Evaluation of postoperative pain relief after pulpotomy using different procedures for disinfection and hemostasis in symptomatic irreversible pulpitis.

Aim: This study aimed to evaluate postoperative pain scores after sodium hypochlorite (NaOCl) and KTP laser pulpotomies in the permanent teeth with symptomatic irreversible pulpitis retrospectively. Materials and Methods: This study is based on the records of patients treated with pulpotomy using sodium hypochlorite or KTP laser for disinfection and hemostasis at the Department of Endodontics. Sixty patients' molar teeth were treated with either NaOCl or KTP laser. Sodium hypochlorite was used on 31 teeth, and KTP laser was used on another 29 teeth, for disinfection and hemostasis. Initial bleeding control was obtained with saline. 2.5% NaOCl or KTP laser was applied to complete hemostasis. Calcium hydroxide was then placed on the chamber floor to cover the canal orifices. The permanent restoration was completed with composite resin. Pre and postoperative pain scores were recorded with a visual analog scale. The evaluation was performed on the 6th, 24th, 48th, 72nd hours, and 7th days depending on the severity of the pain. Results: There was no significant difference between the groups in terms of demographic data and preoperative pain scores (P > 0.05). The postoperative pain score in the KTP laser group was significantly lower at the 24th hour than in the NaOCl group (P < 0.05). No significant difference was found between the groups at other evaluated time intervals (P > 0.05). The greatest pain score was recorded at the 6th hour in both groups. Conclusion: Although the level of pain decreased significantly in both groups in the postoperative period, KTP laser-assisted pulpotomy provided better pain control, especially at the 24th hour.

Effect of different irrigation activation methods on non-infected dentinal tubule penetration of medicaments: A CLSM study.

Background: The whole root canal disinfection is crucial in terms of long-term endodontic success. In this context, applying medicaments following effective irrigation activation procedures becomes an important point. Aims: The purpose of this study was to evaluate and compare the efficacy of various irrigation activation techniques on non-infected dentinal tubule penetration of calcium hydroxide (CH), double (DAP), and triple (TAP) antibiotic pastes. Materials and Methods: A total of 180 extracted human permanent mandibular premolar single-rooted teeth were selected and randomly divided into a control group and four main groups according to the irrigation activation procedures (n = 36) as KTP laser irradiation, conventional needle, NaviTip FX, sonic (SI) and ultrasonic activation (UI) procedures. Each group was randomly subdivided into three subgroups according to the medicament type (n = 12); CH, DAP, and TAP. After the activation procedures, the root canals were filled with CH, TAP, and DAP mixed with 0.1% fluorescent rhodamine B isothiocyanate. Specimens were sectioned at 2, 5, and 8 mm from the apex, and all the sections were examined under a confocal laser scanning microscope to calculate the dentinal tubule penetration. Data were analyzed using a three-way analysis of variance and Tukey's post hoc tests (P = 0.05). Results: TAP provided a statistically significant greater penetration than the other groups (P < 0.05). UI provided a statistically significant higher dentinal tubules penetration area than other activation procedures (P < 0.05). Conclusion: Medicament penetration depends on the type of medicament, activation procedures, and root canal level. The TAP may be preferred following the ultrasonic activation in terms of long term root canal treatment success.

Evaluation of apically extruded debris and irrigant using different file systems.

OBJECTIVE: The aim of this study was to evaluate the amount of apically extruded debris and irrigant during cleaning and shaping with different file systems. MATERIALS AND METHODS: Seventy-five extracted mandibular premolar and canine teeth were randomly divided into five groups (n = 15). The root canals were instrumented by using Mtwo (VDW, Munich, Germany), Twisted File (TF; Sybron Endo, Orange, California, USA), Reciproc (VDW), Self-Adjusting File (SAF; Re Dent-Nova, Ra'anana, Israel) systems, and K-type stainless steel hand file (Mani Inc., Tochigi, Japan). Apically extruded debris was collected and dried in preweighed Eppendorf tubes. Extruded irrigant was collected from the cannula by using a plastic insulin syringe. After drying, the amount of apically extruded debris was established by subtracting the initial weight from the final weight of the tubes. After performing the Kolmogorov-Smirnov test, data were analyzed by Kruskall-Wallis test at a significance level of P value less than 0.05. RESULTS: There were no statistically significant differences between the file systems in terms of debris and irrigant extrusion. Mtwo group produced the highest mean debris extrusion value and the TF group produced the less compared with the other files. The least mean irrigant extrusion value was associated with the SAF group, whereas the highest mean irrigant extrusion value was associated with the Reciproc group. CONCLUSION: Under the conditions of the study, all file systems were associated with apical debris and irrigant extrusion.

Comparison of various current electronic apex locators to determine the working length using the clearing technique.

BACKGROUND: Correct working length determination is an important step for successful endodontic therapy. OBJECTIVE: The objective was to compare in vitro the accuracy of three electronic apex locators (EALs) (DentaPort ZX [Morita Co., Tokyo, Japan], SIROEndo Pocket [Sirona Dental Systems, NY, USA], and Rootor [Meta Biomed, Cheongwon-gun, Korea]) in detecting the major foramen using the clearing technique. MATERIALS AND METHODS: Forty-five human extracted single-rooted teeth with mature apices were used for the study and divided into three groups of 15 teeth each. All teeth were embedded in an alginate model, and the electronic measurements were taken following the manufacturers' orientations. Then, the teeth were cleared and photographed under a stereomicroscope with a digital camera. The distance from the file tip to the major foramen was measured using image analysis software program. Statistical analysis was performed using the Kruskal-Wallis, Mann-Whitney U, and Chi-square tests at a significance level of 0.05. RESULTS: The mean distances from the file tip to the major foramen were 0.164 ± 0.292, -0.162 ± 0.234, 0.341 ± 0.166 mm in the DentaPort ZX, SIROEndo Pocket, and Rootor groups, respectively. Statistical analysis showed that there was a significant difference between SIROEndo Pocket and Rootor (P < 0.05). However, no significant difference was found between DentaPort ZX and other EALs (P > 0.05). CONCLUSION: DentaPort ZX located the major foramen with 100% accuracy within the range of ± 0.5 mm. However, the accuracy of the SIROEndo Pocket and Rootor in locating the major foramen within ± 0.5 mm was 73.3% and 86.7%, respectively. All EALs showed an acceptable determination of the major foramen within the range of ± 0.5 mm.

In vitro comparison of four different electronic apex locators to determine the major foramen using the clearing technique.

OBJECTIVES: The aim of this study was to evaluate the accuracy of four electronic apex locators (EALs) (DentaPort ZX, Raypex 5, Endo Master and VDW Gold) in detecting the major foramen using the clearing technique. MATERIALS AND METHODS: Forty-eight extracted single-rooted extracted teeth with mature apices were used for the study and divided into four groups of 12 teeth each. All teeth were embedded in an alginate model. Electronic measurements were taken using a size 15 K-file attached to the holder. Then, the teeth were cleared and photographed under a stereomicroscope with a digital camera. The distance between the tip of the file and the major foramen was measured by using an image analysis software program. Positive and negative values were recorded when the file tip was beyond or short of the major foramen and zero value when the file tip and the major foramen coincided. Statistical analysis was performed using the Kruskal-Wallis and Chi-square tests at a significance level of 0.05. RESULTS: Mean distance from the file tip to the major foramen were 0.302 ± 0.202, 0.065 ± 0.293, 0.117 ± 0.475, and 0.258 ± 0.160 mm in the DentaPort ZX, Raype 5, Endo Master, and VDW Gold groups, respectively. There were no statistically significant differences among the devices (P > 0.05) . CONCLUSION: Under the experimental conditions, all EALs showed an acceptable determination of the major foramen.

Clinical and radiographic outcomes of direct pulp capping therapy in primary molar teeth following haemostasis with various antiseptics: a randomised controlled trial.

AIM: This was to evaluate the clinical and radiographic outcomes of direct pulp capping (DPC) therapy in primary molar teeth following haemostasis with various antiseptics for 12 months. MATERIALS AND METHODS: A total of 70 vital primary molar teeth with deep dentin caries were randomly allocated to different antiseptic groups. After observing the pinpoint exposure, 0.9% saline solution (SS, control), 0.5% sodium hypochlorite (SH), 2% chlorhexidine digluconate (CHX), or 0.1% octenidine dihydrochloride (OCT) was applied with sterile cotton pellets for 3 min before calcium hydroxide (CH) DPC therapy. Statistical evaluation: The intergroup radiographic success criteria were analysed using a Kruskal-Wallis test in each follow-up period at a confidence interval of 95%. RESULTS: After 12 months, all groups showed a clinical success rate of 100% (no clinical failures were observed at the time of pulpectomy or extraction), and the overall radiographic success rates were OCT (100%) > SH (94.74%) > CHX (93.3%) > SS (84.21%), respectively (p > 0.05). OCT did not exhibit any failures. The undesirable radiographic failure types (pulpectomy or extraction) were mostly observed in the SS group. CONCLUSION: Compared with SS, the success of conventional CH usage in DPC therapy of primary molar teeth could be enhanced by providing acceptable disinfection features with antiseptic solutions. OCT seems to have relative beneficial effects compared to SH and CHX.