The Effectiveness of Different Irrigation Techniques on Debris and Smear Layer Removal in Primary Mandibular Second Molars: An In Vitro Study.

AIMS: The aim of the present in vitro study was to compare the effectiveness of passive ultrasonic irrigation (PUI), sonic irrigation, and mechanic dynamic activation on the removal of debris and smear layer from primary mandibular second molars during pulpectomy. MATERIALS AND METHODS: Mesial roots of 48 primary mandibular second molars were prepared with an R-motion 21 mm file (30/0.04) (FKG Dentaire SA, La Chaux-de-Fonds, Switzerland), irrigated with 1% sodium hypochlorite (NaOCl) and 17% ethylenediaminetetraacetic acid (EDTA), and divided into four groups (n = 24 canals) according to the final irrigation activation technique: control group without activation, PUI with Ultra-X (Eighteeth, Changzhou, China), mechanical activation with XP-endo Finisher (FKG), and sonic irrigation with EQ-S (Meta Biomed, Chungcheongbuk-do, Korea). The roots were split longitudinally and analyzed using scanning electron microscopy (SEM). The presence of debris and smear layer was assessed using a 5-grade scoring scale with 200× and 1000× magnification, respectively. The Kruskal-Wallis and Friedman tests were used for data analysis. RESULTS: The activation of the irrigant significantly improved debris and smear layer removal (p < 0.001). There was no significant difference between Ultra-X, XP-endo Finisher, and EQ-S (p > 0.05). No activation technique was able to completely eliminate debris and smear layer from the root canals of primary mandibular second molars. CONCLUSIONS: During pediatric pulpectomy, the irrigation protocol must include activation of the irrigation solutions using either ultrasonic, sonic, or mechanical activation techniques to enhance the removal of debris and smear layer for a better prognosis. CLINICAL SIGNIFICANCE: During root canal treatment on primary teeth, the clinician must incorporate an activation technique in the irrigation protocol to enhance the removal of debris and smear layer and increase the success of the treatment.

Shaping ability of a new heat-treated NiTi system in continuous rotation or reciprocation in artificial curved canals.

The purpose is to evaluate canal transportation of a new heat-treated NiTi system, the Endostar E3 Azure operated in continuous rotation or reciprocation. 40 resin blocks were divided into two groups. The first was shaped in continuous rotation while the second in reciprocation. A preoperative and two postoperative images were taken, one after the use of the 20/06 and one after the 25/06. The images were superimposed to determine canal transportation. Time required for canal shaping was recorded. One-sample and student t tests, repeated-measure analyses of variance, univariate analyses and Bonferroni multiple comparisons tests were used for statistical analysis. The significance level was set at p < 0.05. There was no significant difference between continuous and reciprocating motion with the 20/06 and 25/06, respectively, at 1 mm (p = 0.761, p = 0.559), 2 mm (p = 0.584, p = 0.810) and 3 mm (p = 0.651, p = 0.070). The reciprocating motion showed significantly less canal transportation at 5 mm (p = 0.049, p < 0.001) and 7 mm (p < 0.001, p < 0.001) for the 20/06 and 25/0.6. Continuous rotation was more time-consuming than reciprocation (p < 0.001). The Endostar E3 Azure in reciprocation respected the original canal curvature better than in continuous rotation at all levels, and required less time to prepare artificial curved canals. Endodontists should know the shaping abilities of novel heat-treated NiTi files, regarding canal transportation and its relation with the instruments' motion and apical diameter enlargement.

Characteristics of Pediatric and Medically Compromised Patients Treated under General Anesthesia in a Middle Eastern Country.

AIM: This study aims to describe dental treatment provided to healthy and medically compromised patients treated under general anesthesia (GA) over a four-year period. MATERIALS AND METHODS: A total of 97 patients who received dental treatment under GA at the Saint Joseph University, Lebanon, from 2016 to 2019 were included in the study. The study population was analyzed according to the patient's age, medical status, and type of treatment done accordingly. RESULTS: The mean age of the patients was 9.15 ± 8.84 years. About 58.8% were aged below 6 years (primary dentition) and 48.5% had medical problems. Dental procedures performed were mostly extractions (4.00 ± 4.15 per patient) followed by resin composite restorations (3.66 ± 3.02 per patient). The mean number of pulpotomies per patient (p <0.001) and stainless steel crowns (p <0.001) were significantly higher in primary dentition, whereas in permanent dentition, the mean number of endodontic treatments per patient (p = 0.016) was significantly larger. Also, there was a significant difference between the type of treatment done on healthy and medically compromised patients (p <0.001). CONCLUSION: Better emphasis on oral health education and preventive strategies for children and special need patients is essential. CLINICAL SIGNIFICANCE: Dental GA is a reliable treatment for young uncooperative children and medically compromised patients. A multidisciplinary treatment plan must be conducted to ensure optimal oral healthcare and avoid unnecessary extractions.

Effectiveness of the REvision System and Sonic Irrigation in the Removal of Root Canal Filling Material from Oval Canals: An In Vitro Study.

This study aimed to evaluate the effectiveness of the Endostar REvision system (Poldent, Warsaw, Poland) in the removal of filling materials from oval root canals using sonic irrigation as an additional cleaning method. Thirty human-extracted mandibular premolars with oval canals were prepared using the ProTaper Universal system (Dentsply Maillefer, Ballaigues, Switzerland) up to instrument F1 (20/.07), and then filled by the continuous wave vertical compaction technique using pulp canal sealer EWT (Sybron Dental Specialties, Orange, CA, USA). The teeth were randomly divided into two groups (n = 15) according to the instrumentation system and the additional cleaning method, as follows: REvision (30/.08, 25/.06) with EQ-S sonic activation (Meta Biomed, Chungcheongbuk-do, Korea), REvision (30/.08, 25/.06) without additional activation. All specimens were sectioned longitudinally at 3 and 7 mm from the apex, and analyzed using digital microscopy (KEYENCE, Osaka, Japan) to measure the total area of the residual obturation materials, followed by SEM analysis. The data on the percentage of remaining filling material were analyzed by Kruskal−Wallis one-way Analysis of Variance on ranks. None of the retreatment protocols completely removed the filling material from the root canals (p > 0.05); the retreatment technique using sonic activation showed statistically less residual filling materials than the retreatment technique using irrigants without activation at the coronal third (p < 0.05), whilst no significant difference was found between both tested groups at the apical and middle thirds (p > 0.05). The REvision system showed promising results in the removal of filling materials from oval canals.

Physicochemical and Antibacterial Properties of Conventional and Two Premixed Root Canal Filling Materials in Primary Teeth.

In this study, some physicochemical and antibacterial properties of three root canal filling materials for primary teeth, Calplus "CP" (Prevest DenPro, Lewes, DE, USA), Bio-C Pulpecto "Bio-CP" (Angelus, Basil, Londrina, Paraná, Brazil), and Zinc Oxide and Eugenol "ZOE" (Prevest DenPro, Lewes, DE, USA) were compared. For each material, the pH, solubility, contact angle, and crystalline microstructure under SEM were evaluated. Their antibacterial activity against Enterococcus faecalis was determined through direct tests. The Kruskal−Wallis test was used to analyze the results using a one-way analysis of variance on ranks. All the materials had an alkaline pH at 3, 24, and 72 h, with CalPlus having the highest (p < 0.05). Bio-CP was more soluble during the evaluation period (24 h) than ZOE and CalPlus (p < 0.05). Bio-CP and ZOE demonstrated the creation of crystallite structures on their surfaces after immersion in PBS at 37 °C, whereas CalPlus showed none. The lowest contact angle was observed for Bio-CP (53 ± 1.5°); contact angles of (86 ± 4°) and (96 ± 1°), respectively, were observed after 10 s of the deposition of the water drop for CalPlus and ZOE. In conclusion, according to this study, there is still a need to develop new filling materials for primary teeth. ZOE, CalPlus and Bio-CP demonstrated different physicochemical and antibacterial properties, but none of the materials had optimal properties and could be considered the most suitable filling material for primary teeth pulpectomy. Bioceramics in their current state are not an alternative. The physicochemical and antibacterial properties still need improvement to fit the intricate anatomy of primary teeth.