Nanostructured ZnO thin film to enhance gutta-percha's adhesion to endodontic sealers.

BACKGROUND: Gutta-percha (GP) combined with an endodontic sealer is still the core material most widely used for tridimensional obturation. The sealer acts as a bonding agent between the GP and the root dentinal walls. However, one of the main drawbacks of GP core material is the lack of adhesiveness to the sealer. ZnO thin films have many remarkable features due to their considerable bond strength, good optical quality, and excellent piezoelectric, antibacterial, and antifungal properties, offering many potential applications in various fields. This study aimed to explore the influence of GP surface's functionalization with a nanostructured ZnO thin film on its adhesiveness to endodontic sealers. METHODS: Conventional GP samples were divided randomly into three groups: (a) Untreated GP (control); (b) GP treated with argon plasma (PT); (c) Functionalized GP (PT followed by ZnO thin film deposition). GP's surface functionalization encompassed a multi-step process. First, a low-pressure argon PT was applied to modify the GP surface, followed by a ZnO thin film deposition via magnetron sputtering. The surface morphology was assessed using SEM and water contact angle analysis. Further comprehensive testing included tensile bond strength assessment evaluating Endoresin and AH Plus Bioceramic sealers' adhesion to GP. ANOVA procedures were used for data statistical analysis. RESULTS: The ZnO thin film reproduced the underlying surface topography produced by PT. ZnO thin film deposition decreased the water contact angle compared to the control (p < 0.001). Endoresin showed a statistically higher mean bond strength value than AH Plus Bioceramic (p < 0.001). There was a statistically significant difference between the control and the ZnO-functionalized GP (p = 0.006), with the latter presenting the highest mean bond strength value. CONCLUSIONS: The deposition of a nanostructured ZnO thin film on GP surface induced a shift towards hydrophilicity and an increased GP's adhesion to Endoresin and AH Bioceramic sealers.

Comparative evaluation of the antibacterial activity of curcumin-coated gutta-percha versus nanocurcumin-coated gutta-percha against Escherichia coli: An in vitro study.

Introduction: Due to its biological and antibacterial qualities, many plants, including curcumin, are used as phytomedicines in dentistry. They are primarily used as intracanal medication in endodontics to prevent probable chemical side effects and also to address antimicrobial resistance. Curcumin nanoformulations have improved antibacterial activity and improved dispersion, making them the superior form of curcumin. The purpose of this study was to assess curcumin and nanocurcumin's antibacterial properties. As a gutta-percha coating, they are to be tested against Escherichia coli. Materials and Methods: The study employs the standard strain of E. coli, ATCC 25922. The antibacterial activity of gutta-percha cones against E. coli is assessed after coating them with suspensions of curcumin and nanocurcumin. Scanning electron microscopy is utilized to evaluate the coatings' continuity. Results: The gutta-percha cones that are untreated, coated with curcumin, and coated with nanocurcumin exhibit significantly different levels of antibacterial activity. There is statistically significant variation in their antibacterial activity. Conclusion: (1) Compared to curcumin-coated and untreated gutta-percha cones, those coated with nanocurcumin exhibit a stronger antibacterial activity. (2) Compared to uncoated gutta-percha cones, gutta-percha cones coated with curcumin exhibit more antibacterial action.

Non-surgical Endodontic Management of Multiple Mishaps: A Case Report.

The description of non-surgical retreatment is to eliminate all previous filling materials and correct any mishaps. An adequate understanding of root and canal morphology is a fundamental requirement for obtaining a favorable outcome in endodontic treatment. The endodontic diagnosis was previously treated through therapy with symptomatic apical periodontitis. Treatment was performed under a dental operative microscope. Gates Glidden (GG) drills size 2 and 3 were used to remove the coronal part of gutta-percha for all canals. A braiding technique with a Hedstrom file size 15 without a solvent was used to remove gutta-percha and separate the file together for the palatal canal whereas the mesiobuccal canal was retreated by ProTaper Retreatment Kit. Proper understanding of root canal morphology and using an endodontic armamentarium could reduce endodontic mishaps. This case report described the successful management of overextended gutta-percha, a separated file, and a missed canal.

Comparative Evaluation of Solite RS3 and HyFlex Remover Retreatment Files in Conserving Remaining Dentin Thickness During Endodontic Retreatment Using Cone Beam Computed Tomography: An In Vitro Analysis.

Introduction Non-surgical retreatment is seen as a conservative choice for dealing with recurrent infections, instead of opting for periapical surgery. The retreatment processes should be promptly and efficiently carried out, utilizing a suitable armamentarium. The objective of this experiment is to evaluate the quantity of root dentin that remains following the removal of gutta-percha (GP) from the root canal employing two distinct retreatment files. Materials and methods Sixty single-rooted teeth were selected for the examination. The process of shaping and cleaning was performed using the step-back approach, with a master apical file size of 40. The smear layer was effectively eliminated by rinsing with a solution of 3% sodium hypochlorite and 17% ethylenediaminetetraacetic acid. Paper points were employed to desiccate the canals. The obturation process involved the utilization of the lateral compaction technique with the AH Plus sealer (Dentsply Sirona, NC, USA). The teeth were classified into two groups: Group I (n=30) underwent retreatment using HyFlex Remover (Coletene India, Pvt., Ltd.), whereas Group II (n=30) received therapy with Solite RS3 retreatment files (Solite Dental in Chennai, India). The remaining dentin thickness (RDT) was assessed by cone beam computed tomography at levels 3, 6, and 9 mm from the cemento enamel junction after the removal of GP. The acquired data underwent examination using an independent t-test to determine statistical significance. Results The findings demonstrate that the utilization of Solite RS3 files led to a higher level of dentin thickness remaining at 3 mm, 6 mm, and 9 mm on the mesial side in comparison to HyFlex Remover retreatment files. The observed difference was found to be statistically significant at a significance level of p<0.05 on the mesial side. Nevertheless, there was no notable disparity seen between the two file types at these three levels on the distal side (p>0.05). Conclusion Based on the obtained results of the study, it can be concluded that Solite RS3 files show promise in preserving the RDT. However, further studies encompassing diverse parameters are needed to establish a conclusive and definitive conclusion.

Assessment of dental students' knowledge and performance of master gutta-percha cone selection and fitting during root canal treatment: a pilot study.

BACKGROUND: Misconceptions should be detected early in dental students' training to improve their clinical performance. Accordingly, this study aimed to assess undergraduate dental students' knowledge and performance of master gutta-percha (GP) cone selection and fitting during clinical endodontic courses at the College of Dentistry, King Saud University. METHODS: Ninety-nine undergraduate dental students completed an online survey about their knowledge of master GP cone selection. Forty-five of these students were observed by faculty members in clinical endodontic courses while they fitted master GP cones during root canal treatments. The observers recorded the details of each student's cone-fitting techniques. The data were analysed using t-tests, one-way analysis of variance, and chi-square tests (p < 0.05). Inter- and intra-observer reliability were tested using Fliess' Kappa. RESULTS SURVEY: All participants had good knowledge of over-extended cone management, while 80.8% knew how to properly manage a short cone. The proper flaring assessment method was selected by 86.9% of the female and 34.2% of the male students, and this difference was statistically significant (p = 0.0001). OBSERVATION: The students labelled the working length on the master GP cone with an indentation in 64.4% of the cases and by bending the cone 35.6% of the time. Of all students, 84.4% encountered an apical stop, and this rate correlated significantly with the length of the cone on the master apical cone radiograph (p = 0.001). Improper shaping of the canal was the most common cause of ill-fitting cones (83.3%), while 16.7% of the students chose the wrong cone size. The final obturation length was adequate in 80% of the cases; 57.8% of the students were helped by instructors. CONCLUSIONS: Most students had the basic knowledge required to solve problems related to the selection of master GP cones. However, in the clinical setting, more than half of the students required the assistance of an instructor to adjust their cone's fit. The presence of an apical stop had the most significant effect on the length of the fitted master GP cone on radiography. The most common cause of ill-fitting master cones was improper shaping of the canal.

Sealing Ability Comparison of Three Different Obturating Systems to Intraradicular Dentin-An In Vitro Stereomicroscopic Study.

Background: Different obturation techniques are being used to improve canal sealing, thereby minimizing marginal leakage. Aims and Objectives: To evaluate the marginal leakage of three different obturating materials and techniques using stereomicroscope. Materials and Methods: Thirty freshly extracted maxillary anterior teeth were collected and were divided into three groups of 10 each for which the biomechanical preparation was done. The teeth were divided into three experimental groups according to the obturation material and technique used, Group I: gutta-percha with AH Plus root canal sealer (lateral condensation): Group II: thermoplasticized gutta-percha technique-non-carrier-based (calamus) with AH Plus sealer (backfill): Group III: C point (self-sealing root canal obturating system) with bioceramic sealer (single cone). Each specimen was subjected for testing apical sealing ability. The values of microleakage associated with different root canal sealers were evaluated using a stereomicroscope. Results: There was no statistically significant difference in the mean scores of apical dye penetration/leakage among all the three groups (P = 0.091), whereas Group I showed a higher degree of apical leakage than the other techniques tested. Conclusion: None of the tested filling materials provided a gap-free or void-free root canal filling; however, thermoplasticized gutta-percha is used with AH Plus sealer exhibited less voids and gaps when compared to other tested materials.

A Comparative Evaluation of Push-Out Bond Strength of Six Different Root Canal Sealers: An In-Vitro Study.

BACKGROUND: Adhesiveness with radicular dentin is absent with gutta-percha, leading to microleakage and hence re-infection. Root canal sealer helps to achieve an adhesive interface between gutta-percha and root dentin thereby resisting the displacement forces during the functioning of teeth which is evaluated by the push-out test. The aim of this study is to compare the push-out bond strength and to assess the relative bond failure between dentin-sealer, sealer-main cone of (1) epoxy resin, (2) silicon, (3) mineral trioxide aggregate (MTA), (4) calcium hydroxide, (5) bioceramic, (6) zinc oxide eugenol containing root canal sealers. METHODOLOGY: Sixty human permanent lower premolars with one root were collected, disinfected, and decoronated at cemento-enamel junction. Instrumentation was done with a K3 40,0.06 Ni-Ti rotary file and obturated using the main cone and sealer. Based on the sealer utilized, six groups were created: Group 1: AH-Plus, Group 2: RoekoSeal, Group 3: MTA Fillapex, Group 4: Apexit, Group 5: Smart Paste Bio, and Group 6: Procosol. One slice each was obtained from the coronal, middle, and apicalsections of all the obturated canals. Push-out bond strength and failure modes were studied. Statistics involved analysis of variance (ANOVA) followed by the post hoc Tukey test. RESULTS: All three sections exhibited the highest strength for Smart Paste Bio sealer and the least was for RoekoSeal. With all the sealers, the apical section had the highest strength followed by the middle and coronal. CONCLUSION: The smart seal system was superior to all other sealers and displayed a good bond to dentin.

Evaluation of Students' Proficiency in Removing Gutta-Percha Prior to Fiber Post Placement: A Retrospective Study.

INTRODUCTION: This retrospective study focuses on dental students' proficiency in removing gutta-percha during fiber post space preparation, which is important for maintaining apical seal integrity in endodontically treated teeth. Emphasizing the significance of preventing further reinfection. The primary objective of this study was to assess the proficiency of undergraduate dental students in the manipulation of gutta-percha during fiber post preparation, specifically focusing on the psychomotor skills involved. In addition, the study aims to determine the predictive value of these skills on the ultimate clinical outcomes of the procedure, with particular emphasis on variations attributable to tooth type. MATERIALS AND METHODS: The analysis encompassed 290 periapical radiographs obtained from endodontically treated teeth, all of which had undergone fiber post placement by undergraduate students at the College of Dentistry, Taibah University, Saudi Arabia. Postoperatively, the length of the remaining gutta-percha was measured by two experts in the field, and subsequent outcomes were classified into three categories: optimal, suboptimal, and inadequate, based on the extent of gutta-percha remaining. RESULTS: Students showed optimal removal rates ranging from 33.3% to 73.1%. Among the studied sample, upper anterior teeth were the highest included teeth (n=117, 40%). Remarkably, lower anterior teeth were more prone to suboptimal and inadequate gutta-percha remaining lengths (n=24, 33%). However, the chi-square test revealed no statistically significant difference in students' psychomotor skills while removing the gutta-percha and preparing the teeth to receive fiber posts across tooth types (p-value > 0.05). CONCLUSION: With the limitations of this study, more than half of the included cases show that undergraduate students of the College of Dentistry at Taibah University, Saudi Arabia, possess an optimum level of psychomotor skills in removing gutta-percha while preparing the teeth for receiving fiber posts. This study suggests enhancing the preclinical training of students by considering more training on different tooth types in relation to dental arches.

Tensile Strength and Elastic Modulus of Gutta-percha Cones Disinfected with Sodium Hypochlorite at Different Immersion Times: An In Vitro Comparative Study.

Aim: The tensile strength and modulus of elasticity of gutta-percha cones can be chemically altered due to disinfectant solutions. Therefore, the aim of the present study was to compare tensile strength and elastic modulus of gutta-percha cones subjected to sodium hypochlorite (NaOCl) disinfection at different times. Materials and Methods: This in vitro and longitudinal experimental study consisted of 45 gutta-percha cones, divided equally into three groups: Group 1 (disinfection with 2.5% NaOCl), Group 2 (disinfection with 5.25% NaOCl), and control group. All groups were subdivided according to immersion times for 1, 5, and 10 minutes. Tensile strength and elastic modulus were measured with a universal testing machine. For comparing more than two independent groups, parametric analysis of variance test with Sheffe's post hoc was used and for multivariate analysis, and multivariate analysis of variance test based on Pillai's Trace was used. In all statistical analysis, a significance level P ≤ 0.05 was considered. Results: When comparing the tensile strength of gutta-percha cones, no significant differences were observed after being immersed at 1, 5, and 10 minutes in NaOCl 2.5% (P = 0.715) and 5.25% (P = 0.585). Regarding the elastic modulus, a significant decrease (P < 0.05) was observed in those that were immersed in NaOCl 2.5% and 5.25% for 1, 5, and 10 minutes. Furthermore, increased NaOCl concentration significantly reduced the elastic modulus (P < 0.001). However, there were no significant differences in tensile strength (P > 0.05) and elastic modulus (P > 0.05), when evaluating the interaction between NaOCl concentration and time. Conclusion: Increasing NaOCl concentration significantly reduced the modulus of elasticity without affecting the tensile strength of gutta-percha cones, regardless of immersion time. Furthermore, the interaction of time and NaOCl concentration did not significantly affect the tensile strength and elastic modulus.

Impact of low-fusion gutta-percha cones used in variations of the continuous wave condensation technique with filling sealers based on bioceramic compounds on the quality of root canal filling.

To evaluate the impact on the quality of filling with of low-fusion and conventional gutta-percha cones. Thirty-six maxillary canines were prepared and divided into three groups: I-conventional cone with Downpack at 200 °C at 4 mm from the WL; II-low-fusion cone with Downpack at 100 °C up to 4 mm from the WL; III-low-fusion cone with Downpack at 100 °C up to 7 mm from the WL. Temperature variations were measured in thirds on the external surface of the root. The bond strength was evaluated using the push-out test. The adhesive interface was analyzed by scanning electron microscopy. The bond strength and the temperature variation data were analyzed using analysis of variance and the failure type using the chi-square test. The low-fusion cone group with 7 mm Downpack showed higher bond strength (4.2 ± 2.7) compared with conventional cones (2.8 ± 1.6) and low-fusion cones with 4 mm Downpack (2.9 ± 1.6) (p < 0.05), with occurrence of a higher number of adhesive failures to the filling material and mixed failures. Relative to temperature variation, there was less temperature change in the apical third, in the low-fusion cone with Downpack 7 mm (1.0 ± 1.0) (p < 0.05). The use of low-fusion cones allowed the continuous wave condensation technique to be performed at a lower depth of Downpack at 100 °C at 7 mm, with less heating in the apical third, without compromising the quality of filling. Using gutta-percha cones with low fusion, which permits a lower condensation temperature and reduced Downpack depth, maintains the quality of filling, in order to minimize possible damage to the periapical tissues.

Effect of various disinfectant solutions on the tensile strength of gutta-percha using the rapid sterilization technique.

Context: Gutta-percha (GP) gets contaminated during handling. It becomes imperative to ensure GP is sterile before placement in root canal space. Aims: The aim of the study was to evaluate and compare the tensile strength of GP treated with four different disinfectant solutions: 3% sodium hypochlorite (NaOCl), amla juice (AJ), Aloe vera (AV) juice, and pancha tulsi (PT). Settings and Design: The study design was an in vitro study. Materials and Methods: Fifty GP cones with a size of 30 were procured from sealed packages in five different groups. Experimental groups were disinfected for 1 min with 3% NaOCl, AJ, AV, and PT except the control group. Tensile and Brinell Testing Machine is used to measure the tensile strengths of GP. Statistical Analysis Used: Results were subjected to statistical analysis using the Kruskal-Wallis test followed by Dunn's post hoc test. Results: The mean tensile strength values for Groups A, B, C, D, and E are 9.49 Mpa, 13.33 Mpa, 12.58 Mpa, 12.69 MPa, and 13.56 MPa, respectively. In the herbal disinfectant group, such as AJ, AV, and PT, the tensile strength was not significantly altered, whereas in the 3% NaOCl group, it was reduced considerably. Conclusions: AJ, AV juice, and PT as a GP disinfectant do not alter the tensile strength of GP cones.

Comparing the softening effect of three gutta-percha solvents on different types of gutta-percha with different application durations.

Introduction: During non-surgical endodontic retreatment, gutta-percha (GP) solvents are indispensable in difficult cases when used with mechanical removal, however studies comparing their efficacy against different types of GP are limited. The purpose of this study was to investigate the softening effect of three solvents on the conventional (CGP), cross-linked carrier-based (CLGP), and thermoplasticized (TGP) and compare the effect of time on the softening effect of the solvents. Methods: Tested GP were embedded in cuboidal blocks of stone with their upper surfaces exposed (1 mm diameter). Three commercial GP solvents based on D-Limonene (DL), Eucalyptol oil (EO), and orange oil (OO) were added to the exposed GP before an indenter (weight = 1Kg) was applied. Using a digital camera, the indentation depth was measured (mm) directly after applying the solvent and indenter (T = 0), and after 1, 2, and 3 min of application (T = 1,2,3). The means of indentation depth were calculated and compared using a two-way analysis of variance and Tukey's post-hoc test to assess the effect of the types of solvent, GP for each application duration, and Friedman's test to evaluate the effect of application duration on the softening effect of solvents. Results: The type of GP (F = 261.43, p < 0.001), type of solvent (F = 3.57, p = 0.015), and application duration (F = 53.088, p < 0.001) were all found to significantly affect GP softening. DL exhibited the highest and only significant effect on CGP after 1 min (p < 0.05), while OO had the only significant effect against CLGP when applied for at least 2 min (p < 0.05). Both OO and EO had significant softening effects on TGP instantly or after 1 min of application, respectively. Conclusions: The results of this study revealed that the softening effect of GP solvents varies depending on their type, their application duration, and the type of GP.

Comparative analysis of novel heat-treated retreatment file system on the removal of obturating material using nano-computed tomography.

Introduction: The aim of nonsurgical retreatment is to remove the previous filling material followed by chemo-mechanical preparation of the canal to achieve proper disinfection of the root canal system. This is then followed by re-obturation. This study evaluates the time taken to retrieve the gutta-percha and the quantity of remaining filling material after retreatment with two different file systems. The quantity of remaining filling material was assessed using nano-computed tomography (CT) due to its increased accuracy. Materials and Methods: Forty extracted single-rooted teeth were split into two groups at random and decoronated and obturated at a standard root length of 16 mm. Solite RS3 (SRS-3) Retreatment and ProTaper Universal Retreatment (PTUR) systems were used to retrieve the gutta-percha after a preoperative nano-CT scan. Postoperative nano-CT scan was taken and both the scans were superimposed to quantify the remaining filling material. The time taken to remove gutta-percha was measured using a stopwatch. The statistical analysis comparing the two groups was conducted using the independent t-test. Results: The quantitative analysis of remaining filling material using nano-CT showed no statistical difference between both the file systems used (P > 0.05). However, SRS-3 took significantly less time in the removal of gutta-percha (P < 0.05). Conclusion: Hence, we can conclude that there is no significant difference in the amount of remaining filling material between both the file systems. However, time taken to remove the gutta-percha was lesser in SRS-3 compared to PTUR file system.

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.

Performance of obturation techniques in anatomical irregularities located at different thirds of the root canal system

Abstract This study aimed to compare the quality of root canal obturation (ratio of area occupied by gutta-percha (G), sealer (S), and presence of voids (V)) in different anatomical irregularities (intercanal communications, lateral irregularities, and accessory canals) located at different thirds of the root canal system of mandibular molar replicas. Sixty-seven 3D printed replicas of an accessed mandibular molar were prepared using ProGlider and ProTaper Gold rotatory systems. Three specimens were randomly selected to be used as controls and did not receive further treatment. The rest were randomly distributed in 4 experimental groups to be obturated using either cold lateral compaction (LC), continuous wave of condensation (CW), and core-carrier obturation (ThermafilPlus (TH) or GuttaCore (GC)) (n=16 per group). AHPlus® sealer was used in all groups. The three controls and a specimen from each experimental group were scanned using micro-computed tomography. The rest of the replicas were sectioned at the sites of anatomical irregularities and examined at 30× magnification. The G, S, and V ratios were calculated dividing the area occupied with each element by the total root canal area and then compared among groups using the Kruskal-Wallis test. Voids were present in all obturation techniques with ratios from 0.01 to 0.15. CW obtained a significantly higher G ratio in the irregularity located in the coronal third (0.882) than LC (0.681), TH (0.773), and GC (0.801) (p<0.05). TH and GC achieved significantly higher G ratios in those located in the apical third (p<0.05). The worst quality of obturation was observed in the loop accessory canal with all obturation techniques. Whitin the limitations of this study, it can be concluded that CW and core-carrier obturation are respectively the most effective techniques for obturating anatomical irregularities located in the coronal and the apical third.

Micro-CT evaluation of the removal of root fillings using rotary and reciprocating systems supplemented by XP-Endo Finisher, the Self-Adjusting File, or Er,Cr:YSGG laser.

Objectives: This study aimed to compare the effectiveness of a single-file reciprocating system (WaveOne Gold, WOG) and a multi-file rotary system (ProTaper Universal Retreatment, PTUR) in removing canal filling from severely curved canals and to evaluate the possible adjunctive effects of XP-Endo Finisher (XPF), the Self-Adjusting File (SAF), and an erbium, chromium: yttrium, scandium, gallium garnet (Er,Cr:YSGG) laser using micro-computed tomography (µCT). Materials and Methods: Sixty-six curved mandibular molars were divided into 2 groups based on the retreatment technique and then into 3 based on the supplementary method. The residual filling volumes and root canals were evaluated with µCT before and after retreatment, and after the supplementary steps. The data were statistically analyzed with the t-test, Mann-Whitney U test, analysis of covariance, and factorial analysis of variance (p < 0.05). Results: PTUR and WOG showed no significant difference in removing filling materials (p > 0.05). The supplementary techniques were significantly more effective than reciprocating or rotary systems only (p < 0.01). The supplementary steps showed no significant differences in canal filling removal effectiveness (p > 0.05), but XPF showed less dentin reduction than the SAF and Er,Cr:YSGG laser (p < 0.01). Conclusions: The supplementary methods significantly decreased the volume of residual filling materials. XPF caused minimal changes in root canal volume and might be preferred for retreatment in curved root canals. Supplementary approaches after retreatment procedures may improve root canal cleanliness.

Effectiveness of Different Rotary Files Systems in Removal of Gutta-percha during Endodontic Retreatment with or without Solvents: A Comparative Study.

AIM: The purpose of the present study was to compare the efficacy of three different file systems in removing gutta-percha during endodontic retreatment with or without solvents. MATERIALS AND METHODS: The current study used 120 freshly extracted, single-rooted human mandibular premolars extracted for orthodontic procedures. The canal was prepared utilizing the step-back technique and obturation was done. The samples were allocated into three experimental groups at random, group I: Hedstrom Files, group II: D-RaCe rotary system, and group III: Mtwo retreatment files system. The three groups were again split into two subgroups of 20 samples each, i.e., with solvent and without solvent. Then, a stereomicroscope with a magnification of × 20 was used to examine the samples. The amount of GP and sealer left was measured in three sections: At apical third (1 mm above the apex), middle third (8 mm from the apex), and coronal third (2 mm below the cementoenamel junction). The obtained data were analyzed using parametric Analysis of Variance (ANOVA). p-values less than 0.05 were considered significant. RESULTS: The overall least debris on the dentinal surface was found in the middle third with/without solvent. The D-RaCe rotary system was 1.24 ± 0.11 and 1.44 ± 0.14, Mtwo retreatment files system was 1.38 ± 0.17 and 1.72 ± 0.09 and Hedstrom files was 2.08 ± 0.21 and 2.18 ± 0.16 respectively and A significant difference was found between the three different file system groups (p < 0.001). CONCLUSION: The current study concluded that, when combined with a solvent, the D-RaCe rotary retreatment system is more effective than the Mtwo rotary retreatment system and Hedstrom Files in removing gutta-percha and sealant from root canal walls. CLINICAL SIGNIFICANCE: When it comes to treating chronic infections, non-surgical retreatment is a more cautious method than periapical surgery. Retreatment should be performed efficiently and with appropriate instruments to ensure effective treatment.

Postoperative pain of single-visit endodontic treatment with gutta-percha versus MTA filling: a randomized superiority trial.

BACKGROUND: Postoperative pain has remained a challenge for clinicians. This randomized superiority trial compared the levels of postoperative pain following the use of gutta-percha (GP) and sealer or mineral trioxide aggregate (MTA) as root canal filling materials in teeth with asymptomatic apical periodontitis. METHODS: A total of 119 patients were initially evaluated in this two-arm, parallel-group, single-blind, superiority randomized trial. The inclusion criteria were participants aged 18-65 years with single-canal premolars diagnosed with asymptomatic apical periodontitis. The participants were finally divided into two groups using the permuted block randomization method. In the GP group (N = 46), the cleaned and shaped root canals were filled with gutta-percha and AH Plus sealer, while in the MTA group (N = 48), the cleaned and shaped root canals were filled with an MTA apical filling and a coronal gutta-percha and sealer. Patient pain level was measured 6, 12, 24, 48, and 72 h postoperatively using a 10-point visual analog scale (VAS). The data were analyzed by the chi-square, independent t, Friedman, and Mann-Whitney U tests. RESULTS: The mean of VAS scores decreased significantly over time in both groups (P < 0.001). The mean VAS scores were significantly lower in the MTA filling group than in the other group (P < 0.05). Female patients reported higher VAS scores at 6- and 12-hour periods in both groups (P < 0.05). CONCLUSION: MTA as a root canal filling material might be a valuable option for clinicians due to its low postoperative pain. TRIAL REGISTRATION: The trial protocol was registered at the Registry of Clinical Trials (IRCT20191104045331N1).

Management of a Radicular Cyst in Anterior Maxilla With Endosurgical Intervention Along With Use of Mineral Trioxide Aggregate (MTA) and Bone Graft: A Case Report.

Radicular cysts are the most common cystic lesions that affect the jaws, which, though mostly asymptomatic, can be seen radiographically as an oval or pear-shaped unilocular radiolucency in the periapical region. Nonsurgical root canal procedures and periapical surgery followed by placement of bone substitute and bioceramic root-end filling material is generally the treatment of choice. This case report highlights the endosurgical management of long-standing trauma that led to a radicular cyst with respect to three maxillary anterior teeth in a young adult. The clinical and radiographic examination led to a provisional diagnosis of a radicular cyst, which was confirmed by biopsy. Non-surgical root canal treatment was performed with Mineral Trioxide Aggregate (MTA) as the apical barrier and surgical enucleation of the cyst was performed followed by placement of hydroxyapatite bone graft. Follow-ups till two years were done, which revealed the successful management of the case.

Biocompatibility of three different root canal sealers, experimental study.

OBJECTIVES: This study was assessed the biocompatibility of three different root canal sealers (Well-Root St, GuttaFlow Bioseal, and AH-Plus) following implantation in rat subcutaneous tissues, using histopathological immunohistochemical analysis. METHODS: Four groups of eighty-four male rats each underwent subcutaneous dorsal implantation of a polyethylene tube, either empty or filled. Tissues were collected, fixed, and processed for histological analysis after 7, 15, and 30 d. Slides were photographed and digitally processed to identify lymphocytes and macrophages using Cluster of differentiation 3 (CD3) and cluster of differentiation 68 (CD68) markers, respectively. P was set at 0.05, when lymphocyte and macrophage infiltration was compared between groups and observation times using one-way analysis of variance (ANOVA). RESULTS: Histopathological analysis of all groups revealed an inflammatory reaction followed by the emergence of a fibrous capsule after 7 days. After 30 days, the thickness of the fibrous capsule and the inflammatory response subsided. CD3 staining for immunohistochemical analysis revealed that the AH-Plus group had the highest mean percentage of lymphocyte infiltration at 7 and 15 days, followed by the Well-Root St, GuttaFlow Bioseal, and Control groups. After 30 days, no discernible difference was observed between the groups in terms of the mean percentage of lymphocyte infiltration. After 7, 15, and 30 days, there was a significant difference in the mean percentage of macrophage infiltration across the groups, as demonstrated by CD68 staining. After 7, 15, and 30 days, the AH-Plus group had the highest mean percentage of macrophage infiltration, followed by the Well-Root St. and GuttaFlow Bioseal groups, while the control group had the lowest mean percentage. CONCLUSION: All observational periods showed minimal inflammatory reactions to GuttaFlow Bioseal. After subcutaneous tissue implantation in a rat model, the initial inflammatory reactions to Well-Root St and AH-Plus had abated by day 30, and all tested sealers had outstanding biocompatibility.