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).

Effect of immersion in sodium hypochlorite on cyclic fatigue resistance of RaCe, HyFlex CM and XP-endo shaper files.

Background: This study assessed the effect of sodium hypochlorite on cyclic fatigue resistance of RaCe, HyFlex CM and XP-endo Shaper files. Materials and Methods: In this in vitro, experimental study, 90 RaCe, HyFlex CM and XP-endo Shaper files (n = 30 of each) were divided into two groups (n = 45). Group 1 included 15 files of each rotary system, which were immersed in 37°C sodium hypochlorite (5.25%) for 5 min. Group 2 files were immersed in 37°C saline for 5 min. The files underwent cyclic fatigue testing using simulated root canals in which, the rotary files could freely rotate until fracture. Time of fracture was recorded by a chronometer and the number of cycles until fracture was calculated. Data were analyzed using two-way ANOVA and Bonferroni test (α = 0.05). Results: No significant difference existed in the mean number of cycles or rotation time of files between saline and sodium hypochlorite (P > 0.05). The mean rotation time of RaCe was significantly shorter than that of HyFlex and XP-endo Shaper in both solutions (P < 0.05). The mean number of cycles of RaCe was significantly lower than that of HyFlex and XP-endo Shaper files in both solutions (P < 0.05). The mean number of cycles of HyFlex was significantly lower than that of XP-endo Shaper (P < 0.05). >Conclusion: Immersion of rotary files made of different alloys in 5.25% sodium hypochlorite for 5 min had no effect on their fracture resistance. However, type of file alloy affected its fatigue resistance such that XP-endo Shaper showed the highest and RaCe showed the lowest fatigue resistance.

Micro-Computed Tomographic Assessment of Microcrack Formation before and after Instrumentation of Curved Root Canals with Neoniti Rotary Files.

The aim of this study was to assess the microcrack formation of moderately and severely curved root canals following instrumentation with Neoniti rotary files using micro-computed tomography. This in vitro study evaluated 18 extracted sound mandibular molars with two separate mesial canals and foramina in two groups (n = 9) with 5−20° (moderate) and 20−40° (severe) root canal curvature. The number of microcracks in the root canal walls was counted at baseline by micro-CT. Subsequently, the root canals were instrumented with 0.20/0.06 v Neoniti files as single files with a torque of 1.5 Ncm and a speed of 400 rpm. The number of microcracks was counted again postoperatively on micro-CT images using Amira software. Statistical analysis was performed using the Shapiro−Wilk test, Levene's test and repeated-measures ANOVA (α = 0.05). The mean number of microcracks significantly increased postoperatively in both the moderately curved (11.59 ± 9.74 vs. 8.2 ± 7.4; p = 0.001) and the severely curved (13.23 ± 5.64 vs. 7.20 ± 5.94; p < 0.001) groups. However, the differences between the two groups were not significant (p = 0.668). Based on the results obtained, it can be stated that the instrumentation of moderately and severely curved root canals with Neoniti rotary files increases the number of microcracks. However, the higher degree of curvature does not necessarily translate to a higher number of microcracks after root canal instrumentation with this specific rotary system and methodological procedures.

Comparative evaluation of Enterococcus faecalis counts in different tapers of rotary system and irrigation fluids: An ex vivo study.

BACKGROUND: Bacteria and their by-products are etiological factors for the failure of endodontic treatment. Reduction of root canal bacterial contamination is one of the chief aims of root canal therapy. The aim of this study was to compare the effects of different rotary file tapers and two irrigation fluids on Enterococcus faecalis counts. MATERIALS AND METHODS: In this ex vivo study Root canals of 72 human upper lateral incisors were enlarged to ISO #20 K-file. Then, the samples were sterilized and inoculated with E. faecalis for 72 h, divided into six experimental groups and prepared with #30 Flexmaster files with 0.02, 0.04, and 0.06 tapers and two different irrigation solutions such as normal saline and sodium hypochlorite. The control group (n = 10) was subdivided into two groups with or without bacterial inoculation and no mechanical instrumentation. Cleaning efficacy was evaluated in terms of the reduction of colony forming units (CFUs). T-test, ANOVA, Duncan, and Tukey tests were applied to the groups. A significant level of α = 0.05 was set for comparison between the groups. RESULTS: The canals instrumented with 0.06 taper exhibited greater significant reduction in CFUs compared to canals instrumented with 0.04 and 0.02 taper (P < 0.05); 0.04 taper also resulted in greater significant reduction in CFUs than 0.02 taper (P < 0.05). In addition, no significant differences were observed in E. faecalis counts between the two irrigation fluids (P > 0.05). CONCLUSION: Under the conditions of this study, root canal preparation with greater taper resulted in canal cleanliness and better debridement.

The Effect of Autoclave Sterilization on Resistance to Cyclic Fatigue of Hero Endodontic File #642 (6%) at Two Artificial Curvature.

STATEMENT OF THE PROBLEM: File fracture can interfere with cleaning and shaping of the canal and compromise periradicular healing. Autoclave sterilization may prone the files to fracture. PURPOSE: The purpose of the present study was to determine the effect of autoclave sterilization on the cyclic fatigue resistance of Hero642 rotary instrument in two curvatures of 45 and 60 degrees. MATERIALS AND METHOD: For this experimental in-vitro study, 90 Nickel-Titanium HERO 642 rotary files #30 with 0.06 taper were selected. They were divided into two groups (curvature of 45 and 60 degree) of 45 files. Each group was then subdivided into 3 subgroups; group I: no sterilization, group II: 5 cycles of sterilization and group III: 10 cycles of sterilization. Files were used in artificial canals until fracture. The cyclic fatigue was measured as the number of cycles before fracture. The data was statically analyzed by Student's t-test and two-way analysis of variance. RESULTS: There was a significant difference in cyclic fatigue of two curvature of 45 and 60 degrees (p= 0.001). However, sterilization process has no significant effect on cyclic fatigue of HERO files (p= 0.557). CONCLUSION: Sterilization had no effect on the cyclic fatigue of HERO 642 files when used in curvature of 45 or 60 degrees.

Stability of antibacterial activity of Chlorhexidine and Doxycycline in bovine root dentine.

OBJECTIVE: The aim of this study was to compare the substantivity of chlorhexidine (CHX) and doxycycline bond to the dentin in diffusion disk method. METHODS: A total of 92 dentin disks were prepared from Bovine's teeth root. After removing cementum and standardizing disks in weight and outer diameter, they were irrigated with sodium hypochlorite 2.5%, ethylenediaminetetraacetic acid 17% and sterile saline and sterilled in autoclave. Then, the first group (n = 36) were irrigated with chlrohexine 2% and the second group (n = 36) with doxycycline 100 mg/mL, each for a period of 10 min. The third group (n = 20) was considered as the control group. Samples were divided into four subgroups, which after 1 day, 3, 6, and 12 weeks were incubated in plates containing Muller Hinton agar broth and Enterococcus faecalis for a period of 48 h at 37°C temperature; then the diameter of the zone of inhibition was measured. The antimicrobial effect of irrigating solutions without binding to the dentin was also studied using the plate well method. One-way and univariate variance tests as well as Post-hoc Tukey were used for data analyses. FINDINGS: The diameter of the zone of inhibition of doxycycline group was significantly more than the CHX group from the beginning to the 3(rd) week (P < 0.005). After 3(rd) week, mean diameter in doxycycline group declined as compared with the CHX group up to 12(th) week (P < 0.005). The difference between means in two groups was not significant in the 3(rd) week (P = 0.87). CONCLUSION: The results of this study show that CHX and doxycycline show antibacterial activity for 12 weeks; although after 3(rd) week, the substantivity of CHX was significantly greater than doxycycline. Both of these irrigants can be used in other pharmacological and medical fields whenever a long-lasting antibacterial action is needed.