POSTOPERATIVE PAIN INCIDENCE AND INTENSITY FOLLOWING ROOT CANAL OBTURATION WITH BIOCERAMIC AND OTHER SEALERS: A SYSTEMATIC REVIEW WITH META-ANALYSIS

Aims: To investigate whether bioceramicsealers induce a lower incidence and intensity of postoperative pain compared to other sealers. Materials and Methods: Six electronic databases were searched for studies published up to April 2022, following the PICOS strategy: (P) adult patients undergoing root canal treatment or retreatment; (I) root canal filling using bioceramic sealer; (C) root canal filling using other types of sealers; (O) Primary: postoperative pain incidence and/or intensity; Secondary: number of medication intake; (S) randomizedclinical trials. Risk of bias assessment was performed with the revised Cochrane risk of bias tools for randomized trials (RoB 2). Overall certainty of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Results: Ten studies were included. Eight studies had a low risk of bias, and two had some concerns risk. Meta-analyses showed no differences regarding postoperative pain intensity and incidence between bioceramic sealers and AH Plus. Number of medication intake seemed to be associated to the preoperative diagnosis. Zinc oxide-eugenol sealer demonstrated an intense postoperative pain compared to bioceramic sealers and AH Plus. GRADE analysis showed a low certainty of evidence for all outcomes. Conclusions: There seem to be no differences between bioceramic sealers and AH Plus regarding postoperative pain intensity and incidence. Number of medication intake seem to be associated to the preoperative diagnosis. Zinc oxide-eugenol evoked a more pronounced postoperative pain.

Effect of music during endodontic treatment on patients' anxiety: a systematic review of randomized clinical trials.

OBJECTIVES: Endodontic treatment is one of the most fearful procedures among dentistry, and the use of music during the procedure has been evaluated to control patients' anxiety. This systematic review has been conducted to provide a synthesis of the state of knowledge in this field and aimed to answer the following question: "Can music therapy reduce patient's state anxiety during endodontic treatment?". METHODS: A search was performed in six electronic databases (PubMed, Cochrane Library, Scopus, Web of Science, EMBASE, and Open Gray) for articles published until April 2022. The eligibility criteria, based on the PICOS strategy, were as follows: (P) patients undergoing endodontic treatment; (I) exposure to music; (C) no music; (O) patients' anxiety; (S) only randomized clinical trials. The risk of bias was analyzed according to the Cochrane Risk of Bias tool for randomized controlled trials (RoB 2). The strength of evidence from the included studies was assessed using the Grading of Assessment, Development, and Assessment Recommendations (GRADE) tool. RESULTS: Five eligible studies were retrieved. A low to high risk of bias was verified. Descriptive analysis showed an effect in favor of music intervention, with differences among state anxiety, heart rate and blood pressure. CONCLUSIONS: With a very low quality of evidence, dental care professionals may consider playing background music during endodontic treatment since it is a cost-effective and easy alternative to trying to reduce dental anxiety. CLINICAL RELEVANCE: Five studies were included in this systematic review and showed, with a very low quality of evidence, that music may reduce state anxiety levels on patients during root canal treatment.

Efficacy of reciprocating instruments and final irrigant activation protocols on retreatment of mesiobuccal roots of maxillary molars: a micro-CT analysis.

Objectives: This study evaluated the efficacy of 3 reciprocating systems and the effects of 2 instruments for irrigant activation on filling material removal. Materials and Methods: Forty mesiobuccal roots of maxillary molars were prepared up to size 25.06 and obturated. Micro-computed tomography (micro-CT) examination #1 was performed. Teeth were then divided into 4 groups (n = 10), according to the retreatment protocol: (1) manual, (2) Reciproc Blue, (3) WaveOne Gold, and (4) X1 Blue. Micro-CT examinations #2 and #3 were performed after filling removal and repreparation, respectively. Next, all teeth were divided into 2 new groups (n = 20) according to the irrigant activation protocol: XP Clean (XP Clean size 25.02) and Flatsonic (Flatsonic ultrasonic tip). Micro-CT examination #4 was performed after irrigant activation. Statistical analysis was performed with a significance level set at 5%. Results: WaveOne Gold removed a significantly greater amount of filling material than the manual group (p < 0.05). The time to reach the WL was similar for all reciprocating systems (p > 0.05). X1 Blue was faster than the manual group (p < 0.05). Only manual group improved the filling material removal after the repreparation stage (p < 0.05). Both activation protocols significantly improved the filling material removal (p < 0.05), without differences between them (p > 0.05). Conclusions: None of the tested instruments completely removed the filling material. X1 Blue size 25.06 reached the working length in the shortest time. XP Clean and Flatsonic improved the filling material removal.

Eficácia de três protocolos de irrigação final para remoção de raspas dentinárias e material obturador em irregularidades simuladas / Effectiveness of three final irrigation protocols for debris and filling removal from simulated irregularities

Objetivos: Avaliar três protocolos de irrigação final para remoção de detritos e material obturador de istmos simulados. Métodos: Setenta e oito pré-molares foram preparados com o sistema WaveOne Gold 45.05. Os dentes foram seccionados longitudinalmente e um istmo padronizado foi confeccionado no terço apical. Seis raízes foram utilizadas como controle negativo. Os espécimes foram randomizados em dois grupos principais (n=36). Trinta e seis raízes tiveram o istmo preenchido com detritos e as outras trinta e seis raízes foram obturadas com guta-percha e cimento endodôntico, por meio da técnica híbrida de Tagger. Cada grupo foi dividido em três subgrupos (n=12), de acordo com o protocolo de irrigação final: Easy Clean; irrigação ultrassônica passiva (PUI); e XP Clean. A ativação do NaOCl 2,5% pelo Easy Clean foi realizada em três ciclos de vinte segundos; e pelo XP Clean, por um minuto em movimento reciprocante e contínuo, respectivamente. No grupo PUI, o irrigante foi ativado em três períodos de vinte segundos. Resultados: Não foi encontrada associação entre os escores de remoção de detritos e os protocolos de irrigação (p=0,165). Foi observada associação entre os escores de remoção do material obturador e os protocolos de irrigação final (p<0,05). Conclusões: Os protocolos de irrigação final foram efetivos para a remoção de detritos, mas não para remoção de material obturador de istmos no terço apical (AU).

This study aimed to assess three final irrigation protocols on debris and filling removal from simulated irregularities. Methods: Seventy-eight mandibular premolars were prepared with WaveOne Gold system 45.05, splitted longitudinally, and a standardized groove was performed in the apical portion of the canals. Six roots served as negative control. The roots were randomly divided into two main groups (n = 36). The grooves were filled with dentin debris in thirty six roots. The others thirty-six were filled with gutta-percha and endodontic sealer using Tagger hybrid technique. Each main group was then divided into three groups (n = 12) according to the final irrigation protocol: Easy Clean, passive ultrasonic irrigation (PUI), and XP Clean. In Easy Clean 2.5% NaOCl activation was performed for 3 cycles of 20 seconds and XP Clean for one minute under reciprocating and continuous rotary motion and continuous rotary motion, respectively. In the PUI group, the irrigant was activated in three periods of 20 seconds. Results: No association was found among the scores of debris removal and the irrigation protocols (p = .165). An association was observed among the filling material removal scores and irrigation protocols (p< .05). Conclusion: Easy Clean, PUI and XP Clean were effective for dentin debris removal, but did not for filling material from artificial grooves in the apical third (AU).

Passive ultrasonic irrigation in calcium hydroxide removal from root canals: a sem/ eds analysis

AIM: The aim of this study was to evaluate the efficacy of different lengths of time of passive ultrasonic irrigation (PUI) in removing calcium hydroxide (CH) paste from root canal, using scanning electron microscopy and energy dispersive spectrometry (SEM/EDS). MATERIAL AND METHODS: Fifty-four human premolars were used. After coronal access, a size #15 K-file was used to obtain apical patency. Root canal preparation was performed using WaveOne 40.08 instruments. CH paste was placed into the root canal. Specimens were stored in a humid environment, and after seven days, they were divided into five groups (n=12) according to the irrigation protocols: Manual­ a size #40 K-file; PUI/1­ 1 min; PUI/2­ 2 min; PUI/3­ 3 min; and Control­ without CH paste. An elementary chemical microanalysis (SEM/EDS) was performed to quantify the presence of calcium on the dentinal walls. RESULTS: The percentage of calcium was higher in all experimental groups when compared to the control group (P < 0.05); but no differences among them were found (P > 0.05). CONCLUSION: The amount of calcium hydroxide paste on the dentinal walls was not dependent on length of time of ultrasonic activation. SEM/EDS analysis seems to be a reliable method to assess CH paste removal from the root canals.