Evaluation of various obturation techniques with bioceramic sealers in 3D-printed C-shaped canals.

This in vitro study compared various obturation techniques with bioceramic sealers for filling C-shaped 3D-printed replicas. A mandibular molar with a C-shaped root canal with a C1 configuration was obtained. After instrumenting with M3 Pro Gold files (United Dental, Shanghai, China) up to size #30/0.04, a CBCT scan of the tooth was taken. Sixty 3D-printed replicas of the tooth were created. The samples were obturated with EndoSeal TCS sealer (E. TCS; Maruchi, Wonju, Korea) or EndoSeal MTA (E. MTA; Maruchi, Wonju, Korea) (n = 30). The samples in each group were obturated with the following techniques (n = 10): (1) single-cone technique (SC), (2) SC with ultrasonic activation (UA), and (3) cold hydraulic compaction (CHC). Following incubation, the replicas' apical, middle, and coronal thirds were inspected under a digital microscope, and the proportion of filling material and void were calculated. Also, the obturation time and sealer extrusion were recorded. Data were analyzed using ANOVA, LSD post-hoc, and the chi-square tests (α = 0.05). The results indicated that in the apical third, E. TCS-SC, E. TCS-UA, and E. MTA-UA had the lowest void percentage among groups (p < 0.05). In the middle thirds, samples obturated with E. TCS-UA showed a significantly lower void percentage among all groups (p < 0.05). However, in the coronal third, E. TCS-CHC showed the least void percentage (p < 0.05), followed by E. TCS-UA and E. MTA-CHC. The E. TCS-SC and E. TCS-UA were the least time-consuming methods (p < 0.05). Sealer extrusion significantly differed among the groups, with E. MTA-UA and E. TCS-UA showing higher incidence (p = 0.019). It was concluded that E. TCS-UA was the most convenient obturation technique. However, care must be taken when obturating the canals with high flow and ultrasonic activation near the vital anatomical landmarks.

Exploring age and gender variations in root canal morphology of maxillary premolars in Saudi sub population: a cross-sectional CBCT study.

BACKGROUND: In complex teeth like maxillary premolars, endodontic treatment success depends on a complete comprehension of root canal anatomy. The research on mandibular premolars' root canal anatomy has been extensive and well-documented in existing literature. However, there appears to be a notable gap in available data concerning the root canal anatomy of maxillary premolars. This study aimed to explore the root canal morphology of maxillary premolars using cone-beam computed tomography (CBCT) imaging, considering age and gender variations. METHODS: From 500 patient CBCT scans, 787 maxillary premolar teeth were evaluated. The sample was divided by gender and age (10-20, 21-30, 31-40, 41-50, 51-60, and 61 years and older). Ahmed et al. classification system was used to record root canal morphology. RESULTS: The most frequent classifications for right maxillary 1st premolars were 2MPM1 B1 L1 (39.03%) and 1MPM1 (2.81%), while the most frequent classifications for right maxillary 2nd premolars were 2MPM1 B1 L1 (39.08%) and 1MPM1 (17.85%). Most of the premolars typically had two roots (left maxillary first premolars: 81.5%, left maxillary second premolars: 82.7%, right maxillary first premolars: 74.4%, right maxillary second premolars: 75.7%). Left and right maxillary 1st premolars for classes 1MPM1 and 1MPM1-2-1 showed significant gender differences. For classifications 1MPM1 and 1MPM1-2-1, age-related changes were seen in the left and right maxillary first premolars. CONCLUSION: This study provides novel insights into the root canal anatomy of maxillary premolars within the Saudi population, addressing a notable gap in the literature specific to this demographic. Through CBCT imaging and analysis of large sample sizes, the complex and diverse nature of root canal morphology in these teeth among Saudi individuals is elucidated. The findings underscore the importance of CBCT imaging in precise treatment planning and decision-making tailored to the Saudi population. Consideration of age and gender-related variations further enhances understanding and aids in personalized endodontic interventions within this demographic.

Micro-computed tomography (micro-CT) evaluation of root canal morphology in immature maxillary third molars.

The endodontic treatment of immature permanent teeth with necrotic pulp is a significant clinical challenge. The success of regenerative endodontic procedure is highly dependent on disinfection of the root canal and an accurate anatomical knowledge of the root canal. The aim of this study was to use micro-computed tomography (micro-CT) analysis to investigate the configuration of root canals in the upper permanent third maxillary molars with incomplete root development in their coronal, apical and middle third portions. Thirty immature third permanent maxillary molars were scanned using a micro-CT system. Then, we measured the diameters and areas of the root canal in the coronal, middle and apical third of the roots. The ratio between the long and short diameter of each root canal was then calculated and the canals were divided into several groups: round, oval, long oval, flat and irregular. The round configuration was not observed in the distobuccal and mesiobuccal roots in any of their anatomical regions. Oval and long oval canals predominated in the distobuccal root. The greatest variations were observed in the mesiobuccal root, with the ribbon-shaped canal predominating in the middle region and an irregular shape in the apical region. In the coronal region of the palatal canal, the round configuration predominated; in the middle third, we observed an almost equivalent distribution between round and oval configurations; apically, the oval shape predominated. In conclusion, we observed significant complexity and variation in the morphology and configuration of root canals in immature permanent molars, thus generating additional obstacles for the success of regenerative endodontics.

Effects of different irrigation activation methods on root canal treatment of primary teeth.

There is currently a lack of research on the application of newly developed irrigation techniques in root canal treatment of primary teeth. This study aimed to evaluate the effects of various irrigation activation techniques on two key parameters: apical debris extrusion (ADE) and dentinal tubule penetration depth (DTPD) of the root canal filling material. A total of 96 primary mandibular second molars were randomly divided into 4 groups: Group 1-Conventional Needle Irrigation (CNI), Group 2-XP-Endo Finisher (XPF), Group 3-EndoActivator (EA), and Group 4-Passive Ultrasonic Irrigation (PUI). In all groups, the One Reci single-file system was used for root canal preparation. For ADE measurement, each group was rinsed with distilled water. For DTPD assessment, sodium hypochlorite (NaOCl) was applied. ADE quantification was performed by collecting debris in pre-weighed Eppendorf tubes. A combination of fluorescent dye and root canal filling material (DiaPex Plus) was used for root canal filling. In order to examine DTPD, horizontal cross-sections of the coronal and apical regions of the teeth were taken with a thickness of 1 mm. The maximum and mean DTPD was examined by confocal laser scanning microscopy. Data were analyzed using the Kruskal-Wallis, One-way ANOVA, and Mann-Whitney U tests (p = 0.05). As a result, PUI had the highest mean ADE and CNI had the lowest mean ADE, while CNI had the highest mean DTPD in both the coronal and apical regions, whereas PUI had the lowest mean DTPD in the coronal region, and EA had the lowest mean DTPD in the apical region. There were no statistically significant differences in DTPD and ADE among the four groups. Comparing intragroup maximum DTPD across all groups, it was significantly higher in the coronal region than in the apical region (p < 0.05). ADE and DTPD of root canal filling materials in primary teeth did not differ significantly among CNI, XPF, EA and PUI irrigation activation techniques.

Deciduous pulp tissue implantation into the root canal of mandibular incisor resulted in pulp revascularization: a case report with a 5-year follow-up.

To explore a new method to implant deciduous tooth pulp into the canal of young permanent teeth with necrotic pulps and apical periodontitis for the regenerative endodontic treatment of tooth no: 41 in a 7-year-old male. Briefly, 1.5% Sodium Hypochlorite (NaOCl) irrigation and calcium hydroxide-iodoform paste were used as root canal disinfectant at the first visit. After 2 weeks, the intracanal medication was removed, and the root canal was slowly rinsed with 17% Ethylene Diamine Tetraacetic Acid (EDTA), followed by flushing with 20 mL saline and then drying with paper points. Tooth no: 72 was extracted, and its pulp was extracted and subsequently implanted into the disinfected root canal along with induced apical bleeding. Calcium hydroxide iodoform paste was gently placed over the bleeding clot, and after forming a mineral trioxide aggregate (MTA) coronal barrier, the accessed cavities were restored using Z350 resin composite. The root developments were evaluated via radiographic imaging at 6 months, 1 year and 5 years after treatment. Imaging and clinical analysis showed closure of the apical foramen, thickening of the root canal wall, and satisfactory root length growth. Autologous transplantation might be useful to regenerate dental pulp in necrotic young permanent teeth.

Morphology and classification of the second mesiobuccal canal in maxillary first molars: a cone-beam computed tomography analysis in a Chinese population.

BACKGROUND: Understanding the tooth anatomy is crucial for ensuring effective endodontic treatment. This study investigated the root canal morphology of the second mesiobuccal (MB2) canal in maxillary first molars (MFMs) in a Chinese population using cone-beam computed tomography (CBCT). METHODS: This study evaluated 486 MFMs with MB2 canals from 285 participants undergoing CBCT examination and determined the Vertucci's classification and position of the MB2 canal orifice. The prevalence of the MB2 canal was correlated with the sex, age, and tooth side. The correlations between the prevalence of the MB2 canal and sex and tooth side were assessed using the Fisher's exact test. The chi-square test was used for evaluating the correlation between the prevalence of the MB2 canal and age. RESULTS: The number of type II, III, IV, V, VI, VII, and other root canals in the MFMs was 30.9%, 0.6%, 65.0%, 1.2%, 1.2%, 0.4%, and 0.6%, respectively. Among the 201 cases with bilateral inclusion, 87.6% showed consistent canal configuration. Results of the first clear apparent position (FCAP) of the MB2 canals showed that 434, 44, and 3 teeth had FCAP at the upper, middle, and bottom one-third of the root, respectively. The FCAPs of the MB2 canal in the MFMs with types II, IV, and VI, as well as types III and V canals showed significant differences (p<0.05). The horizontal distance between the MB1 and MB2 canal orifices in the type II canals of MFMs was significantly lesser than those in the type IV canals of MFMs (p < 0.01). The longitudinal distance between the pulp chamber floor plane and MB2 canal orifice significantly correlated with age (p < 0.05). CONCLUSIONS: The morphology of the mesiobuccal root canal in the MFMs is complex. Complete understanding of the anatomical morphology of the root canal combined with the CBCT and dental operating microscope is necessary for the accurate detection of the MB2 canal and consequently improved success rate of root canal treatment. Our study findings can help endodontists improve endodontic treatment outcomes.

A systematic review and meta-analysis of the prevalence and global distribution of middle mesial canals in mandibular molars identified by CBCT.

OBJECTIVES: This systematic review and meta-analysis aimed to evaluate the prevalence of middle mesial canal (MMC) in permanent mandibular molars of different populations and regions based on cone-beam computed tomography (CBCT) studies. MATERIALS AND METHODS: PubMed, Scopus, Embase, Web of Science, and Open-Grey were searched up to October 2023 according to specific keywords. A hand search was conducted on the references of the included studies and articles from three peer-reviewed journals in endodontics. The main variable of interest was the prevalence of MMC. Additional data such as the total number of included cases, age and country of the population, CBCT device information, voxel size, and field of view details were also extracted. Extracted data were analyzed qualitatively with the JBI quality assessment checklist and quantitatively with STATA software. RESULTS: Of 32,793 studied teeth, the cumulative prevalence of MMC in both mandibular 1st and 2nd molars was 3.11% (95% CI: 2.00-4.44%). The subgroup analysis reveals a prevalence of 4.15% (95% CI: 2.69-5.89%) for mandibular 1st molars and 1.2% (95% CI: 0.2-2.83%) for mandibular 2nd molars. The highest prevalence of MMC in 1st molar was attributed to South Asia (11.24%) and Africa (6.61%). CONCLUSIONS: The prevalence of MMC varies among regions. Clinicians should be aware of the potential prevalence of MMC, particularly in mandibular first molars, as a missed MMC could result in endodontic failure. CLINICAL RELEVANCE: The presence of MMCs varies in different geographic regions (0% to 29.7%). Clinicians should always look for MMC when doing an endodontic treatment on mandibular molars, as the presence of this canal is not uncommon. We suggest searching for this canal as if searching for the second mesiobuccal canal of maxillary 1st molars.

An improved diagnostic method for taurodontism and a comparative study on its effectiveness evaluation.

OBJECTIVE: The two commonly used diagnostic methods for taurodontism are susceptible to aging changes, mastication wear and other factors. Therefore, this study proposed an improved diagnostic method for taurodontism, and compared it with the previous two methods as a supplement for taurodontism diagnosis. METHODS: The included patients were aged 10-89 years and admitted to the Department of Stomatology of Hebei Eye Hospital from June 1, 2022 to May 31, 2023. Eighty cone-beam computed tomography images were divided equally into 4 groups: 10-29, 30-49, 50-69, and 70-89 years old. The right mandibular first molars were selected as measurement objects. Firstly, |BD| and taurodontism index (TI)-related parameters were measured using Shifman and Chanannel's method and crown-body(CB) and root (R) lengths was measured by Seow and Lai's method. The improved method used the length from the cementoenamel junction(CEJ) to the root bifurcation point(body, B)and the root length(root, R)as the measurement objects. Finally, TI, CB/R ratios, and B/R ratios were calculated according to the formulas given below. One-way ANOVA analysis was mainly used to compare the differences in the values, indices and ratios of taurodontism among different age groups (p<0.05). RESULTS: With the increase of age, |BD| and TI values decreased significantly (p<0.01). The CB/R ratios of 70-89 years group were significantly lower than those of the other three groups (p<0.01). Ratios derived from the improved method were significantly lower in the 70-89 years than in 10-29 years group (p<0.05). CONCLUSIONS: The |BD| and TI parameters proposed by Shifman and channel are significantly influenced by age. The measurements of Seow and Lai (CB/R ratios) were less affected by age compared with those of the former. The improved method(B/R ratios) was least affected by age, which would reduce error and bias in the measurement of taurodontism and obtain more objective results in older patients.

Assessment of multispecies biofilm growth on root canal dentin under different radiation therapy regimens.

OBJECTIVES: To assess the growth of a multispecies biofilm on root canal dentin under different radiotherapy regimens. MATERIALS AND METHODS: Sixty-three human root dentin cylinders were distributed into six groups. In three groups, no biofilm was formed (n = 3): NoRT) non-irradiated dentin; RT55) 55 Gy; and RT70) 70 Gy. In the other three groups (n = 18), a 21-day multispecies biofilm (Enterococcus faecalis, Streptococcus mutans, and Candida albicans) was formed in the canal: NoRT + Bio) non-irradiated + biofilm; RT55 + Bio) 55 Gy + biofilm; and RT70 + Bio) 70 Gy + biofilm. The biofilm was quantified (CFUs/mL). Biofilm microstructure was assessed under SEM. Microbial penetration into dentinal tubules was assessed under CLSM. For the biofilm biomass and dentin microhardness pre- and after biofilm growth assessments, 45 bovine dentin specimens were distributed into three groups (n = 15): NoRT) non-irradiated + biofilm; RT55 + Bio) 55 Gy + biofilm; and RT70 + Bio) 70 Gy + biofilm. RESULTS: Irradiated specimens (70 Gy) had higher quantity of microorganisms than non-irradiated (p = .010). There was gradual increase in biofilm biomass from non-irradiated to 55 Gy and 70 Gy (p < .001). Irradiated specimens had greater reduction in microhardness after biofilm growth. Irradiated dentin led to the growth of a more complex and irregular biofilm. There was microbial penetration into the dentinal tubules, regardless of the radiation regimen. CONCLUSION: Radiotherapy increased the number of microorganisms and biofilm biomass and reduced dentin microhardness. Microbial penetration into dentinal tubules was noticeable. CLINICAL RELEVANCE: Cumulative and potentially irreversible side effects of radiotherapy affect biofilm growth on root dentin. These changes could compromise the success of endodontic treatment in oncological patients undergoing head and neck radiotherapy.

Biomechanical impact of different isthmus positions in mandibular first molar root canals: a finite element analysis.

OBJECTIVE: This study used image-based finite element analysis (FEA) to assess the biomechanical changes in mandibular first molars resulting from alterations in the position of the root canal isthmus. METHODS: A healthy mandibular first molar, characterized by two intact root canals and a cavity-free surface, was selected as the subject. A three-dimensional model for the molar was established using scanned images of the patient's mandibular teeth. Subsequently, four distinct finite element models were created, each representing varied root canal morphologies: non-isthmus (Group A), isthmus located at the upper 1/3 of the root (Group B), middle 1/3 of the root (Group C), and lower 1/3 of the root (Group D). A static load of 200 N was applied along the tooth's longitudinal axis on the occlusal surface to simulate regular chewing forces. The biomechanical assessment was conducted regarding the mechanical stress profile within the root dentin. The equivalent stress (Von Mises stress) was used to assess the biomechanical features of mandibular teeth under mechanical loading. RESULTS: In Group A (without an isthmus), the maximum stress was 22.2 MPa, while experimental groups with an isthmus exhibited higher stresses, reaching up to 29.4 MPa. All maximum stresses were concentrated near the apical foramen. The presence of the isthmus modified the stress distribution in the dentin wall of the tooth canal. Notably, dentin stresses at specific locations demonstrated differences: at 8 mm from the root tip, Group B: 13.6 MPa vs. Group A: 11.4 MPa; at 3 mm from the root tip, Group C: 14.2 MPa vs. Group A: 4.5 MPa; at 1 mm from the root tip, Group D: 25.1 MPa vs. Group A: 10.3 MPa. The maximum stress in the root canal dentin within the isthmus region was located either at the top or bottom of the isthmus. CONCLUSION: A root canal isthmus modifies the stress profile within the dentin. The maximum stress occurs near the apical foramen and significantly increases when the isthmus is located closer to the apical foramina.

Volumetric Analysis of Hand and Rotary Instrumentation, Root Canal Filling Techniques, and Obturation Materials in Primary Teeth Using Spiral CT.

AIM AND BACKGROUND: To compare the root canal volume in primary teeth using hand and rotary instruments and to evaluate root canal filling techniques and flow of root canal obturation materials in the postinstrumented root canal volume using spiral computed tomography (SCT). MATERIALS AND METHODS: Freshly extracted 16 primary molars were randomly divided into two groups and subjected to SCT analysis before and after instrumentation. For the manual technique (group I) with eight teeth were prepared using K files, and rotary (group II) eight teeth preparation was performed with ProTaper files. The filled volume in each canal was measured using SCT, and the percentage of obturated volume was calculated. The data were statistically analyzed using the Mann-Whitney U test. RESULTS: There was a statistically significant difference in both groups' volume of root canals enlarged. Even though both K files and the ProTaper system brought about enlarged canals after instrumentation, there was a statistically significant increase in volume after using K files in two canals. In three canals, there was a statistically significant increase in volume after using ProTaper. Irrespective of the obturation technique and materials used, there is no statistically significant difference in the volume after obturation. CONCLUSION: From the results of this study, the ProTaper file system shows suitable volumetric enlargement up to an optimum level, which is needed in primary root canal walls, and is better in canal shaping, as evidenced by good postobturation volume. CLINICAL SIGNIFICANCE: The traditional method of cleaning and shaping the root canals in permanent teeth using manual stainless-steel files can lead to undesirable curvatures in root canal morphology, making correctly filling the root canals difficult. It is also time-consuming and sometimes leads to iatrogenic errors. Rotary nickel-titanium (Ni-Ti) instrumentation techniques have been developed to overcome these problems. How to cite this article: Yadav DBUC, Varma RB, Kumar JS, et al. Volumetric Analysis of Hand and Rotary Instrumentation, Root Canal Filling Techniques, and Obturation Materials in Primary Teeth Using Spiral CT. J Contemp Dent Pract 2024;25(3):250-259.

Performance of obturation techniques in anatomical irregularities located at different thirds of the root canal system.

This study aimed to compare the quality of root canal obturation (ratio of area occupied by gutta-percha (G), sealer (S), and presence of voids (V)) in different anatomical irregularities (intercanal communications, lateral irregularities, and accessory canals) located at different thirds of the root canal system of mandibular molar replicas. Sixty-seven 3D printed replicas of an accessed mandibular molar were prepared using ProGlider and ProTaper Gold rotatory systems. Three specimens were randomly selected to be used as controls and did not receive further treatment. The rest were randomly distributed in 4 experimental groups to be obturated using either cold lateral compaction (LC), continuous wave of condensation (CW), and core-carrier obturation (ThermafilPlus (TH) or GuttaCore (GC)) (n=16 per group). AHPlus® sealer was used in all groups. The three controls and a specimen from each experimental group were scanned using micro-computed tomography. The rest of the replicas were sectioned at the sites of anatomical irregularities and examined at 30× magnification. The G, S, and V ratios were calculated dividing the area occupied with each element by the total root canal area and then compared among groups using the Kruskal-Wallis test. Voids were present in all obturation techniques with ratios from 0.01 to 0.15. CW obtained a significantly higher G ratio in the irregularity located in the coronal third (0.882) than LC (0.681), TH (0.773), and GC (0.801) (p<0.05). TH and GC achieved significantly higher G ratios in those located in the apical third (p<0.05). The worst quality of obturation was observed in the loop accessory canal with all obturation techniques. Whitin the limitations of this study, it can be concluded that CW and core-carrier obturation are respectively the most effective techniques for obturating anatomical irregularities located in the coronal and the apical third.

Antibacterial ability of different activated irrigation after root canal preparation: intratubular analyses.

This study assessed the intratubular antibacterial ability of different activated irrigations after chemical mechanical preparation. Seventy-two palatal root canals of upper molars were infected with Enterococcus faecalis for 4 weeks, and then initial bacterial collection from the main root canal was performed. The root canals were prepared by using a WaveOne Gold large (45/.05) and distributed into 6 groups according to the activation of the final irrigation: ultrasonic activation (UA), XP-Endo Finisher (25/.00), XP Clean (25/.02), EasyClean (25/.04) in reciprocating motion and continuous rotary motion (ECRot), and conventional irrigation. After final irrigation, another bacterial collection from the main root canal was performed, and the root was sectioned transversely in three-thirds and stained for analysis by confocal laser microscopy. Intratubular bacteria were collected through dentin powder and plated for bacterial viability analysis. Intergroup and intragroup comparisons were performed by using analysis of variance and repeated measures analysis of variance, respectively, both at 5% significance. ECRot had higher antibacterial ability than UA (p<0.05), and both were superior to the other groups (p<0.05) in both methodologies. It can be concluded that activation of final irrigation enhances the disinfection of the root canal system, and activators have different efficacies.

Efficacy of electronic apex locators in comparison with intraoral radiographs in working length determination- a systematic review and meta-analysis.

BACKGROUND: Successful endodontic treatment needs accurate determination of working length (WL). Electronic apex locators (EALs) were presented as an alternative to radiographic methods; and since then, they have evolved and gained popularity in the determination of WL. However, there is insufficient evidence on the post-operative pain, adequacy, and accuracy of EALs in determining WL. OBJECTIVE: The systematic review and meta-analysis aims to gather evidence regarding the effectiveness of EALs for WL determination when compared to different imaging techniques along with postoperative pain associated with WL determination, the number of radiographs taken during the procedure, the time taken, and the adverse effects. METHODS: For the review, clinical studies with cross-over and parallel-arm randomized controlled trials (RCTs) were searched in seven electronic databases, followed by cross-referencing of the selected studies and related research synthesis. Risk of bias (RoB) assessment was carried out with Cochrane's RoB tool and a random-effects model was used. The meta-analysis was performed with the RevMan software 5.4.1. RESULTS: Eleven eligible RCTs were incorporated into the review and eight RCTs into the meta-analysis, of which five had high RoB and the remaining six had unclear RoB. Following meta-analysis, no significant difference in postoperative pain was found among the EAL and radiograph groups (SMD 0.00, CI .29 to .28, 354 participants; P value = 0.98). Radiograph group showed better WL accuracy (SMD 0.55, CI .11 to .99, 254 participants; P value = 0.02), while the EAL group had 10% better WL adequacy (RR 1.10, CI 1.03-1.18, 573 participants; P value = 0.006). CONCLUSION: We found very low-certainty evidence to support the efficacy of different types of EAL compared to radiography for the outcomes tested. We were unable to reach any conclusions about the superiority of any type of EAL. Well-planned RCTs need to be conducted by standardizing the outcomes and outcome measurement methods.

Evaluation of Antimicrobial Efficacy and Clinical Outcomes of Triphala and 2.5% Sodium Hypochlorite as Intraradicular Irrigants in Pulpectomy of Primary Teeth.

A natural irrigation solution with a broad spectrum of antimicrobial coverage, triphala was selected for the pulpectomy procedure. Because of its natural ingredients, it is well-known for promoting tissue healing. It also supposedly has certain additional qualities as compared to usual irrigation solutions that are made chemically. Although 2.5% NaOCl is thought to be perfect since it meets most of the requirements for an irrigation solution but it cannot be optimized for pulpectomy procedure. Primary teeth that were recommended for pulpectomy underwent this randomized controlled experiment. Two groups of eighty-four primary teeth were randomly assigned to receive irrigations: triphala in Group A; 2.5% Sodium hypochlorite in Group B. Sample were taken from infected primary root canals. A sterile test tube with bhi broth as the transport media was used to collect pre- and post-irrigation samples using sterile absorbent paper tips. On agar media, microorganisms were cultivated and their mean colony count was assessed. Following the procedure, the patient's follow-up visits at one, two and three months were used to evaluate the clinical result. The post-microbial colony count was dramatically reduced (p<0.001) by both irrigation treatments. Triphala in Group A is demonstrating desirable efficacy. Clinical success was found satisfactory in both the groups studied (p<0.001). But statistically significant difference was not found (p=0.175). Considering undesirable properties of sodium hypochlorite triphala can be a better alternative as a root canal irrigants in pulpectomy of primary teeth.

Microcomputed tomography analysis of curved root canal preparation when coronal flaring and glide path files used with heat-treated nickel titanium rotary files.

The objective was to evaluate the effect of glide path and coronal flaring on the dentin volume removal and percentage of touched walls in curved canals using two heat-treated rotary files. The mesiobuccal canal of forty-eight, randomly selected, extracted mandibular molars was divided into two groups of 24 each, according to the type of instrument used (RACE EVO and EdgeSequel rotary files). Each group was further divided into three subgroups; Group (A): Control using one file shaped to 04/30, Group (B) with a glide path (EdgeGlidePath (EGP)), and Group (C): with a glide path and coronal flaring (EGP and EdgeTaper Platinum (ETP) SX file respectively). The root canals were then instrumented using the assigned instruments. The assessment was carried out using micro-CT. The comparison of the mean values of the tested groups about dentin volume removal and percentage of untouched walls did not reach statistical significance (p<0.05). Glide path and coronal flaring had an insignificant effect on the dentin volume removal and percentage of untouched walls in curved canals.

Variations in the Root Form and Root Canal Morphology of Permanent Mandibular canine.

BACKGROUND: Mandibular canines are recognized as usually having one root and one root canal in most cases. However, many investigators have reported the anatomical variations associated with mandibular canines. Thus; the objective of this study is to determine the number of roots and morphology of the root canal system of permanent mandibular canine in a Nepalese population. METHODS: Cone Beam Computerized Tomography images of 390 patients in a Nepalese population were selected, and a total of 780 mandibular canines were analyzed. The number of root and the canal configurations were investigated. Data were analyzed with descriptive analysis and Chi-square tests using the Statistical Package for the Social Sciences (SPSS) software version 20 (SPSS Inc, Chicago, IL, USA). RESULTS: Out of the 780 mandibular canines, 741(95%) were single-rooted canines while only 39 (5%) were double-rooted canines. The most common type of Vertucci in single-rooted canines was Type I (1-1) in the percentage of 85.6% and the least type was Type IV (1-2) in the percentage of (2.5%). The Chi-square tests showed no significant association between gender and number of roots (P = 0.87) and gender and root canal configuration in single-rooted canine (P = 0.52). CONCLUSIONS: All mandibular permanent canines were single rooted but 5.2% of the permanent mandibular canines had two roots.

ANTIBACTERIAL EFFECT OF CRATAEGUS PINNATIFIDA EXTRACT AGAINST ENTROCOCCUS FAECALIS A ROOT CANAL DISEASE-CAUSING BACTERIA.

Studies have substantiated the anti-inflammatory and anti-thrombotic effects of (C. pinnatifida); however, research on its antibacterial activity using organic solvent remains limited. Therefore, in this study, we aimed to validate the antibacterial activity of C. pinnatifida as a natural extract against Enterococcus faecalis (E. faecalis), a multidrug-resistant bacterium. E. faecalis was treated with different concentrations of C. pinnatifida to determine the optimal concentration for the most effective antibacterial effect. Fifteen different concentrations were applied for 6 and 24 h. The experimental method centered on confirming antibacterial activity using colony-forming units. The experimental results demonstrated a proportional increase in antibacterial activity with elevated C. pinnatifida concentration. Notably, 99.99% and 100% antibacterial activity were observed at 10 mg/mL and 40 mg/mL concentrations, respectively. Our results suggest that C. pinnatifida holds potential as an antibacterial agent against the multidrug-resistant E. faecalis.

Post-endodontic pain in curved canals prepared with different rotary instrumentation techniques: A randomized controlled trial.

BACKGROUND: Curved root canals are associated with the highest number of procedural errors during endodontic instrumentation. Recently, numerous rotary instruments have been developed, with both manual and automated mechanisms, to facilitate endodontic treatment and manage the complications related to it. OBJECTIVES: The aim of the study was to assess post-endodontic pain after using the HyFlex® EDM OneFile (HEDM), WaveOne® Gold (WOG) and XP-endo® Shaper (XPS) systems in the preparation of curved canals in patients with asymptomatic irreversible pulpitis. MATERIAL AND METHODS: A total of 45 molars with curved canals and asymptomatic irreversible pulpitis were randomly divided into 3 equal groups based on the instrumentation used: HEDM (group A); WOG (group B); and XPS (group C). All teeth were prepared according to the manufacturers' instructions. Postendodontic pain was assessed using the visual analog scale (VAS) at 6, 12, 18, 24, 48, and 72 h after root canal instrumentation. The data was analyzed using the one-way analysis of variance (ANOVA) and the paired-samples t test with the Bonferroni correction, with a p-value of 0.05 set for statistical significance. RESULTS: The highest levels of post-endodontic pain were recorded at 6 h after treatment. Then, the values gradually decreased until the pain nearly vanished after 72 h. No statistically significant differences were observed in the VAS scores between groups A and B. At the same time, group C showed the lowest VAS scores at all follow-up time points. CONCLUSIONS: The use of the XPS system resulted in the lowest pain scores at all follow-ups. The HEDM and WOG groups showed no differences in the pain scores throughout the whole follow-up period.

Antimicrobial action and cytotoxicity of hypochlorous acid obtained from an innovative electrolytic device - An in vitro study.

OBJECTIVE: This study evaluated the antimicrobial effect and cytotoxicity of hypochlorous acid(HClO) obtained from an innovative electrolytic device. DESIGN: The root canals of fifty extracted human teeth were inoculated with Enterococcus faecalis and divided into 5 groups (n = 10): DW (control); 2% chlorhexidine gel(CHX); 2.5% sodium hypochlorite(NaOCl); 250 ppm HClO and 500 ppm HClO. The counting of colony forming units evaluated the decontamination potential of each group. Cytotoxicity was evaluated after inoculation of tested protocols in fibroblastic cells for 3 min, calculating the cell viability. Specific statistical analysis was performed (α = 5%). RESULTS: The highest bacterial reduction was observed in experimental groups, with no statistical differences from each other (p > 0.05). The highest number of viable cells was observed in control group, followed by 250 ppm HClO and 500 ppm HClO groups, with statistical differences from each other (p < 0.05). CONCLUSIONS: It could be concluded that HClO presented high antimicrobial activity and low cytotoxicity at both tested concentrations.