Outcome of curcumin-based photodynamic therapy in endodontic microsurgery: A case report.

INTRODUCTION: Persistent apical periodontitis after root canal treatment may require surgical retreatment when non-surgical options are ineffective or impractical due to anatomical challenges or iatrogenic errors. Endodontic microsurgery (EMS) is a precise technique that aims to overcome extraradicular biofilm and root morphology issues. Photodynamic therapy (PDT) is an emerging supplementary disinfection approach that utilizes a photosensitizer agent and light to eliminate microorganisms through oxidative reactions. REPORT: A 60-year-old male with persistent apical periodontitis in a left maxillary first molar underwent non-surgical root canal retreatment followed by surgical reintervention due to anatomical complexities. During surgery, PDT was performed using a novel curcumin-based photosensitizer agent. After the procedure, the tooth was retrofilled with bioceramic cement, and photobiomodulation was applied to enhance tissue healing. One year post-surgery, the patient exhibited complete periradicular repair and remained asymptomatic. DISCUSSION: EMS is considered a last resort to salvage an endodontically treated tooth and has shown moderate success rates. PDT has demonstrated promise in improving periapical healing and reducing microorganisms. In this case, curcumin, diluted with 2 % chlorhexidine gel, served as an effective photosensitizer agent with antimicrobial properties. Moreover, performing photobiomodulation aided in cell recovery and reduced postoperative discomfort. CONCLUSION: The proposed EMS treatment protocol with PDT using curcumin yielded positive outcomes in this case report. Further randomized clinical trials are necessary to assess the efficacy of this approach in EMS. Additionally, further research on curcumin-based photosensitizer agents encapsulated in nanoparticles and enhanced antimicrobial agents is recommended to refine this treatment protocol for routine use.

Well-being, postoperative pain and outcome after clinical application of a novel root canal irrigation fluid-RISA-in teeth with apical periodontitis: A first-in-human study.

AIM: The aim of the study was to assess the tolerance to the new root canal irrigation fluid RISA after root canal treatment (RCT) by evaluating the subject's postoperative well-being, postoperative pain (PP) and treatment outcome. METHODOLOGY: A single-arm prospective study with 16 subjects (17 teeth) diagnosed with asymptomatic apical periodontitis. Endodontic treatment in one session performed using RISA for root canal irrigation. Well-being was assessed on the same day and after 24 h by telephone. For pain intensity, a visual analogue scale was used at 0-5 days. Clinical and radiographic evaluations were performed at ≥12 months. Well-being, occurrence of PP and outcome were qualitatively reported. Friedman test for paired samples and Spearman correlation coefficient were used. Significance was set at p < .05. RESULTS: At the same day and after 24 h, 14/16 subjects felt 'good'. 9/16 presented intra- or extra-oral swelling. The frequency of PP ≥36 (weak) was 82.4%. On the same day, 1 and 2 days postoperatively, there was more pain compared with preoperative pain p < .05. At Day 3, PP equalled preoperative pain (p > .05). 62.5% of subjects needed analgesics Day 0-2. The recall rate was 94.1%, and resolution of apical periodontitis was observed in 87.5%. CONCLUSIONS: The well-being of subjects was good, and the overall PP intensity was low. However, postoperative intra- and extra-oral swelling occurred often. At the recall visit, the effectiveness of the RCT with RISA appeared high (87.5%). The encouraging outcome results plus the fact that RISA has a broader action range than NaOCl in vitro, justify further work on the RISA solution. To reduce postoperative swelling, it is advised to further investigate the optimal way of application of RISA in the laboratory before clinical application is recommended.

Comparison of intracanal ozone and low-level laser therapy on postoperative pain in vital teeth with symptomatic apical periodontitis:placebo-controlled randomize trial.

The aim of this study was to compare the effect of ozone and low-level-laser therapy (LLLT) on postoperative pain after root canal treatment in symptomatic apical periodontitis on vital teeth. Eighty patients were divided into four groups using a web program as follows: LLLT placebo (mock laser therapy), LLLT, Ozone placebo (mock ozonated water irrigation), and Ozone. Postoperative pain levels for 7 days after treatment and percussion pain levels at the 7th day were recorded on the visual analog scale. A regression analysis, Cochran's Q test, Chi-square test, Kruskal-Wallis tests were performed to analyze the data (P=.05). A regression analysis demonstrated that the most effective variables are "group" and "jaw" (P=0.01). Pain in the lower jaw is higher than the upper jaw. There was difference between the groups on postoperative pain at the days 1, 2, and 3; however, there was no significant difference on other days. LLLT and ozone groups had less postoperative pain and pain on percussion. Low-level laser and ozone therapy are useful methods on postoperative-pain in vital symptomatic teeth ,but they don't have superiority to each other.

Effect of a 980-nm diode laser on post-operative pain after endodontic treatment in teeth with apical periodontitis: a randomized clinical trial.

BACKGROUND: This study aimed to assess the effect of a 980-nm diode laser following chemomechanical root canal preparation on the severity of post-operative pain (PP) after root canal treatment (RCT). METHODS: This study included asymptomatic, single-rooted teeth with a periapical index (PAI) score of 3 or 4. All the patients received RCT, including dressing with calcium hydroxide (Ca(OH)2), during two visits. The patients were randomly divided into two groups (n:30): a control group, in which the final irrigation was performed using 5 ml of 2.5% sodium hypochlorite (NaOCI), followed by 5 ml of 17% and ethylenediaminetetraacetic acid (EDTA) and 5 ml of distilled water, and a laser group, in which the root canals were irradiated using a 980-nm diode laser after the final irrigation at both visits. The pain levels after both visits were evaluated using a visual analogue scale (VAS) after 8 h, 24 h, 48 h and 7 d. In addition, the time intervals to medication intake were recorded. The collected data were statistically analysed using the chi-square and Mann-Whitney U test (p < 0.05). RESULTS: The average pain level in the control group 24 h after the first visit was significantly higher than that in the laser group (p < 0.05). The average pain level 24 h and 48 h after the second visit was significantly higher in the control group (p < 0.05). The levels of PP 24 h after the first visit were higher than those after the second visit only in the control group (p < 0.05). After the first visit, analgesic use in the control group was significantly higher after 8 h (40%) and 24 h (23%) as compared with that in the laser group (p < 0.05). CONCLUSIONS: Root canal irradiation with a diode laser may reduce PP after RCT in single-rooted teeth with a PAI score of 3 or 4. TRIAL REGISTRATION: Effect of the Diode Laser on Post-operative Pain After Endodontic Treatment in Teeth with Apical Periodontitis: NCT04486196. Registered 24 July 2020-Retrospectively registered, http://clinicaltrials.gov/ct2/show/NCT04486196.

Evaluation of effect of low level laser therapy with intracanal medicament on periapical healing: A randomised control trial.

OBJECTIVE(S): Photobiomodulation, also commonly referred to as low level laser therapy (LLLT), uses light energy to elicit biological responses from the cell and normalise cell function. Using LLLT on bone has been demonstrated to be effective in modulating inflammation, accelerating bone cell proliferation and enhancing the healing process. The objectives of this study were to evaluate postoperative pain and periapical healing in two different groups. MATERIALS AND METHODS: 40 subjects with periapical lesion were selected and were assigned randomly into two groups. Group I: Conventional root canal therapy along with LLLT. Group II: Conventional root canal therapy only. Radiographs were obtained and assessed at baseline, 3, 6 and 9 months postoperatively. The VAS pain scale was assessed post operatively at 0, 7th and 14th day respectively. The Independent t-test was used for evaluation of the data. RESULTS: Significant differences were noted in reduction of periapicallesion at 3 and 9 months follow-up. The healing was better in Group I that received LLLT with the conventional Root Canal Treatment (RCT). Values for postoperative pain was lower in Group I than Group II, but were statistically non-significant. CONCLUSION(S): LLLT when used as an adjunct with conventional root canal treatment showed acceleration of the healing process of periapical lesions. LLLT has a positive effect on modulating the immune response for favourable healing.

Effect of Different Concentrations of Sodium Hypochlorite on Outcome of Primary Root Canal Treatment: A Randomized Controlled Trial.

INTRODUCTION: The aim of this study was to evaluate the effect of 2 different concentrations of sodium hypochlorite on healing and postoperative pain after primary endodontic treatment. METHODS: One hundred mandibular molars with pulp necrosis and chronic apical periodontitis were randomly assigned to 2 treatment groups: high-concentration (HC) 5% sodium hypochlorite and low-concentration (LC) 1% sodium hypochlorite. Root canal treatment was performed using a standardized protocol. Canals were prepared using equal volumes of respective irrigants after each instrument change. After chemomechanical preparation, the final flush was performed with 5 mL 17% EDTA solution followed by 5 mL 5% or 1% sodium hypochlorite depending on the group. All patients were asked to record the degree of pain on a visual analog scale every 24 hours for 1 week. At the second visit, canals were obturated, and the teeth were restored permanently. Clinical and radiographic evaluations were performed every 3 months for 12 months. The data collected were statistically analyzed. RESULTS: Eighty-six teeth were available for evaluation at the 1-year follow-up. The overall healing rate observed was 76.7%. Greater healing was observed in the HC (81.4%) group compared with the LC group (72.1%), but the difference was not statistically significant (P > .05). No significant differences in pain incidence and pain scores were found between the 2 groups (P >.05), with lower values reported in the LC group. CONCLUSIONS: The use of LC or HC sodium hypochlorite did not result in a significant difference in the clinical outcome.

Effect of Low-level Laser Therapy on Postoperative Pain in Molars with Symptomatic Apical Periodontitis: A Randomized Placebo-controlled Clinical Trial.

INTRODUCTION: In this clinical trial, we evaluated the effect of low-level laser therapy (LLLT) on postoperative pain in mandibular molar teeth with symptomatic apical periodontitis. METHODS: Forty-two patients were included in the study according to the inclusion and exclusion criteria. Root canal treatment was conducted using reciprocating instruments. The patients were randomly distributed into 3 groups using a Web program as follows: control (no laser was applied), placebo (mock laser therapy), and LLLT. Postoperative pain levels on the 1st, 3rd, 5th, 7th, and 30th day and postoperative percussion pain levels on the visual analog scale were recorded. The chi-square, 1-way analysis of variance, and least significant difference post hoc tests were performed to analyze the data (P = .05). RESULTS: LLLT resulted in lower pain levels than those noted in the control and placebo groups on days 1 and 3 (P < .05). There were no significant differences among the placebo, LLLT, and control groups in terms of postoperative percussion pain levels (P < .05). CONCLUSIONS: LLLT can be beneficial in reducing postoperative pain in endodontics.

The Antibacterial Effect of Nd:YAG Laser Treatment of Teeth with Apical Periodontitis: A Randomized Controlled Trial.

INTRODUCTION: The aim of this blind, in vivo, randomized controlled trial was to evaluate the antibacterial effect of Nd:YAG laser irradiation in endodontic treatment of single-rooted teeth with apical periodontitis. The hypothesis was that mechanical enlargement of the root canal and Nd:YAG laser irradiation would yield more negative bacterial samples than conventional treatment. METHODS: Forty-one patients (45 teeth) were allocated to the laser (n = 22) or control (n = 23) group. The teeth in the laser group were instrumented, irrigated with saline, and irradiated with Nd:YAG laser according to a standard protocol. The teeth in the control group were similarly instrumented but irrigated with 1% unbuffered sodium hypochlorite and 15% EDTA solution. Bacterial samples were taken before and after treatment, blinded, and immediately sent for culturing and analysis. RESULTS: The initial bacterial samples were positive in 20 of 22 teeth in the laser group and 18 of 23 (P = .414) in the control group. After the initial treatment, negative bacterial samples were found in 11 teeth in the laser group and 13 (P = .768) in the control group. After 2 to 4 days with no antibacterial dressing in the root canals, 5 teeth in the laser group and 9 (P = .337) in the control group yielded negative bacterial samples. CONCLUSIONS: After intervention, neither the test group nor the control group yielded predictable negative bacterial samples. Thus, the results failed to verify the hypothesis that Nd:YAG laser irradiation would yield significantly more negative bacterial samples than conventional irrigation with 1% unbuffered sodium hypochlorite solution.

A case of tooth autotransplantation after long-term cryopreservation using a programmed freezer with a magnetic field.

This case report describes the treatment of a skeletal Class III malocclusion with autotransplantation of a cryopreserved tooth. To gain an esthetic facial profile and good occlusion, extraction of bimaxillary premolars and surgical therapy were chosen. The patient had chronic apical periodontitis on the lower left first molar. Although she did not feel any pain in that region, the tooth was considered to have a poor prognosis. Therefore, we cryopreserved the extracted premolars to prepare for autotransplantation in the lower first molar area because the tooth would probably need to be removed in the future. The teeth were frozen by a programmed freezer with a magnetic field (CAS freezer) that was developed for tissue cryopreservation and were cryopreserved in -150°C deep freezer. After 1.5 years of presurgical orthodontic treatment, bilateral sagittal split ramus osteotomy was performed for mandible setback. Improvement of the facial profile and the occlusion were achieved in the retention phase. Six years after the initial visit, the patient had pain on the lower left first molar, and discharge of pus was observed, so we extracted the lower left first molar and autotransplanted the cryopreserved premolar. Three years later, healthy periodontium was observed at the autotransplanted tooth. This case report suggests that long-term cryopreservation of teeth by a CAS freezer is useful for later autotransplantation, and this can be a viable technique to replace missing teeth.

Revascularization of an immature tooth with apical periodontitis using a single visit protocol: a case report.

AIM: To discuss the clinical and radiological outcome of a revascularization procedure which was completed in a single visit (using sodium hypochlorite 5% as the sole disinfectant) in an immature tooth with a necrotic pulp and apical periodontitis. SUMMARY: A 7-year-old girl was referred in pain following trauma to the maxillary anterior region some 6-7 weeks previously. The maxillary left central incisor tooth was diagnosed with a necrotic pulp and acute apical periodontitis. Under local anaesthesia and rubber dam isolation, an access cavity was prepared. The canal was irrigated with a 5% sodium hypochlorite solution and agitated with an ultrasonic file. A 17% EDTA solution was also used for a final rinse. Bleeding was induced into the canal space from the periapical tissues using a K-file. An MTA layer/barrier was placed directly onto the blood clot, and a further layer of GC Fuji IX cement was placed on top of the MTA to restore the access cavity. The tooth was reevaluated at 6 weeks, 3 months, 6 months, 1 year and 18 months. The tooth has remained symptom free. Radiographic examination shows progressive thickening of the root canal walls, root lengthening and apical closure. KEY LEARNING POINTS: Disinfection with 5% sodium hypochlorite followed by the induction of a blood clot into the root canal space may be sufficient to promote revascularization in certain circumstances. A single visit revascularization procedure is a potential treatment option.

Microbial infection and its control in cases of symptomatic apical periodontitis: a review.

Apical periodontitis is an inflammation of dental periapical tissues developed as a response to colonization of microorganisms in root canal system. Etiology of periapical pathology is associated with different species of microorganisms that are not fully defined yet. The changes in the composition of root canal microbiota as well as other factors, such as host resistance to various infections and concomitant viral infection, etc., can influence development of the symptomatic apical periodontitis. Etiology of disease is reviewed in this article. The purpose of treatment of symptomatic apical periodontitis is to eliminate the infection in root canal system and to obtain relief of symptoms. It can be done by conventional root canal therapy, which can be combined with anti-inflammatory medication. Indications for antibiotic therapy in such cases are limited to particular occasions, which are considered in article. Nevertheless, findings show that usually dentists prescribe antibiotics improperly in clinical practice. It can render drugs ineffective against diseases of dental origin as well as against potentially fatal infectious diseases. Selection of antibiotics for the treatment of root canal infections is reviewed in this article. Importance of antimicrobial susceptibility testing is emphasized. There is a need for more research on microbial causes and interactions in different forms of apical periodontitis to improve diagnosis and treatment.

Calcium hydroxide barrier over the apical root-end of a type III dens invaginatus after endodontic and surgical treatment.

AIM: To report the simultaneous endodontic and surgical treatment of a tooth associated with Oehlers type III dens invaginatus and a persistent periapical lesion, which comprised root-end resection, root-end filling and application of a calcium hydroxide barrier placed on the resected dentine surface. SUMMARY: Three root canals were identified in a tooth with a type III dens invaginatus, which presented with a necrotic pulp, wide foraminal opening and extensive periapical lesion, and with a previous history of acute abscess, intracanal exudate and fistula. After root canal preparation followed by intracanal application of calcium hydroxide pastes, the clinical-pathological status persisted. After periapical curettage and root-end resection, the root canals were filled, followed by root-end filling with Sealer 26 mixed with zinc oxide powder to a clay-like consistency. Calcium hydroxide paste was then applied over the exposed dentinal surface forming a covering over the root apex. At the 20-month follow-up examination the patient had no symptoms and no fistula; advanced periapical bone repair was obvious on the radiograph. KEY LEARNING POINTS: Because of the variable morphology and extent of invagination, type III dens invaginatus represents a challenge for conventional treatment, often leading to the need for a surgical approach. Sealer 26 thickened with zinc oxide powder provided satisfactory clinical properties for use as a root-end filling material. Application of a calcium hydroxide barrier over the resected root-end is a potential treatment option to encourage tissue repair.

Periodontal tissue disposition of azithromycin in patients affected by chronic inflammatory periodontal diseases.

BACKGROUND: The recognition that periodontal diseases are associated with specific pathogens has led to interest in the use of antibacterial drugs for inhibition of these microorganisms. On these bases, the present study was aimed at evaluating the tissue distribution of the new macrolide antibiotic azithromycin in patients subjected to oral surgery for chronic inflammatory diseases of both marginal and periapical periodontium. METHODS: Thirty-two patients were treated with azithromycin 500 mg/day orally for 3 consecutive days, and drug concentrations in plasma, saliva, normal gingiva, and pathological periodontal tissues were evaluated. For this purpose, samples of blood, saliva, normal gingiva, granulation tissue, and radicular granuloma or cyst wall (from dentigerous cyst) were collected during oral surgery or 0.5, 2.5, 4.5, and 6.5 days after the end of pharmacological treatment; then, azithromycin levels were measured by a microbiological plate assay, using Micrococcus luteus NCTC 8440 as the indicator organism. RESULTS: The concentrations of azithromycin in plasma, saliva, normal gingiva, and pathological tissues reached the highest values 12 hours after the last dose (0.37+/-0.05 mg/l, 2.12+/-0.30 mg/l, 6.30+/-0.68 mg/kg, and 11.60+/-1.50 mg/kg, respectively) and then declined gradually. Consistent levels of the drug in normal gingiva and pathological tissues could be detected, however, up to 6.5 days, indicating that azithromycin was retained in target tissues for a long time after the end of treatment. Moreover, azithromycin levels in both normal gingiva and pathological tissues exceeded the minimum inhibitory concentrations of most pathogens involved in the pathophysiology of chronic inflammatory periodontal diseases. Notably, azithromycin levels in pathological tissues were significantly higher than those in normal gingiva 0.5, 2.5, and 4.5 days after the last dose. CONCLUSIONS: The present results indicate a marked penetration of azithromycin into both normal and pathological periodontal tissues, suggesting that azithromycin represents a promising option in both adjunctive and prophylactic treatments of chronic inflammatory periodontal diseases.

Local anesthesia failure in endodontic therapy: the acute inflammation factor.

The attainment of clinically acceptable local anesthesia is often problematic in the treatment of symptomatic pulpitis and symptomatic apical periodontitis. This article reviews the literature to identify the extent of this problem and to understand the organic components involved with this condition. Inflammation, infection, pH changes, alteration in nerve cell membranes, and anatomic variations are all possible causes for failure of local anesthesia during emergency endodontic therapy.