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.

Photodynamic therapy on the extrusion bond strength of gutta-percha to radicular dentin sealed with bioceramic and conventional sealers.

OBJECTIVE: The aim of this study was to evaluate the influence of photodynamic therapy (PDT) on the extrusion bond strength (EBS) of gutta-percha to radicular dentin sealed with bioceramic sealers. MATERIALS AND METHODS: Sixty human-extracted mandibular premolars were used in the present study, being decoronated up to the cementoenamel junction, and secured in heat cure acrylic resin for root canal therapy. The specimens were randomly divided into groups based on conventional [2.25% sodium hypochlorite (NaOCl) + 17% EDTA] and disinfection protocols (2.25% NaOCl + PDT + 17% EDTA) (n = 10). Specimens in groups 1, 3, 5: conventional treatment modality (2.25% NaOCl + 17% EDTA). Samples in groups 2, 4, 6: adjunctive PDT treatment modality (2.25% NaOCl+ PDT+ 17% EDTA). Specimens in groups 1 and 2 were sealed with AH Plus sealer (AH). Specimens in groups 3 and 4 were sealed using Endo Sequence BC sealer, and samples in groups 5 and 6 were sealed with MTA Fillapex. All specimens were cut in the coronal and middle segments and positioned in a universal testing machine (UTM) for assessment of extrusion bond strength (EBS). ANOVA and Post-Hoc Tukey multiple comparison tests were applied for performing statistical analysis (p < 0.05). RESULTS: Coronal root samples in group 1 (2.25% NaOCl + 17% EDTA) sealed with AH Plus sealer demonstrated the highest EBS value (9.21 ± 0.62 MPa) whereas the middle-third of specimens in group 6 (2.25% NaOCl + PDT + 17% EDTA) sealed with MTA Fillapex exhibited the lowest EBS value (5.07 ± 0.17 MPa). Intergroup comparison revealed that group 3 (2.25% NaOCl + 17% EDTA) sealed with Endo Sequence BC Sealer and group 5 (2.25% NaOCl + 17% EDTA) sealed with MTA Fillapex disclosed comparable EBS results to group 1 (p > 0.05) while group 2 (2.25% NaOCl + PDT + 17% EDTA) sealed with AH Plus sealer and group 4 (2.25% NaOCl + PDT + 17% EDTA) sealed with Endo Sequence BC Sealer unveiled analogous EBS values to group 6 (2.25% NaOCl + PDT + 17% EDTA) MTA Fillapex (p > 0.05). The most noticeable failure mode in the coronal and middle thirds of non-PDT subjected groups was cohesive. CONCLUSIONS: Combination of 2.25% NaOCl with PDT  and 17% EDTA for canal disinfection with AH Plus sealer, calcium silicate sealer, and MTA-based bioceramic sealers have an unfavorable effect on the EBS of gutta-percha to the root canal wall.

Ex Vivo Evaluation of the Efficacy of Photodynamic Therapy in Eliminating Enterococcus faecalis from Dentinal Tubules by Confocal Laser Scanning Microscopy.

INTRODUCTION: The aim of the present study was to investigate ex vivo by confocal laser scanning microscopy the antibacterial effect of photodynamic therapy (PDT) on dentinal tubules in the apical 5 mm of human mandibular premolars contaminated with Enterococcus faecalis. METHODS: Thirty-four teeth were standardized to 20 mm and foraminal anatomic diameters using a #20 K-file (Dentsply Maillefer). Samples were contaminated for 21 days and divided into the following 3 experimental groups (n = 10): the PDT group (instrumented canals and PDT), the passive ultrasonic irrigation (PUI) group (instrumented canals and PUI), and the PUI-PDT group (instrumented canals, PUI, and PDT), along with a control group (n = 4) (noninstrumented canals). The canals in the experimental groups were instrumented with ProTaper Next (Dentsply Maillefer) up to X3 and rinsed with EDTA and sodium hypochlorite. The photosensitizer used was 0.01% methylene blue with a preirradiation time of 5 minutes and a diode laser with 4 J energy and a 660-nm wavelength. Cross sections were made 5 mm from the apex of all samples, which were analyzed using confocal laser scanning microscopy. The results were analyzed using the Shapiro-Wilk and Kruskal-Wallis (Dunn) tests. RESULTS: There was a lower percentage of live bacteria in the PUI-PDT group, with a statistical difference compared with the control and PDT groups (P < .05). There was no statistical difference in the percentage of live bacteria between PUI-PDT and PUI (P > .05). CONCLUSIONS: It was concluded that the PUI-PDT association was most effective in disinfecting root canals compared with the control group and PDT.

Influence of Sapindus mukorossi extract in comparison to 17% EDTA as final root canal irrigant on the sealer penetration and microleakage of dentinal tubules.

OBJECTIVE: The study evaluated the effect of Sapindus mukorossi (SM) extract as a final root canal irrigant on sealer penetration (SP) in dentinal tubules and microleakage. MATERIALS AND METHODS: Samples were selected based on inclusion and exclusion criteria. An access opening in all samples was performed and the working length was decided using pro taper for canal finishing along with constant irrigation. Specimens were randomly divided into 3 groups. Group 1 was irrigated with 3 ml of 17% EDTA; group 2 was irrigated with SM irrigant and group 3 samples were irrigated with 0.9% saline. After obturation, samples were vertically placed in 1% methylene blue dye cut in half longitudinally, and viewed under a stereomicroscope. Analysis of SP in the dentinal tubule was assessed using scanning electron microscopy (SEM). For microleakage assessment, mean and standard deviation were reported and One-Way ANOVA was applied. SP was compared using Kruskal-Wallis' test. For inspecting the interaction between SM/EDTA and NaOCl, Fisher's exact test was applied. No statistically significant difference between microleakage in any of the tested groups was observed. The control group showed minimum leakage as compared to EDTA and SM. RESULTS: The results displayed that there was no significant difference, (p=0.67), between dentinal tubule SP at 2 mm. A significant difference between dentinal tubule SP among groups at 5 mm was observed (p<0.05). CONCLUSIONS: SM ethanolic extract showed comparable outcomes of smear layer removal and sealer penetration to 17% EDTA, as a final irrigant in root canal cleaning. Therefore, SM has the potential to be used as an adjuvant final irrigant in conjunction with NaOCl.

Adjunctive use of different lasers Er, Cr: YSGG, femtosecond, potassium titanyl phosphate and photodynamic therapy on radicular disinfection bonded to glass fiber post.

OBJECTIVE: The aim of this study was to evaluate and compare the effect of different laser prototypes [Er, Cr: YSGG laser (ECYL), potassium titanyl phosphate laser (KTP), and Femtosecond laser (FSL)]and curcumin photosensitizer (CP) activated by Photodynamic therapy (PDT) on the bond strength of Pre-fabricated fiber reinforced composite (PFRC) post-bonded to radicular dentin. MATERIALS AND METHODS: A total of fifty mandibular single-rooted closed apex teeth were extracted carefully, assembled, and decoronated up to the cementoenamel junction. The working length of all specimens was determined by using a 10 K patency file and later, were cleaned and shaped with Protaper NiTi system using the crown down approach, dried, and obturated with gutta-percha using an AH Plus sealer. Post space was prepared by guiding peeso-reamer. Based on the method of disinfection, the samples were allocated to five groups (n=10) at random: samples in group 1: curcumin photosensitizer (CP) activated by PDT, samples in group 2 disinfected using 5.25% NaOCl+17% EDTA, samples in group 3 disinfected using 5.25% NaOCl+17% EDTA+FSL, specimens in group 4 sterilized using 5.25% NaOCl+17% EDTA+KTP and samples in group 5 cleaned with 5.25% NaOCl+17% EDTA+ECYL. The fiber post was cemented via self-etch resin cement into the post space. All specimens with posts were dissected perpendicularly into apical, middle, and coronal dentin and subjected to the universal testing machine for push-out bond strength (PBS) testing. Statistical analysis was performed using a One-Way analysis of variance and Post Hoc Tukey multiple comparison tests. RESULTS: The highest PBS was corroborated when the radicular canal was disinfected with 5.25% NaOCl +17% EDTA+ ECYL at all three root levels (coronal, middle, and apical) and the lowest was adjudicated by decontamination with CP activated by PDT at all inspected root levels. Intergroup comparison presented that specimens in group 2: 5.25% NaOCl+17% EDTA (control) and group 4: 5.25% NaOCl+17% EDTA+KTP revealed comparable PBS outcome to group 5 (p>0.05) while samples in group 3 revealed the equivalent PBS values to group 1 (p<0.05) at all three root levels. CONCLUSIONS: Er, Cr: YSGG laser and potassium titanyl phosphate laser when used in combination with the conventional canal disinfection 5.25% NaOCl and 17% EDTA demonstrated the highest push-out bond strength values at coronal, middle, and apical levels of the root.

Comparative evaluation of Sapindus Mukorossi extract with 17% EDTA on smear layer removal in various parts of the tooth root.

OBJECTIVES: This study aimed to compare the effectiveness of an experimental root canal irrigant and 17% Ethylene-di-amine tetra acetic acid for removal of the smear layer in the coronal, middle and apical portions of the root canal. MATERIALS AND METHODS: Ninety human single rooted maxillary and mandibular teeth were selected for this study. The teeth were randomly divided into two experimental groups and one control group as follows: Group A (Ethanolic extract of Sapindus Mukorossi), Group B (17% EDTA), and Group C (Distilled water). The root canals of all three groups were prepared with stainless steel K-files by means of the standard step-back technique and irrigated with 5.25% sodium hypo chloride. The teeth were decoronated, following the irrigation and divided longitudinally into two-halves and visualized using scanning electron microscope (SEM) for the amount of smear layer present utilizing the three-point score system. The observations were noted both before and after the treatment. Nonparametric tests were applied for the comparison and p-value ⩽ 0.05 was considered as statistically significant. RESULTS: It was evident from that smear layer was completely removed in coronal portion of 27 out of 30 teeth in-group A. For middle and apical areas of group A, 24 and 19 teeth showed complete smear layer removal. In-group B it was found that there were 24, 21, and 3 teeth at coronal, middle and apical, areas respectively where smear layer were completely absent. Intra group comparison showed a significant difference (p = 0.002) in smear layer removal was found for group A at coronal, middle and apical thirds. Similarly, a significant difference (p = 0.001) was also found for group B; however heavy smear layer was found among the three parts of the canal for group C. CONCLUSIONS: Ethanolic extract of Sapindus Mukorossi have higher effectiveness in removing the smear layer from the root canal in comparison to 17% EDTA.

Bromelain-based endodontic irrigant: preparation, properties, and biocompatibility: An in-vitro study.

The aim of the study was to determine the properties, efficacy and biocompatibility of combining bromelain enzyme, chlorohexidine and EDTA (BCE) to create a novel endodontic irrigant. Fourier transform infrared spectrometry was performed to confirm the stability of the BCE and direct contact inhibition test was performed to determine antibacterial action. Baseline pH and surface tension of irrigants was compared with determine stability. Subcutaneous injection to dorsal skin of rabbits was graded for presence of inflammation, oedema, granulation and fibrosis. BCE caused less overall irritation, less oedematous and was earlier to heal than 2.5% NaOCl. The pH stability of BCE was also superior to 2.5% NaOCl. A one-way ANOVA test was performed for the direct contact inhibition and microleakage test. A significant difference was determined (p ≤ 0.05) between BCE and 2.5% NaOCl for antibacterial action. BCE irrigant is effective in preparing dentinal surfaces for root canal without adverse effects and promising longevity.

Evaluation of the Antibacterial Effect of Xylene, Chloroform, Eucalyptol, and Orange Oil on Enterococcus faecalis in Nonsurgical Root Canal Retreatment: An Ex Vivo Study.

Objectives: The present ex vivo study is aimed at evaluating the antibacterial efficacy of chloroform, eucalyptol, orange oil, and xylene against E. faecalis biofilm during nonsurgical root canal retreatment. Materials and Methods: Eighty single-rooted teeth were instrumented. The samples were autoclaved, infected with E. faecalis for 4 weeks, and obturated with gutta-percha. Then the teeth were randomly assigned to 4 groups (n = 20): (1) chloroform, (2) eucalyptol, (3) orange oil, and (4) xylene. In all of the groups, gutta-percha removal was conducted according to the same protocol although the solvent used in each group was different. Bacterial samples were collected after gutta-percha removal and following additional apical enlargement. Intergroup and intragroup analyses were conducted using one-way ANOVA combined with the post hoc Tukey test and the paired-sample t-test, respectively. Statistical significance was set to 0.05. Results: All of the groups showed more than 99% bacterial load reduction. The least bacterial load after gutta-percha removal was observed in the chloroform group (p < 0.001). The orange oil group showed a significantly lower bacterial load compared to the eucalyptol group (p = 0.001), while it was not different from the xylene group (p = 0.953). The xylene group also had a significantly lower bacterial load compared with the eucalyptol group (p = 0.017). After apical enlargement, the chloroform group had a significantly lower bacterial load compared to the other groups. The comparison of bacterial load values before and after apical enlargement in the chloroform and eucalyptol groups showed a statistically significant difference (p choloroform = 0.011, p eucalyptol = 0.001). Conclusion: Chloroform was the most effective solvent in terms of antimicrobial activity against E. faecalis followed by orange oil and xylene, which were not significantly different though, and eucalyptol. All of the solvents showed more than 99% bacterial load reduction. Chloroform and xylene revealed to be associated with favorable antibiofilm activity among the examined solvents.

Comparative effects of SWEEPS technique and antimicrobial photodynamic therapy by using curcumin and nano-curcumin on Enterococcus faecalis biofilm in root canal treatment.

OBJECTIVES: This study aimed to compare the antimicrobial effects of the shock wave enhanced emission photoacoustic streaming (SWEEPS) technique and Antimicrobial photodynamic therapy (aPDT) with curcumin and nano-curcumin photosensitizers on Enterococcus faecalis (E. faecalis) biofilm in root canals of extracted teeth. MATERIALS AND METHODS: This experimental study was conducted on extracted single-rooted human teeth. The teeth were decoronated at the cementoenamel junction, the root canals were instrumented with BioRace system, and their apices were sealed. Smear layer was removed, and the teeth were autoclave-sterilized. E. faecalis strains were cultured in sterile brain heart infusion (BHI) and a bacterial suspension with 0.5 McFarland standard concentration was prepared. The root canals were inoculated with the bacterial suspension and incubated at 37 °C for 4 weeks. The teeth were then divided into 12 groups (curcumin, nano-curcumin, curcumin + LED, nano-curcumin + LED, curcumin + SWEEPS, nano-curcumin + SWEEPS, curcumin + LED + SWEEPS, nano-curcumin + LED + SWEEPS, SWEEPS, positive control and negative control). The number of colony forming units (CFUs) was counted and analyzed by one-way ANOVA and Tukey's test. RESULTS: A significant difference was noted in colony count among the groups (P<0.001). LED alone had the lowest and nano-curcumin + LED + SWEEPS had the highest root canal cleaning efficacy. SWEEPS along with curcumin, nano-curcumin, and LED significantly decreased the bacterial count compared with other groups (P<0.05). CONCLUSION: Application of the SWEEPS technique with curcumin and nano-curcumin as photosensitizer activated by LED in aPDT improved the reduction of E. faecalis in root canals.

USAGE OF CHLORHEXIDINE AS A FINAL IRRIGANT IN ONE-VISIT ROOT CANAL TREATMENT IN COMPARISON WITH CONVENTIONAL TWO-VISIT ROOT CANAL TREATMENT IN MANDIBULAR MOLARS: A RANDOMIZED CLINICAL TRIAL.

OBJECTIVES: The effectiveness of 1-visit root canal treatment (RCT), especially for teeth with large periapical lesions, are still being debated. Although, the use of chlorhexidine (CHX) as a final irrigant have been recommended to provide an optimized approach in 1-visit RCT, there is limited knowledge about the outcome of 1-visit RCT using CHX as the final irrigant. AIM: The aim of this randomized clinical trial was to evaluate the healing of mandibular molar teeth with large periapical lesions after RCT that was completed in 1 visit using 2% CHX as a final irrigant, comparing the results with a conventional 2-visit RCT as a control group. METHODOLOGY: This study is a prospective, parallel-designed, and single-blinded randomized clinical trial. One-hundred asymptomatic mandibular molar teeth with large periapical lesions were randomly assigned to 2 groups. All teeth were instrumented with Reciproc files with 2.5% sodium hypochloride (NaOCl) and 5% ethylenediaminetetraacetic acid (EDTA) as irrigants. In the intervention group, half of the teeth were treated in 1 visit, receiving an additional final rinse with 2% CHX before obturation; the other half of the teeth, however, were treated in 2 visits with calcium hydroxide (CH) dressings, in the control group. All root canals were obturated with Reciproc gutta-percha cones and AH Plus root canal sealer. All patients were recalled and investigated clinically and radiographically for 48 months. Periapical healing was evaluated statistically using the Mann-Whitney U test, followed by the Friedman and the Wilcoxon tests (α = 0.05). RESULTS: During the 48-month follow-up process, 86 teeth (44 in 1-visit and 42 in 2-visit group) were examined. There were no significant differences between the 2 groups regarding the radiographic healing rates (1-visit group 91% and 2-visit group 88%) (P > .05). CONCLUSION: In this study, 1-visit RCT using 2% CHX as final irrigant in asymptomatic mandibular molars with large periapical lesions produced favorable healing results, similar to 2-visit root canal treatment with calcium hydroxide.

Microbiome Changes during Regenerative Endodontic Treatment Using Different Methods of Disinfection.

INTRODUCTION: The purpose of this study was to characterize qualitatively and quantitatively the changes in the endodontic microbiome, in teeth with necrotic pulp, open apexes, and apical periodontitis, with 3 antimicrobial protocols, undertaken in a multicenter clinical trial. METHODS: Microbiological samples were collected from 116 regenerative endodontic teeth, and 97 qualified for inclusion. The teeth were randomly divided into 3 treatment groups: apexification (APEX), regeneration (REGEN), and revascularization (REVASC), all in 2 appointments. The group variables in the first appointment irrigants, and second appointment irrigants and medicaments were as follows: APEX: 5.25%-6% NaOCl, 5.25%-6% NaOCl + 17% EDTA and calcium hydroxide; REGEN: 1.25% NaOCl, 17% EDTA, and 0.1 mg/mL triple antibiotic paste (TAP); and REVASC 5.25% NaOCl, saline, and 1 g/mL TAP, respectively. Sampling was done upon access (S0), after irrigation in the first appointment (S1), and after using medication and irrigation in the second appointment (S2). RESULTS: Quantitative polymerase chain reaction analysis of the 16S ribosomal RNA gene showed significant reduction in bacterial load from S0 to S2 in all groups; however, the APEX and REVASC groups had significantly less residual DNA than the REGEN group (P = .0045). The relative abundance of Bacteroidetes, Fusobacteria, Spirochaetes, and Synergistetes were reduced with the treatment rendered. However, relative abundance of Firmicutes and Actinobacteria was not changed, and that of Proteobacteria increased. LEfSe analysis showed that reduction in bacterial taxa was more in REVASC than APEX, which in turn was more than in REGEN. CONCLUSION: Enhanced antimicrobial protocols lead to better reduction in quantitative and qualitative parameters of the endodontic microflora.

Herbal Agents versus Ethylene Diamine Tetra Acetic Acid on Removal of the Smear Layer-A Systematic Review of In Vitro Studies.

This systematic review aimed to compare the efficacy of herbal agents with ethylene diamine tetraacetic acid (EDTA) in removing the smear layer during root canal instrumentation. The research question in the present study was to assess: "Is there a significant difference in reducing smear layer comparing EDTA and herbal agents?" Electronic databases (PubMed, Scopus, and Web of Science) were searched from their start dates to April 2022 using strict inclusion and exclusion criteria, and reviewed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Only in vitro studies comparing herbal agents with EDTA were included in the current systematic review. Two reviewers independently assessed the included articles. A total of 625 articles were obtained from an electronic database. Eighteen papers were included for review of the full text, out of which, ten papers were excluded because they did not meet the inclusion criteria. Finally, eight articles were included in the systematic review. The present systematic review considered only in vitro studies; hence, the result cannot be completely translated to strict clinical conditions. The results of the present systematic review have shown that quixabeira, morindacitrifolia, oregano extract, and neem show better smear layer removal compared to other herbal agents, whereas they showed reduced smear layer removal when compared with EDTA. Although, it was seen that most of the included studies did not report a high quality of evidence. Hence, the present systematic review concludes that herbal agents have reported to show inferior smear layer removal when compared to EDTA. Thus, as far as herbal based alternatives are concerned, there is no highest level of evidence to state its real benefit when used as a chelating root canal irrigant.

[Comparison of three root canal disinfection methods for removal of Enterococcus faecalis under minimally invasive root canal treatment].

PURPOSE: To obtain an efficient and simple root canal disinfection method based on minimally invasive root canal treatment by comparing different root canal disinfection methods between minimally invasive root canal treatment and conventional root canal treatment. METHODS: Sixty-six extracted maxillary first molars were randomly divided into experimental group (computer-guided precision minimally invasive root canal treatment) and control group (conventional root canal treatment). All teeth were prepared to ProTaper universal F2, and Enterococcus faecalis infection models were established.Each group was randomly divided into three subgroups, sodium hypochlorite+EDTA root canal irrigation, sodium hypochlorite+EDTA+ultrasonic and sodium hypochlorite +EDTA +Er: YAG laser. After root canal disinfection,the samples were collected by paper tip method and cultured, and colony forming units (CFU) values of each sample were calculated. Then dentin debris was prepared and collected with F3 file. After being diluted and cultured, the CFU value was calculated. Statistical analysis was performed by SPSS 26.0 software package. RESULTS: Comparison of the amount of bacterial inner wall of root canal between the experimental group and the control group showed that the germicidal efficacy of group C and group B were significantly better than that of group A (P＜0.05), but there was no significant difference between group B and group C(P＞0.05). In the experimental group, there was significant difference between group B1, C1 and A1 (P＜0.05). The results of group B1 and C1 were lower than that of group A1, but there was no significant difference between group B1 and group C1(P＞0.05). In the control group, there were significant differences between group B2, C2 and A2 (P＜0.05). The results of group B2 and C2 were lower than that of group A2, but there was no significant difference between group B2 and C2(P＞0.05). Comparison of the amount of bacteria in dentin debris between the experimental group and the control group showed that the effect of group C was the best, followed by group B, and group A, and there were significant differences between three groups(P＜0.05). CONCLUSIONS: The disinfection effect of Er:YAG laser or ultrasound assisted computer-guided precision minimally invasive root canal treatment is similar to conventional root canal treatment, and Er:YAG laser is better than ultrasound in removing bacteria from dentinal tubules, which is more suitable for minimally invasive root canal treatment.

Efficacy of sonic and ultrasonic activation during endodontic treatment: a Meta-analysis of in vitro studies.

OBJECTIVE: To ensure a successful endodontic treatment, it is important to have a proper disinfection of the root canal. The current study compares the root canal cleanliness and smear layer score between sonic and ultrasonic activation. METHOD: Systematic literature review was implemented, using 12 databases. All in vitro studies comparing the efficacy of sonic and ultrasonic activation and reporting at least one outcome of interest were included. RESULTS: At the apical level, pooling the data in the random-effects model (I2=64%, p = .1) revealed a statistically significant lower smear layer score within the sonic activation group (MD-0.48; 95% CI-0.92, -0.04; p = .03). Furthermore, there was a statistically significant lower push-out bond strength value among the sonic group, in contrast to the ultrasonic group at the middle (MD-0.69; 95% CI-1.13, -0.25; p = .002) and at the apical levels (MD-0.78; 95% CI-1.09, -0.46; p < .0001) of the root canal. CONCLUSIONS: Sonic activation accomplished advancement relative to ultrasonic agitation in removing the smear layer, while ultrasonic activation resulted in significant cohesion between the sealers and the dentine tubules, decreasing the vulnerability of apical leakage and tooth fracture.

Management of teeth with dens invaginatus and apical periodontitis: A case series.

BACKGROUND: Dens invaginatus is a dental anomaly that can predispose the tooth to pulp and periapical pathology. CASE DESCRIPTION: Different endodontists treated 6 maxillary incisors with dens invaginatus associated with apical periodontitis. Cone-beam computed tomography was used to help with diagnosis and treatment planning in most patients. Four patients received diagnoses of Oehlers type II dens invaginatus and the other 2 as type III. In some patients with type II, the invagination had to be perforated to permit access to the apical part of the true root canal. Both the true canal and the invagination (pseudocanal) were treated in all cases using an antimicrobial regimen based on chemomechanical preparation with sodium hypochlorite irrigation and supplementary disinfection approaches. Calcium hydroxide medication was used in all but 1 case. The root canal and invagination were often filled using thermoplasticized gutta-percha techniques, sometimes using an apical plug with a bioceramic material in teeth with large apical openings. All treated patients had favorable clinical and radiographic outcomes. PRACTICAL IMPLICATIONS: Regardless of the complex anatomic variations, common strategic therapeutic approaches were identified that might serve as recommendations for proper management of teeth with dens invaginatus and apical periodontitis. These approaches include cone-beam computed tomographic planning, aggressive disinfection using sodium hypochlorite ultrasonic or sonic activation and calcium hydroxide intracanal medication, and thermoplasticized gutta-percha obturation of both the root canal and invagination.

A critical analysis of research methods and experimental models to study intracanal medicaments.

In order to ensure predictable decontamination of the root canal system, chemo-mechanical preparation of the root canal space is sometimes supplemented with the use of intracanal medication. As microbial control of the root canal space is fundamental to the resolution of apical periodontitis, root canal disinfection strategies haven been researched intensively. The use of intracanal medication as a supplementary step to the chemo-mechanical preparation of the root canal space is one of them. Because of the costs and limitations of clinical research it is relevant and common practice to first evaluate alternative or new root canal disinfection modalities in laboratory studies. This involves the simulation of a root canal infection in a laboratory model, on which different disinfection strategies can be tested. When modelling the infected root canal, different levels of infection can be discriminated: suspended bacteria, microbial biofilms and infected dentine. This review describes the experimental models associated with these infection levels and critically appraises their value and methodological details. Suggestions for relevant research methods and experimental models are given, as well as some good practices for laboratory-based microbiological studies.

Can Ethanolic Leaf Extract of Olive or Black Mulberry Substitute Sodium Hypochlorite as a Root Canal Irrigant? An In Vitro Study.

AIM: This study aimed to evaluate Olea europaea (olive) leaves and Morus nigra (black mulberry) leaves as potential natural alternatives to sodium hypochlorite (NaOCl) endodontic irrigant. Their antimicrobial activity against Enterococcus faecalis (E. faecalis) and their effects on both root dentin microhardness and push-out bond strength of resin sealer/root dentin were assessed. METHODOLOGY: Fifty-four extracted teeth were selected. Samples were grouped according to the irrigant used: group I (control): 2.5% NaOCl, group II: 8% ethanolic extract of Olea europaea, and group III: 2% ethanolic extract of Morus nigra. Antibacterial activity (n = 6) was evaluated after each canal was autoclaved, inoculated with E. faecalis, and incubated. Canals were sampled before and after chemicomechanical canal preparation with 2 mL of irrigant. The colony-forming units (CFUs) were counted at 1/10 and 1/100 broth concentrations. Vickers hardness number (VHN) of root dentin (n = 6) was measured before and after root canal preparation and irrigation. Push-out bond strength testing (n = 9) was carried out following preparation, irrigation, obturation, and thermocycling. Results were considered statistically significant at p ≤0.05. RESULTS: Following irrigation, the CFUs of E. faecalis were significantly reduced with no significant difference in the CFU count between all groups at both broth concentrations. A significant reduction in root dentin microhardness resulted in all groups following irrigation, with Morus nigra resulting in the lowest percentage reduction (26.42 ± 1.12). The lowest significant mean push-out bond strength was revealed in the Olea europaea group (3.372 ± 1.513 MPa). CONCLUSION: The use of 2% mulberry (Morus nigra) leaf extract and 8% olive (Olea europaea) leaf extract as alternatives to NaOCl provides promising antimicrobial action against E. faecalis. CLINICAL SIGNIFICANCE: 2% Morus nigra extract may represent a promising natural endodontic irrigant.

Chitosan: A natural substitute of EDTA solution for final irrigation in endodontics treatment.

BACKGROUND: The purpose of this study was to assess the quantity of the chelated calcium ions and the smear layer removal efficiency after root canal final irrigation with three different solutions. MATERIALS AND METHODS: Forty-five teeth were instrumented with rotary-files, then randomly divided into 3 equal groups (n = 15) depending on the final irrigation solution; group I: 17% ethylenediaminetetraacetic acid (EDTA), group II: 0.2% chitosan, and group III: 10% trisodium citrate. According to the time of application, every group was divided into 3 subgroups (1 min, 5 min, and 24 h). The quantification analysis of chelated calcium ions was performed by flame atomic absorption spectrometry (FAAS). Then, the presence of smear layer was examined by splitting the samples longitudinally and using scanning electron microscopy (SEM) to examine coronal, middle, and apical root canal levels. One-way analysis of variance (ANOVA) test was used for the evaluation of treatment effect. Kruskal-Wallis test was executed to detect a significant difference between groups, while Mann-Whitney U test has determined the difference between each two groups for smear layer. RESULTS: Both 17% EDTA and 0.2% chitosan had not been statistically significant difference for smear layer removal efficiency and observed calcium ion concentrations. Although, they were more efficient of 10% trisodium citrate with a significant difference (P < 0.05). CONCLUSION: The application time of the chelators' solutions must not exceed 5 min to completely remove smear layer, and 0.2% chitosan is a natural substitute for 17% EDTA with a safety application for 24 h.

Influence of Trigonella foenum graecum seed extract as root canal irrigation agent on root surfaces: A scanning electron microscope/energy dispersive X-ray analysis study.

The purpose of this in vitro study was to investigate the effect of Trigonella foenum graecum seed extract (TFGSE) as a root canal irrigation agent on the surface of instrumented root canals and on changes in the mineral contents of the root dentin. A total of 90 extracted human mature maxillary central incisor teeth with a single root and without root resorption were selected. The specimens were subdivided into five groups according to irrigation protocol groups G0: distilled water (n = 15): G1: Sodium hypochlorite (5.25% NaOCl); G2: 1% TFGSE G3: NaOCl +17% EDTA (3 min); G4: NaOCl+1% TFGSE; G5: 1% TFGSE +17% EDTA. All the roots were sectioned longitudinally into two halves and examined under scanning electron microscope/energy dispersive X-ray analysis (SEM/EDX) to assess changes in the mineral content of the tooth. Smear layer removal from root canals was evaluated with scanning electron microscopy (SEM). A statistical analysis was performed using the Kruskal-Wallis test. The most effective irrigation protocols in removing smear layer occurred with TFGSE and NaOCl, both with rinsing with 17% EDTA. TFGSE was more effective than NaOCl for removing the smear layer. The results showed the ability of 1% TFGSE to remove the smear layer from the root canals. TFGSE is a promising alternative irrigation agent for root canals.

Postoperative Quality of Life Following Conventional Endodontic Intracanal Irrigation Compared with Laser-Activated Irrigation: A Randomized Clinical Study.

Objective: The aim of this randomized clinical study was to evaluate the effect of laser-activated irrigation using a photon-induced photoacoustic streaming (PIPS) technique on postoperative pain following completion of root canal obturation. Methods: Fifty-six patients were enrolled in this randomized clinical trial. Fifty-six healthy premolars or molars with asymptomatic irreversible pulpitis, symptomatic irreversible pulpitis, or symptomatic pulpal necrosis, with or without apical periodontitis, were mechanically prepared for endodontic treatment and divided into two groups. Patients were randomly allocated to treatment groups. In the positive control group G1, the final irrigation with 2 cc of 5.25% sodium hypochlorite (NaOCl) was achieved using a 27G needle, introduced into the canal to a distance of 5 mm from the predetermined working length. In the experimental group G2, the root canals were irrigated with 17% ethyldiamine tetric acid (EDTA) and 5.25% NaOCl following the PIPS protocol, using an Er:YAG 2940 nm laser (LightWalker ATS®; Fotona, Slovenia) with a 600 µm diameter tip and operating parameters of 20 mJ per pulse, 15 Hz frequency, 0.3 W average power, and a 50-µs pulse duration. Postoperatively, the patients were advised to take a minor analgesic (ibuprofen 400 mg) in the event of pain perception. Postoperative pain levels were assessed after 24, 48, and 72 h and 7 days through the use of a Visual Analogue Scale questionnaire, completed by each patient. Data were analyzed using Kolmogorov-Smirnov, Fisher Exact, Chi square, Mann-Whitney test, and Friedman's test. The level of significance was set at α = 0.05. Results: There was no significant difference between the laser-irradiated group and the control group (p < 0.5). Laser activation of irrigating solutions did not increase postoperative pain. Conclusions: The outcome of this investigation indicated that PIPS was as effective as conventional irrigation in relation to postoperative pain, making this activation technique interesting to use for supplementary root canal disinfection.