Influence of sonic activation of epoxy-resin and calcium silicate sealer on postoperative pain: a patient-blinded, parallel group, randomized clinical trial.

BACKGROUND: This clinical study aims to compare postoperative pain after single-visit root canal treatment of teeth with asymptomatic apical periodontitis using epoxy-resin-based AH Plus and calcium silicate-based Endosequence BC sealers with or without sonic activation. METHODS: This study included 72 individuals with one first or second mandibular premolar tooth with asymptomatic apical periodontitis. They were randomly divided into four groups according to the root canal sealer (AH Plus or Endosequence BC) and activation protocol (sonic activation or non-activation) (n = 18). The participants were ask to rate their postoperative pain intensity on a NRS scale as none, minimal, moderate, or severe after 24 h, 48 h, 72 h, and 7 days following treatment. Patients were also asked to record the number of prescribed analgesic medication tablets (400 mg of ibuprofen) taken. Statistical analysis were performed using the Mann-Whitney U test, the Friedman test, the Spearman's correlation test, the Chi-square test. Significance level was established at 0.05. RESULTS: There was no statistically significant difference in postoperative pain scores or analgesic intake between AH Plus and Endosequence BC sealers regardless of the activation protocol (p > 0.05). There was no statistically significant difference in postoperative pain scores between the sonic activation and non-activation groups (p > 0.05). A weak positive correlation was detected between Endoactivator sonic activation and sealer extrusion (r = 0.36). CONCLUSIONS: AH Plus and EndoSequence BC root canal sealers showed similar results in terms of prevalance and intensity of postoperative pain. Sonic activation and non-activation groups had similar postoperative pain scores. CLINICAL TRIAL REGISTRATION: The study was retrospectively registered with ClinicalTrials.gov (NCT06403293). Date of Registration: 07/05/24.

Comparative Evaluation of Different Methods of Activation of Chelating Solution for Smear Layer Removal in the Apical Portion of the Root Canal Using a Scanning Electron Microscopy: An In Vitro Study.

Background The smear layer has an adverse effect on the sealing of root canals during obturation, and it is the main reason for the failure of root canal treatment. Root canal irrigation using a conventional irrigation system is ineffective for smear layer removal, especially from the apical third region, where most lateral canals are present. For successful endodontic treatment, the smear layer should be removed from the apical third region using an effective irrigation activation system. Aim This study aimed to compare smear layer removal by conventional irrigation, XP Endo Finisher (XPF), endoactivator (EA), passive ultrasonic activation, and root canal brush using 17% ethylenediaminetetraacetic acid (EDTA) as a chelating solution and 5.25% sodium hypochlorite after chemomechanical preparation, using scanning electron microscopy (SEM). Method A total of 50 extracted human mandibular single canal premolars with mature roots were selected for this study. Samples were decoronated to obtain a standard working length (WL) of 15 mm. Canal patency was achieved using a 10 k file. Samples were sealed with sticky wax to obtain the vapor lock effect. Biomechanical preparation is done till F3. The samples were divided into five groups according to the final irrigation activation protocol: Group 1, control group; group 2, XPF; group 3, EA; group 4, passive ultrasonic irrigation (PUI); and group 5,, root canal brush. Samples were divided into two equal halves longitudinally. Each sample was analyzed for a smear layer under SEM at 2000x magnification. Statistical analysis was done using the one-way Anova "F" test and Tukey's post-hoc test. Results Group 3 showed the least presence of a smear layer, followed by groups 4, 2, 5, and 1. All the groups exhibited highly significant differences between each other (p < 0.001). Group B shows no significant difference with groups C, D, and E. Group C shows no significant difference with groups D and E. Group D shows no significant difference with group E. Conclusion The EA removes the smear layer effectively as compared with other groups. All the irrigation activation system shows the presence of smear layer. No activation systems were able to remove the smear layer completely.

Comparative Assessment of Postoperative Pain After Three Irrigation Techniques in Single-Rooted Teeth With Symptomatic Irreversible Pulpitis and Symptomatic Apical Periodontitis: A Randomized Controlled Trial.

Aim This study aimed to assess the impact of positive pressure, negative pressure (EndoVac), and sonic-activated irrigation (EndoActivator) on postoperative pain with symptomatic irreversible pulpitis and symptomatic apical periodontitis. The hypothesis tested the superiority of negative pressure irrigation in reducing pain and analgesic requirements. Methodology Forty-eight eligible patients meeting inclusion criteria were enrolled, ensuring comprehension through verbal and written patient information sheets. The sample size calculation, based on prior data, determined 14 teeth per group with consideration for potential dropouts, resulting in 16 teeth per group. Inclusion criteria included healthy individuals aged 16-65 years with single-rooted teeth diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis, while exclusion criteria comprised recent analgesic intake, pregnancy, lactation, and specific dental conditions. Participants were allocated to three groups using computer-generated block randomization with allocation concealment via sequentially numbered opaque sealed envelopes. While blinding of the operator was not feasible, patient and assessor blinding was ensured. Preoperative data collection included patient demographics, tooth details, and pain intensity assessed on a Visual Analogue Scale (VAS). Root canal therapy procedures, conducted in two visits, included instrumentation and irrigation using 3% NaOCl across three groups: positive pressure irrigation, negative pressure irrigation, and sonic activation. Postoperative pain and analgesic intake were evaluated using VAS at specific intervals. One assessor tabulated and analyzed all the information. Results Postoperative pain assessments revealed that the EV group experienced the lowest pain levels, followed by the EA and SVN groups, with significant differences observed at six and 24 hours postoperatively (p < 0.05). Analgesic requirements correlated with pain levels, with the SVN group requiring the most analgesics and the EV group the least, highlighting the efficacy of the interventions. Conclusions Negative pressure irrigation (EndoVac) significantly reduced postoperative pain compared to conventional side-vented needle irrigation. These findings enhance understanding and guide evidence-based recommendations for optimizing endodontic procedures and prioritizing patient comfort and outcomes.

Postendodontic Pain Using Single File System with Different Irrigation Protocols in Single-visit Root Canal Treatment: A Randomized Control Trial.

AIM: To evaluate the intensity of postendodontic pain (PEP) using final irrigation with side-vented needle (SV), EndoActivator (EA), and Ultra X (UX) in single-visit endodontics (SVE) with F-One rotary files. MATERIALS AND METHODS: A total 150 patients indicated for endodontic treatment were selected. Single-visit endodontics treatment was performed under local anesthesia. For the final irrigation protocol, they were divided into three groups: group I (SV), group II (EA), and group III (UX). The severity of PEP was assessed using visual analogue scale (VAS) score after 6, 12, 24, and 48 hours. Analgesics taken by patients, for pain, were also recorded. Finally, the data were tabulated and statistically analyzed using SPSS 20.0 software at a level of significance being 0.05. RESULTS: Postendodontic pain was less in group III (UX) and group II (EA) compared with group I (SV) at 6 and 12 hours, which is statistically significant (p < 0.05). There was no statistically significant difference found after 24 hours and 48 hours. CONCLUSION: The intensity of PEP was minimum in patients treated with EndoActivator and ultrasonic along with single rotary file systems. The incidence of analgesic intake was similar in all three groups. How to cite this article: Kathiria NV, Attur K, Bagda KM, et al. Postendodontic Pain Using Single File System with Different Irrigation Protocols in Single-visit Root Canal Treatment: A Randomized Control Trial. J Contemp Dent Pract 2024;25(2):180-185.

Effect of Different Irrigant Activation Techniques on the Penetration of Calcium Hydroxide, an Intracanal Medicament: An In Vitro Study.

Background and objective The main goal of root canal treatment is to eliminate microorganisms from the canal and to prevent re-infection. To achieve these goals, instrumentation must be combined with adequate irrigation and the placement of intracanal medicament. This study aims to compare the effect of different irrigation activation techniques, i.e., passive ultrasonic irrigation (PUI), EndoActivator (EA), and conventional needle irrigation on the penetration of calcium hydroxide (CH), an intracanal medicament into dentinal tubules. Methodology A total of 60 single-rooted extracted human teeth were selected, which were de-coronated to standardize the root length of 12 mm. An access cavity was prepared, and biomechanical preparation was done. The samples were randomly assigned to three experimental groups: Group I received conventional needle irrigation, Group II underwent EA irrigation, and Group III was subjected to PUI. All the samples were filled with CH paste mixed with Rhodamine B dye, and the orifice openings were sealed with Cavit. The samples were stored in an incubator for 24 hours and were subsequently sectioned horizontally at the coronal, middle, and apical thirds using a hard tissue microtome. These were observed under a confocal laser scanning microscope to evaluate the depth of medicament penetration. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp., Armonk, NY). The Shapiro-Wilk test was employed to assess normality, while ANOVA and Tukey's post hoc analysis were utilized to determine significance. Results It was observed that the depth of penetration of CH into dentinal tubules was highest in Group III (PUI), followed by Group II (EA irrigation), with the least penetration observed in Group I (conventional needle irrigation). All the groups showed maximum penetration at the coronal third followed by the middle and apical third. Conclusions Passive ultrasonic irrigant activation resulted in more penetration of CH into the dentinal tubules followed by EA irrigant activation.

Efficacy of Three Irrigation Methods in Removing Calcium Hydroxide from Curved Root Canals: An In Vitro Micro-CT Study.

Aims and Objectives: This in vitro study aimed to compare the efficacy of three different irrigation methods in removing calcium hydroxide from curved root canals and to estimate the amount of residual medicament using microcomputed tomography. Materials and Methods: Thirty extracted molars with curved mesial root canals, ranging from 25° to 30°, were prepared with ProTaper Next using X2 to full working length and were filled with calcium hydroxide. Teeth also were randomly divided into four groups: group 1 (n = 8)- Erbium: Yttrium-Aluminum-Garnet (Er:YAG) laser; group 2 (n = 8)-EndoActivator; group 3 (n = 8)-EndoVac; and a control group (n = 6)-negative control with no calcium hydroxide. Microcomputed tomography was used to evaluate the residual amount of filling material. Statistical analysis was performed using IBM SPSS Statistics 26, with a significance level of 0.05. Descriptive statistics, student t test, and Chi-square test were applied for data analysis. Results: The greatest amount of residual calcium hydroxide was observed in the samples with EndoVac irrigation (0.515 mm3), followed by EndoActivator (0.381 mm3) and Er:YAG laser (0.121 mm3). However, no statistically significant difference was observed between the groups. The greatest residual amount was observed in the apical third (0.419 mm3), followed by the middle (0.050 mm3) and the coronal (0.015 mm3). Conclusions: No statistically significant differences were observed in the efficacy of the tested techniques for removing calcium hydroxide from curved root canals, whereas a significant difference was observed in the distribution of residual material depending on the technique used. The removal of the calcium hydroxide was more effective in the coronal and middle third of the canal. The greatest residual material was found in the apical portion of the root canal.

Comparative evaluation of four different root canal irrigation techniques for apical extrusion of sodium hypochlorite - An in vitro study.

Objective: This study compared the potential for apical extrusion of sodium hypochlorite (NaOCl) when using needle irrigation (NI), passive ultrasonic irrigation (PUI), passive subsonic irrigation (PSI), and negative pressure system (NP). Materials and Methods: One hundred freshly extracted human permanent anterior teeth with complete root formation were embedded rigidly in agarose gel-containing cresol purple. Teeth were randomly allocated to six groups: G1-NI; G2-PUI; G3-PSI; G4-NP; G5-positive control; and G6-negative control. The chemomechanical preparation was completed and 12 ml of 3% NaOCl was delivered for 180 s in all groups. Dye diffusion was standardized by doing gel photography after the NaOCl final irrigation the Chi-square test and Kruskal-Wallis one-way analysis of variance test were used for the data analysis. Results: G1 had statistically significant apical extrusion compared to G2 (P = 0.001), G3 (P = 0.001), and G4 (P = 0.001) groups. G4 showed the least amount of apical extrusion. Conclusions: pH-sensitive gel model is useful in evaluating NaOCl extrusion. NP produced least NaOCl extrusion as compared to the other three systems. Due consideration should be given to the potential for apical extrusion of the irrigant before the selection of an irrigation system.

Is XP-endo Finisher a better treatment option for its efficacy against intracanal bacteria for post-treatment apical periodontitis cases than EndoActivator?

To investigate the efficacy of the supplementary use of a rotary agitation method [XP-endo Finisher (XPF)] and sonically-activated irrigation [EndoActivator (EA)], using droplet digital PCR (ddPCR) on reducing the bacterial load in previously root canal treated teeth with apical periodontitis. Twenty patients with post-treatment apical periodontitis were allocated into two groups according to the irrigation activation method used: XPF and EA group. Total bacterial loads, as well as the amount of Enterococcus faecalis (E. faecalis) were determined before (S1) and after (S2) chemomechanical preparation, and after final irrigation activation (S3) by means of ddPCR. The bacterial copy numbers were compared between groups using the Friedman test (Nonparametric Repeated Measures ANOVA). When the groups were examined in terms of gender, age, number of root canals, periapical index score, sterility control total bacteria (SCTB), S1- and S2-total bacteria copy number, it was found that there was no statistical difference between the XPF group and the EA group (p > 0.05). Subsequent activation (S3) resulted in a significant microbial reduction in both XPF and EA groups, both of which reduced significantly more bacteria than chemomechanical instrumentation (S2) (p < 0.0001). On the contrary, S3-total bacteria copy number of the EA group was lower than the XPF group (p < 0.0147). There was no statistical difference between the XPF group and the EA group in terms of E. faecalis copy number (p > 0.05). Although both the XPF and the EA optimised the antibacterial efficiency of chemomechanical preparation in previously root canal-treated teeth with apical periodontitis, a lower total bacterial copy number was achieved with the EA application than the XPF application.

The efficacy of EndoActivator, passive ultrasonic irrigation, and Ultra X in removing calcium hydroxide from root canals: an in-vitro study.

BACKGROUND: This study aimed to compare the efficacy of EndoActivator, passive ultrasonic irrigation, and Ultra X in removing calcium hydroxide from the artificial grooves in root canal walls. METHODS: The root canals of 50 extracted human maxillary incisors were instrumented by using the ProTaper rotary system up to #F4 (size 40/0.06 ProTaper) and the teeth were split longitudinally. Lateral grooves were created in the apical and coronal parts of one half and the middle part of the other half. Calcium hydroxide paste was applied to the grooves and the root halves were reassembled. After seven days, the calcium hydroxide was removed from the canal by using one of the EndoActivator, passive ultrasonic irrigation, and Ultra X devices; one group went without irrigation (control group). The CH remnants in the grooves were scored at 20× magnification. The data were analyzed by using the Kruskal-Wallis, Dunn's post hoc, and Friedman tests. P < 0.05 was considered to be statistically significant. RESULTS: No statistically significant difference existed among the experimental groups at the coronal and middle grooves (P > 0.05). However, Ultra X was significantly more effective than passive ultrasonic irrigation at the apical grooves (P = 0.023). CONCLUSION: Within the limitations of this study, Ultra X can be reported to remove the calcium hydroxide from the apical third more efficiently than passive ultrasonic irrigation.

Passive ultrasonic irrigation, EndoActivator system and XP-endo Finisher R as additional cleaning techniques to remove residual filling materials from flattened root canals.

Background: The effectiveness of endodontic retreatment essentially depends on the cleaning and/or disinfection processes. In this context, the removal of root canal filling materials plays a crucial role. Aims: To assess the efficacy of passive ultrasonic irrigation (PUI), EndoActivator system (EAS), and XP-endo Finisher R (XPEFR) as additional cleaning techniques to remove the remaining root canal filling materials from flattened root canals. Subjects and Methods: Thirty-six similar flattened distal root canals of extracted human first lower molars were selected by micro-computed tomography (micro-CT) and then instrumented and filled. After the initial retreatment procedures, the residual volume of root canal filling materials was assessed by micro-CT (V1). Then, the specimens were divided into three groups (n. 12), according to the additional cleaning technique and submitted to another micro-CT scan (V2). Statistical Analysis Used: Analysis of variance and Games-Howell tests (P < 0.05). Results: The percentage reduction in the residual volume of root canal filling materials reached by PUI, EAS, and XPEFR was 28.38%, 28.12%, and 43.52%, respectively, considering the total space of the root canal (P > 0.05). In the apical third, these values were 20.05%, 21.54%, and 48.82% (P < 0.05). Conclusions: Additional cleaning techniques enabled removing a greater amount of root canal filling material from flattened distal root canals of extracted human first lower molars. Considering the total space of the root canal, there were no statistically relevant differences among the groups. In the apical third, XPEFR performed better.

Comparative evaluation of different irrigating and irrigant activation system in removal of gutta-percha/sealer during retreatment: An in vitro Micro-CT study.

Background: The aim of the study was to compare the efficacy of different irrigation and irrigant activation system used as an adjuvant to retreatment rotary files in removal of gutta-percha and sealer from endodontic retreatment using Micro-CT. Method: 64 extracted permanent maxillary central incisor teeth with single canal, were collected and decoronated to standard length of 16 mm. Instrumentation was done using rotary files and obturation was performed using GuttaCore and AH plus sealer. After setting of sealer, initial removal of filling material was performed using ProTaper universal retreatment files (D1, D2, D3). All 64 sample were randomised into four groups (n = 16) Group1: Endodontic syringe irrigation, Group 2: Passive Ultasonic Irrigation (PUI), Group 3: EndoActivator, and Group 4: EndoVac. Micro-CT scanning was performed after obturation, initial removal of filling material by retreatment file and after using experimental protocols of each group, and volume of remaining filling material was calculated using Dolphin software. Statistical analysis performed with one-way ANOVA followed by Tukey's post hoc. Results: A significant reduction in the volume of residual obturation material were found between each group. PUI was superior to the sonic (EndoActivator), negative pressure irrigation technique (EndoVac) and positive pressure irrigation at the coronal, middle third and apical third of the root canal. However, none of the supplementary techniques were able to completely remove the residual obturation material. Conclusion: PUI and EndoActivator were found better in remaining filling material removal, demonstrating clinically useful as supplementary technique in removing remaining obturation material during endodontic retreatment.

Micro-computed tomography assessment of triple antibiotic paste removal using different irrigation methods.

Purpose: The study aimed to compare four irrigation methods for triple antibiotic paste (TAP) removal using micro-computed tomography (micro-CT) analysis. Materials and methods: Forty bovine central incisor teeth were selected, and the root canals were prepared up to #6 Peeso reamer drills. Equal portions of metronidazole, ciprofloxacin, and minocycline were used for the TAP preparation. The TAP was prepared by mixing the powder with distilled water (with a powder to liquid ratio of 1 mg/1 mL). The TAP was introduced to the canals with a lentulo spiral; then, the access cavities were temporarily sealed. After 21 days of storage, the teeth were randomly divided into four equal groups according to irrigation techniques: open-ended, side-vented, double side-vented needle irrigations and EndoActivator irrigation device. The TAP was removed using 17% EDTA (20 mL) and distilled water (5 mL) for all of the groups. The volume of the intracanal medicament before and after the irrigation procedure was recorded by scanning the samples with micro-CT, and the TAP percentage was calculated. The percentages obtained from each group were compared using ANOVA. The significance level was set at p<0.05. Results: The results showed that there was no statistically significant difference among the TAP percentage volumes removed by the different irrigation techniques. Conclusion: The irrigation techniques used in this study showed similar TAP removal efficiency, however, they could not completely remove the TAP from the root canal systems.

Can Type of Instrumentation and Activation of the Final Irrigant Improve the Obturation Quality in Oval Root Canals? A Push-Out Bond Strength Study.

To appraise the outcome of file systems and activation of the final irrigant on the push-out bond strength of root fillings in oval canals. Single-rooted mandibular premolars (n = 180) with oval canals were divided into three groups (n = 60) for instrumentation: ProTaper Next (PTN), WaveOne (WO), and Self-adjusting File (SAF). The specimens were further divided into subgroups (n = 20) and subjected to final irrigation with activation by EndoActivator or passive ultrasonic irrigation or without activation. Then, the specimens were again subdivided (n = 10) and obturated with gutta-percha and AH Plus (GP-AH) or C-Point with EndoSequence bioceramic sealer (C-EBC). One-millimeter-thick horizontal slices were cut from the apical third of the root, 5 mm from the apex, and subjected to push-out bond strength (BS) testing. Specimens for which SAF was used exhibited higher BS values than those for which PTN or WO was used (p < 0.05). Activation of the final irrigation did not affect the BS of the root fillings. Root fillings made of C-EBC presented a higher BS than those made of GP-AH (p < 0.05). Adhesive failure was more common with specimens instrumented using PTN and WO. Root canals instrumented with SAF, showed the highest bond strength values for both root filling materials. The C-EBC produced significantly higher bond strength values than those of the GP-AH.

A Comparative Assessment of Three Different Irrigating Systems in Root Canal Treatment: An In vitro Study.

BACKGROUND: Exact diagnosis, efficient cleaning, shaping as well as disinfection of the root canals lead to successful root canal treatment. The present study compared three different irrigating systems in root canal treatment. METHODOLOGY: Sixty recently extracted permanent mandibular molars were classified into four groups: Group I, II, III, and IV with 15 teeth each. Group I comprised Endo-Irrigator Plus system. Group II comprised EndoActivator, Group III utilized passive ultrasonic irrigation (PUI), and Group IV was control, in which no activation of the irrigant was done. Stereomicroscope (X20) magnification was used for checking isthmus cleanliness. The scoring criteria were divided into score 1-5 depending on the amount of debris in root canal walls. RESULTS: The mean ± standard deviation debris removal score in Group I was 2.6 ± 0.80, in Group II was 3.8 ± 0.72, in Group III was 3.9 ± 1.06, and in Group IV was 4.2 ± 0.82. The difference was significant (P < 0.05). CONCLUSION: Authors found that Endo-Irrigator Plus exhibited better cleaning efficacy followed by EndoActivator and PUI.

Examining the Effect of Gravity on Different Irrigation Systems: An In vitro Study.

BACKGROUND: Periapical extrusion is frequently observed during endodontic therapy. It can lead to acute injury of periapical tissues, resulting in interappointment pain or swelling. The effect is pronounced in teeth with immature apex, which are more susceptible to the extrusion of irrigant. The aim of this study was to evaluate the effect of gravity on the apical extrusion of irrigating solution with different irrigation protocols in single-rooted premolars. METHODOLOGY: A total number of 80 permanent single-rooted teeth (premolars) with same working length (WL) were divided into two main groups: Group A: Penetration depth of irrigation syringe to 2 mm from the WL and Group B: Penetration depth of irrigation syringe to 4 mm from the WL. Each group was subdivided into four subgroups. (n = 10). The extruded debris and irrigants were weighed, and the data were statistically analyzed by the analysis of variance and the Tukey test. RESULTS: Irrespective of the irrigation technique used, the amount of irrigant extruded from the apex showed a statistically significant difference related to the effect of gravity (P < 0.05). There was no statistically significant difference observed between irrigation methods (P > 0.05). CONCLUSION: The degree of apical extrusion of irrigant was dependent on the type of irrigation technique and gravity. Greater caution should be taken during irrigation to prevent postoperative pain.

Influence of different irrigation regimens on the dentinal tubule penetration of a bioceramic-based root canal sealer: a confocal analysis study.

This study aims to assess the efficacy of various irrigation protocols on the dentinal tubule penetration of a bioceramic-based endodontic sealer. Sixty-four single-rooted extracted human mandibular incisors were used. After instrumentation, teeth were randomly divided into the following four groups (n = 16 each) according to the final irrigation technique: group 1, conventional endodontic needle (CEN); group 2, EndoActivator (EA); group 3, Er,Cr: YSGG laser; group 4, XP-endo Finisher (XPF). The root canals were finally irrigated with 17% EDTA and 5.25% NaOCl for 1 min (min) respectively. The teeth were then obturated with Endosequence BC Points and rhodamine B dye-labeled BC Sealer. After 2 weeks, 1-mm-thick transverse sections were cut 2 and 5 mm from the apex, and examined by confocal laser scanning microscopy at 5 × magnification. The total percentage of sealer penetration (TPSP), sealer penetration area (SPA), and maximum sealer penetration depth (MSPD) was measured. Data were analyzed by Kruskal-Wallis, Dunn's multiple comparison, and Wilcoxon tests, with significance set at P < 0.05. At 2 mm level, no significant differences were detected among the groups (P > 0.05). At the 5 mm level, the XPF group showed significantly higher values for both TPSP and SPA in comparison with the Er,Cr: YSGG laser and CEN groups (P < 0.05), but no significant difference was observed with the EA group. The choice of different final irrigation techniques can affect dentinal tubule penetration.

The Sealer Penetration into the Dentinal Tubules: An Appraisal of Different Irrigation Systems: Original Research.

INTRODUCTION: A good endodontic sealer aids in a successful root canal treatment. Sealer in turn depends on the thorough irrigation technique and debris removal. Hence, in the present study, we intend to compare the sealer's dispersion into dentinal tubules of the different irrigation systems by confocal laser scanning microscopy (CLSM). METHODOLOGY: Seventy-six single-rooted, freshly removed human mandibular premolars were taken. They were separated into equal groups as conventional endodontic needle irrigation system, Endovacirrigation, Endoactivator irrigation, and manual dynamic agitation groups. Protaper rotary system was used and obturation was done with gutta-percha. The sealer used was AH Plus labeled with fluorescent dye (0.1% Rhodamine B isothcyanate). Transverse sections from the root apex at the levels of 1 mm, 3 mm, and 5 mm were scanned using CLSM. The sealer's penetration for the depth and the percentage were measured. RESULTS: We observed that endovac irrigation system showed maximum percentage and depth of sealer's penetration compared to endoactivator, manual dynamic agitation, and conventional methods at 1, 3, and 5 mm levels from the apex. CONCLUSION: The irrigation systems significantly influence the penetration of the Sealer into root dentinal tubules. When penetration of sealer at different levels, compared to endoactivator, manual dynamic agitation, and conventional method, significant greater levels were attained with the EndoVac system.

Efficacy of different irrigation activation systems on bacterial extrusion.

The purpose of this study was to evaluate the quantity of extruded bacteria following with EndoVac, EDDY, EndoActivator (EA) and standard needle irrigation (SNI). Ninety teeth with a single root and canal were included in this study. Fifteen teeth were selected as the negative control group to confirm sterilization. Seventy-five teeth were contaminated with Enterococcus faecalis (E. faecalis) for 4 weeks. Teeth were prepared and divided into five groups (n:15): EndoVac, EDDY, EA, SNI and positive control groups. The extruded bacteria were cultured for bacterial quantification. The counts of extruded bacteria were lower in the EndoVac group compared to the EDDY group (P˂ 0.05). The counts of extrusion bacteria were not different in EA and SNI groups compared to EDDY and EndoVac groups (P > 0.05). Within the limits of this study, EndoVac was found to be more reliable irrigation systems than EDDY in terms of the bacterial extrusion.

Postoperative pain after different irrigation activation techniques: a randomized, clinical trial.

The aim of this study was to assess the effectiveness of irrigation activation techniques on postoperative pain (PP) in mandibular premolar teeth with irreversible pulpitis after single-visit endodontic treatment. A total of 160 patients with symptomatic irreversible pulpitis were included in this prospective randomized clinical study. Four different activation methods were used in mandibular premolar teeth. In group 1, teeth were irrigated with side-port endodontic needles (NI) without any agitation; in groups 2 and 3, sonic activation was performed using EDDY and EndoActivator (EA), respectively; and in group 4, passive ultrasonic irrigation (PUI) was used. Patients' analgesic intake-as well as pain intensity during and after treatment-were recorded at 8, 24, 48 h and 7 days. The data relating to age, sex and analgesic intake was evaluated using the Chi-square test and the preoperative pain and PP intensity at different time intervals was evaluated with the Kruskal-Wallis test at a 5% significance level. Highest PP was recorded at 8 h, pain intensity decreased in all groups by the time. Pain in the NI group was found higher than that of EDDY group at 24 h (P < 0.05). EA and PUI had caused mild pain and had similar pain scores at 24 h. (P > 0.05). No statistically difference was found among the groups with regard to analgesic intake (P > 0.05). Although there were slight differences in PP levels between the groups at 24 h, pain levels decreased in all groups after 24 h. Activation of the irrigation solution did not make any difference in terms of PP after 24 h.

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

PURPOSE: Postoperative pain following root canal treatment is a concern for pediatric patients and pediatric dentists. The purpose of this study was to evaluate the effect of using sonic activation (SA) on postoperative pain levels after root canal therapy of primary molars. METHODS: A total of 110 patients aged 5-9 years with symptomatic irreversible pulpitis involving primary molars were included in the study and were randomly divided into two groups according to agitation methods: SA and no sonic activation (NSA). Root canal treatments were completed, and the teeth were restored permanently. Postoperative pain levels were evaluated using the five-face scale at 8, 24, 48, and 72 h and 1 week after treatment. Pain levels and frequency of analgesic intake were recorded and analyzed. RESULTS: Postoperative pain values were lower in the SA group than in the NSA group at 8, 24, and 48 h after treatment (p < 0.05). No significant difference was observed between the groups in terms of postoperative pain values at 72 h and 1 week after treatment (p > 0.05). CONCLUSIONS: It was determined that the use of SA reduces postoperative pain level significantly after root canal treatment in primary molar teeth. CLINICAL RELEVANCE: The use of SA can be recommended to clinicians since it is effective in the successful management of postoperative pain of root canal treatment in primary molar teeth. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT04197531.