandibular premolars, they were randomly distributed into five groups: Group I: root canals preparation and fillings with AHP sealer; Group II: root canals preparation and fillings with EndoSequence BC sealer; Group III: root canals preparation and fillings with BC HiFlow sealer; Group IV (Negative Control): without root canals preparation; and Group V (Positive Control): canals preparation without root canals filling. A glide path was established by #10 hand K-file, then the crowns were cut, and the canals were prepared and filled. All teeth were restored with glass ionomer cement and kept in an incubator at 37°C for a week. All samples were placed within acrylic bases and a vertical force was applied using a Testometric machine and the fracture resistance force was recorded. Results EndoSequence BC and BC HiFlow groups showed slightly better fracture resistance (494.440, 496.960 N respectively) than AHP group (492.680 N). However, no statistically significant difference was found between the two groups (P-value >0.05). The greatest mean fracture force was observed in the positive control group (736.040 N) with statistically significant difference between the other groups (P-value <0.01) and the least mean fracture force was shown in the negative control group (318.040 N) with statistically significant difference between the other groups (P-value <0.01). Conclusion Based on this in vitro study, the use of EndoSequence BC, BC HiFlow, and AHP enhanced the fracture resistance in root-filled single-rooted premolar teeth. While, the application of EndoSequence BC, BC HiFlow, and AHP did not increase the fracture resistance of roots compared to that of unprepared root canals.