Interleukin-8 (IL-8) levels in gingival crevicular fluid during root canal treatment of molar teeth with symptomatic irreversible pulpitis: impact of varying sodium hypochlorite concentrations.

BACKGROUND: The aim of this study was to evaluate the effect of the use of different NaOCl concentrations (1%, 2.5%, and 5.25%) during root canal treatment of molar teeth with symptomatic irreversible pulpitis on the change of the IL-8 level in gingival crevicular fluid (GFC). METHODS: GCF sampling was performed on experimental tooth with irreversible pulpitis before and after treatment and also contralateral healthy tooth of 54 patients. The patients were divided into three groups according to concentration of NaOCl solution (n = 18); 1%, 2.5%, and 5.25% NaOCl solution. GCF sampling from experimental teeth was repeated one week after root canal treatment. Statistical analysis was performed using Mann-Whitney U, Wilcoxon test, one-way ANOVA and Pearson correlation analysis. RESULTS: There was a significant correlation between IL-8 levels in GCF samples taken from teeth with pulpitis before treatment and from healthy contralateral teeth (p = .000). Furthermore, the pretreatment IL-8 level was significantly higher than the posttreatment IL-8 level(p < .05). The effect of the NaOCl concentration on the change in IL-8 level betweeen pre and post treatment was not found statistically significant (p > .05). CONCLUSIONS: The use of NaOCl during root canal treatment can effectively reduce the levels of IL-8 in GCF and improve clinical outcomes. TRIAL REGISTRATION: This study was registred in the Institutional Review Board and the Ethics Committee of the University (No:11) on 15/12/2021.

The Effect of Using Different Kinematics Single File Systems with Coronal Preflaring Instruments on Postoperative Pain with Symptomatic Irreversible Pulpitis: A Randomized Clinical Trial.

INTRODUCTION: The aim of this study was to investigate the effect of using coronal preflaring file (One Flare; OF) with rotational (One Curve; OC) and reciprocal (WaveOne Gold; WOG) single file systems on postoperative pain in mandibular premolar teeth with symptomatic irreversible pulpitis. METHODS: Eighty patients were included in this prospective, superiority, parallel, and randomized controlled clinical trial. The patients were randomly divided into four groups (n = 20) based on the use of coronal preflaring and the kinematics of the shaping instrument: WOG (without coronal preflaring), WOG with coronal preflaring (OF), OC (without coronal preflaring), and OC with coronal preflaring (OF). Patients recorded their postoperative pain intensity at 6, 24, 48, and 72 hours using a 10-cm visual analog scale. Friedman and Wilcoxon's tests were used for intragroup comparisons, and Kruskal-Wallis test was used for intergroup comparisons. The post hoc analysis was performed using Dunn's test. The Chi-square test was used to compare gender and tooth localization according to the groups, and Kruskal-Wallis test was used to compare age and preoperative pain (P < .05). RESULTS: At 6 and 24 hours, WOG and OC with coronal preflaring groups showed statistically significantly lower pain scores than WOG and OC groups without coronal preflaring (P < .05). No significant difference was found between the groups in terms of analgesic medication intake. CONCLUSIONS: The use of coronal preflaring with both rotational and reciprocal single file systems in root canal preparation resulted in less postoperative pain in mandibular premolar teeth diagnosed with symptomatic irreversible pulpitis.

Histological evaluation of the debris removal efficiency of activation of sodium hypochlorite solution at different concentrations.

BACKGROUND: This study aims to histologically evaluate the efficiency of debris removal through activation of 2.5% and 5.25% NaOCI using laser, ultrasonic, and intracanal heating methods. METHODS: Sixty-four maxillary central incisor teeth were randomly divided into two groups according to the irrigation solution (n = 32); 2.5% NaOCI and 5.25% NaOCI. Subsequently, the samples were further divided into four subgroups according to the final irrigation activation technique (n = 8); SubgroupA: Er,Cs:YSGG laser, SubgroupB: Ultrasonic, Subgroup C: Intracanal heating, Subgroup D: no activation. Generalized Linear Models and Bonferroni tests were used for statistical analysis (p < 0.05). RESULTS: The effect of NaOCI concentration was statistically significant (p < 0.001). Furthermore, the activation of NaOCI by laser exhibited a statistically significant difference compared to the ultrasonic and intracanal heating methods (p < 0.001). CONCLUSION: The efficiency of root canal cleaning increases with higher NaOCI concentration. Activation of NaOCI also significantly enhances its effectiveness.

The effects of laser and ultrasonic irrigation activation methods on smear and debris removal in traditional and conservative endodontic access cavities.

In this study, it was aimed to evaluate the smear and debris removal efficiency of laser and ultrasonic irrigation activation methods in traditional and conservative endodontic access cavity preparations. 60 freshly extracted human mandibular molar teeth were randomly divided into 2 groups according to the access cavity preparation (n = 30): Traditional endodontic access cavities (TEC) and Conservative endodontic access cavity (CEC). After the access cavity preparation, the mesiobuccal root canals were prepared to 35/0.4 with the VDW Rotate file system. Teeth with completed root canal preparation were randomly divided into 3 subgroups according to the final irrigation activation protocol (n = 30): Conventional needle irrigation, passive ultrasonic activation and laser activation. The crowns of the teeth were removed and the mesiobuccal roots were divided longitudinally into two halves, mesial and distal. Samples were scanned with scanning electron microscopy. Photomicrographs in the coronal, middle, and apical thirds of each specimen were taken at a magnification of 200 for debris and 1000 for evaluation of the smear layer. Data were analysed using the three-way Robust Anova test and Bonferroni test.The effect of access cavity design on remaining smear (p = 0.057) and debris (p = 0.5) was not statistically significant. The effect of the interaction of access cavity and irrigation activation on the remaining smear and debris was not statistically significant (p = 0.556, p = 0.333). Significantly fewer smears were detected in the laser activation group than in the ultrasonic activation and control groups. Conservative access cavities did not differ from conventional access cavities in terms of debris and smear.

Effect of using calcium-silicate and silicone based root canal sealers in bulk or with main core material on bond strength.

Background: The purpose of this study was to assess the push-out bond strength of calcium-silicate and silicone based root canal sealers in bulk and with main cone. Methods: Roots (n=48) randomly divided into 4 groups (n=12) according to the obturation protocol; (1) iRoot SP in bulk; (2) iRoot SP with gutta-percha; (3) GuttaFlow Bioseal in bulk; (4) GuttaFlow Bioseal with gutta-percha. Six horizontal sections were obtained from each root (n=72). Effect of sealers on bond strength was statistically significant (P<0.05). Results: Highest mean value was obtained in iRoot-Bulk group and lowest in GuttaFlow Bioseal-GP group. Both iRoot SP groups had significantly higher bond strength values than both GuttaFlow Bioseal groups (P<0.05). There was no significant difference between iRoot-GP and iRoot-Bulk groups (P=0.603) also GuttaFlow Bioseal-GP and GuttaFlow Bioseal-Bulk groups (P=0.684). Conclusion: Based on findings, using calcium silicate-based sealer in bulk can be also suitable in clinical practice.

The effect of glide path preparation on the shaping ability of XP-endo® Shaper in simulated canals

Aims: To compare the shaping efficiency of the XP-endo Shaper with or without glide path preparation with sequenced Scout Race files in J-shaped resin blocks Material and Methods: Forty simulated J-shaped root canals were classified into two groups (n=20). While the root canals were shaped with XPS after a glide path was created with Scout Race files in Group 1, the same procedures were done without the glide path preparation in Group 2. The pre-and post-instrumentation images were taken and superimposed. Transportation value (TV), centering ability (CA) and the total amount of resin removed (TRR) was calculated by using the obtained images with Adobe Photoshop CS5 software. These parameters were calculated based on 18 reference points (9 inner/9 outer walls) with 1-mm intervals according to 3 sections (coronal, middle, and apical of the canals). The data were analyzed with Kruskal-Wallis and then Dunn's multiple comparison tests (p ≤ 0.05). Results: More resin was removed in Group 2 apical and coronal sections than in Group 1 (p=0.036). In Group 2, a higher transportation value was obtained in apical and middle sections compared to Group 1 (p<0.001). Group 1 showed a higher centering ratio in apical and middle sections than in Group 2 (p<0.001). The centering ability of the instruments was decreased in the curvature part (middle section) of the canals. Conclusions: Within the limits of this study, glide path preparation using Scout Race instruments improved the shaping ability of XPS instrument by leading to less transportation and maintaining centering ability.

The effect of solution and gel forms of sodium hypochlorite on postoperative pain: a randomized clinical trial.

OBJECTIVES: The aim of this study is to evaluate the effect of using gel and solution forms of NaOCI during the chemomechanical preparation of the root canals on postoperative pain at different time intervals. METHODOLOGY: 114 patients with mandibular molar teeth and symptomatic irreversible pulpitis were included in the study. All patients were divided into two groups based on the irrigant used during root canal preparation (n=57): Group 1, 5.25% NaOCI, Group 2, 5.25% NaOCI gel. All groups were filled with gutta-percha and AH Plus root canal sealer using single-cone technique. VAS scale (1-10) was used for postoperative pain assessment. After endodontic treatment, all patients were asked to record their postoperative pain levels at the 6th, 24th, 48th, 72nd hours, and 1 week later. The data were analyzed using Chi-Squared, Independent Samples T, Cochran Q and Friedman tests. RESULTS: Statistically significant difference was not found between the distributions of pain levels at different times according to the groups (p>0.050). A statistically significant difference was observed between the distributions of pain levels measured at different times in the solution group (p<0.001). A statistically significant difference was found between the distributions of pain levels measured at different times in the gel group (p<0.001). In both groups, highest postoperative pain levels occurred in the first 6 hours. Pain levels of the gel group as 38,5% mild, 17.3% moderate, 5.8% severe and pain levels of the solution group were obtained as 46.2% mild, 26.9% moderate, 9.6% severe at the 6th hour. CONCLUSIONS: The use of the gel form of NaOCI during the chemomechanical preparation of the root canals showed similar postoperative pain when compared to the solution form.

Accuracy of the London atlas, Willems, and Nolla methods for dental age estimation: a cross-sectional study on Eastern Turkish children.

OBJECTIVES: This study aimed to estimate the dental age (DA) using the London Atlas, Willems, and Nolla methods and to compare their accuracies. METHODS: The DA was estimated using the aforementioned methods on panoramic radiograms of a total of 919 Eastern Turkish patients aged 6-14 years, of whom 459 were female and 460 were male. The overestimation and underestimation values were determined in relation to the chronological age (CA) values. The paired t test was used to compare the mean DA and CA values. Multiple regression analysis was used to derive gender-specific formulations for the three methods. RESULTS: The most accurate method for estimating the DA was the Willems method (mean prediction error 0.80), followed by the London Atlas (mean prediction error 0.83) and Nolla (mean prediction error 0.89) methods. Statistically significant differences were found only between the Willems and Nolla methods. CONCLUSION: All three methods can be used for DA estimations of Eastern Turkish children. CLINICAL RELEVANCE: Willems was the most suitable method for this patient sample. However, the London Atlas method may be preferred due to its practicability and comparable accuracy.

Evaluation of the Effect of Different Bracket Systems on External Apical Root Resorption Using Cone-Beam Computed Tomography.

OBJECTIVE: The aim of this study was to evaluate the external apical root resorption (EARR) developed in the maxillary and mandibular teeth of patients undergoing orthodontic treatment with conventional and self-ligating bracket systems. METHODS: Cone-beam computed tomography images of patients treated with self-ligating and conventional bracket systems, which were taken at the beginning and end of treatment, were evaluated. The teeth where EARR developed during the treatment period were identified. EARR was evaluated as yes or no. A P value of < .05 was considered statistically significant. RESULTS: Of a total of 300 patients (68.7% female, 31.3% male), 20% were treated with the self-ligating bracket system, while 80% were treated with the conventional bracket system. EARR occurred in 8.3% (n = 25) of the patients after treatment. A statistically significant difference was found when the effect of age, gender, and treatment duration on the incidence of EARR was evaluated. The incidence of EARR was higher in the age group of 18-30 years than in the age group of 12-17 years. Similarly, it was found to be higher in men than in women and higher in the group with a treatment duration of 33-49 months than in the group with a treatment duration of 8-32 months. CONCLUSION: Treatment duration has been observed to affect the incidence of EARR in patients undergoing fixed orthodontic treatment, and the incidence of EARR increases with increased treatment duration. Furthermore, it has been concluded that EARR during orthodontic treatment is influenced by age and gender. There is no difference between self-ligating and conventional bracket systems in terms of EARR.

Effectiveness of different rotary file systems in removing the root canal filling material: A micro-computed tomography study.

Background. This study aimed to examine the retreatment efficiency of four NiTi rotary file systems with micro-computed tomography (micro-CT). Methods. Forty premolar teeth were shaped up to F2 using the ProTaper Universal rotary file system and obturated with MTA Fillapex. The root canals were scanned with micro-CT to evaluate the volume of root canal filling before retreatment. The samples were randomly divided into four groups according to the file system used to remove root canal filling material (n=10): ProTaper Universal Retreatment, ProTaper NEXT, EdgeFile XR, and EdgeFile® X3 NiTi system. All the samples were scanned with a micro-CT device for the second time to evaluate the amount of residual filling material in the root canals. The percentages of filling material removed from root canals were calculated. Additionally, the time spent on the removal of the root canal filling material was recorded. The data were analyzed using the Shapiro-Wilk and Kruskal-Wallis tests. Results. There were no significant differences between the groups in the percentage of root canal filling material removal. However, a statistically significant difference was found between the groups in the time required to reach the apex and remove the entire filling material. The time required to remove the root canal filling material was higher in the EdgeFile® X3 group. Conclusion. NiTi files manufactured for root canal preparation can be used effectively and safely to remove root canal filling materials. EdgeFile XR produced for retreatment can be used as an alternative to ProTaper Universal Retreatment files.

Debris extrusion during root canal preparation with nickel-titanium instruments using liquid and gel formulations of sodium hypochlorite in vitro.

This study compared the amount of apically extruded debris during root canal preparation with three single-file systems using liquid and gel-based formulations of sodium hypochlorite (NaOCl) or distilled water. Seventy-two single-canalled roots were divided into three groups: HyFlex EDM (Coltene-Whaledent); Reciproc Blue (VDW); and F-One Blue (Shanghai Fanta) and then divided into three subgroups: NaOCl liquid (Imicrly), NaOCl gel (Cerkamed Medical) and distilled water. The amount of extruded debris was calculated by determining the dry weight of the debris collected. Data were analysed using Kruskal-Wallis test with Bonferroni correction. Debris extrusion occurred in all subgroups. Both the instrument and the irrigant had an impact. The F-One Blue tended to extrude the least debris, though no significant difference was observed in the pairwise comparisons between instruments. NaOCl liquid resulted in significantly more extruded debris than NaOCl gel or distilled water. The results lead us to conclude that the NaOCl gel reduced debris extrusion compared to NaOCl liquid.

The effect of solution and gel forms of sodium hypochlorite on postoperative pain: a randomized clinical trial

Abstract Objectives The aim of this study is to evaluate the effect of using gel and solution forms of NaOCI during the chemomechanical preparation of the root canals on postoperative pain at different time intervals. Methodology 114 patients with mandibular molar teeth and symptomatic irreversible pulpitis were included in the study. All patients were divided into two groups based on the irrigant used during root canal preparation (n=57): Group 1, 5.25% NaOCI, Group 2, 5.25% NaOCI gel. All groups were filled with gutta-percha and AH Plus root canal sealer using single-cone technique. VAS scale (1-10) was used for postoperative pain assessment. After endodontic treatment, all patients were asked to record their postoperative pain levels at the 6th, 24th, 48th, 72nd hours, and 1 week later. The data were analyzed using Chi-Squared, Independent Samples T, Cochran Q and Friedman tests. Results Statistically significant difference was not found between the distributions of pain levels at different times according to the groups (p>0.050). A statistically significant difference was observed between the distributions of pain levels measured at different times in the solution group (p<0.001). A statistically significant difference was found between the distributions of pain levels measured at different times in the gel group (p<0.001). In both groups, highest postoperative pain levels occurred in the first 6 hours. Pain levels of the gel group as 38,5% mild, 17.3% moderate, 5.8% severe and pain levels of the solution group were obtained as 46.2% mild, 26.9% moderate, 9.6% severe at the 6th hour. Conclusions The use of the gel form of NaOCI during the chemomechanical preparation of the root canals showed similar postoperative pain when compared to the solution form.

Dentinal Tubule Penetration and Dislocation Resistance of a New Bioactive Root Canal Sealer Following Root Canal Medicament Removal Using Sonic Agitation or Laser-Activated Irrigation.

OBJECTIVE: To investigate the influence of sonic agitation or laser-activated irrigation techniques on the removal chlorhexidine (CHX) and modified triple antibiotic paste (mTAP) on the sealer penetration depth and dislocation resistance of Guttaflow Bioseal. METHODS: Single-rooted mandibular premolars (n=96) were prepared with rotary nickel titanium instruments and randomly divided into two groups (n=48) based on the intracanal medicaments used: Group 1, mTAP; Group 2, CHX gel. After 7 days, the specimens in each group were divided into three subgroups (n=16) based on the supplementary irrigation technique used to remove the medicaments: laser activated irrigation (Er, Cr: YSGG laser, Waterlase MD, Biolase Technology Inc., San Clemente, CA, USA), sonic agitation (EndoActivator, Dentslpy Sirona Endodontics, PA, USA) and syringe-and-needle irrigation (control) techniques. Canals were filled with single matched-taper gutta-percha cone and a calcium silicate-based sealer (GuttaFlow® Bioseal, Coltène/Whaledent, Langenau, Germany). At the end of three weeks, sealer penetration was investigated using confocal microscopy (n=6), and dislocation resistance was calculated by measuring the push-out bond strength (n=10). Statistical analysis was performed using three-way analysis of variance (ANOVA) and Tukey post-hoc test (P=0.05). RESULTS: Laser activated irrigation resulted in significantly higher depth of sealer penetration compared to sonic agitation and syringe irrigation (P<0.01). The average sealer penetration depths were recorded as 846.6 µm, 786.5 µm and 505 µm in the Er,Cr: YSGG laser, EndoActivator and control groups, respectively. The mean bond strength obtained in group 3 (syringe-and-needle irrigation) was significantly less than the other groups (P<0.05). The mean values were 9.08 in the Er,Cr: YSGG laser group, 8.44 in the EndoActivator group and 5.08 in the needle group. CONCLUSION: Er,Cr;YSGG laser irrigation to remove the medicaments was advantageous to other irrigation techniques in sealer penetration and dislocation resistance of the sealer.

Dentin moisture conditions strongly influence its interactions with bioactive root canal sealers.

OBJECTIVES: It is known that bioactive materials interact with the dentin to undergo biomineralization. The exact role of moisture in this interaction is unknown. Here, we investigate the effects of dentin moisture conditions on the dislocation resistance of two bioactive root canal sealers (MTA Fillapex [Angelus Solucoes Odontologicas] and GuttaFlow BioSeal [Colténe/Whaledent AG]) at 3 weeks and 3 months after obturation. MATERIALS AND METHODS: Mandibular premolars (n = 120) were prepared and randomly divided into 3 groups based on the dentin condition: group 1, dry dentin; group 2, moist dentin; group 3, wet dentin. Each group was divided into 2 subgroups for root canal filling: MTA Fillapex and GuttaFlow BioSeal. Dislocation resistance was evaluated by measuring the push-out bond strength at 3 weeks and 3 months. Failure modes were examined under a stereomicroscope. Data were statistically analyzed by Kruskal-Wallis test with a significance level of 5%. RESULTS: Moist dentin resulted in higher bond strength values for both materials at both time points. This was significantly higher than wet and dry dentin for both the sealers at the 3 months (p < 0.05), while at 3 weeks it was significant only for GuttaFlow Bioseal. The different moisture conditions demonstrated similar trends in their effects on the dislocation resistance of the 2 root canal sealers. CONCLUSIONS: The dentin moisture conditions had a significant impact on its interaction with the bioactive materials tested. Maintaining moist dentin, but not dry or wet dentin, may be advantageous before the filling root canals with bioactive sealers.

A chitosan-based irrigant improves the dislocation resistance of a mineral trioxide aggregate-resin hybrid root canal sealer.

OBJECTIVES: To investigate the effectiveness of root canal irrigation with chitosan on the dislocation resistance of a root canal sealer (MTA Fillapex) in vitro, measured by the push-out bond strength test. MATERIALS AND METHODS: Root canals of mandibular premolars (n = 57) were prepared using rotary files with 5.25% sodium hypochlorite as the irrigant during instrumentation. Following this, the specimens were randomly divided into three groups (n = 19) based on the final irrigant: group 1, 0.2% chitosan solution; group 2, 17% EDTA solution; group 3, saline. Three specimens from each group were analyzed using scanning electron microscopy-energy dispersive spectroscopy (SEM-EDS). The remaining specimens of each group were divided into two subgroups (n = 8) based on the method of agitation of the final irrigants (chitosan/EDTA/saline): subgroup A, sonic (Endoactivator, Dentsply Maillefer); subgroup B, no activation (control). After irrigation, all specimens obturated with a commercial mineral trioxide aggregate-resin hybrid sealer (MTA Fillapex, Angelus, Londrina, Brazil). Dislocation resistance was measured using the push-out bond strength test after 3 weeks. The data were analyzed using Kruskal-Wallis test (P = 0.05). RESULTS: Immaterial of the irrigant agitation, groups irrigated with chitosan showed significantly higher bond strength values than those irrigated with EDTA (P < 0.05). Groups irrigated with saline showed the least bond strength values (P < 0.05). When EDTA was used, sonic agitation significantly improved the bond strength of the sealer, compared to the control (P < 0.05). There was no significant difference between sonic agitation and the control when chitosan solution was used as the final irrigant (P > 0.05). The nitrogen/carbon ratio was significantly higher in chitosan groups compared to the control group (P < 0.05). CONCLUSION: This study provides the first evidence that chitosan irrigation improves the dislocation resistance of MTA-resin hybrid root canal sealer, compared to EDTA and saline irrigation. CLINICAL RELEVANCE: Chitosan-based irrigation has been previously shown to demonstrate anti-biofilm properties in the root canal. The present study demonstrates that chitosan can improve the bond strength of a root filling material, which may contribute to better sealing of the root canal system.

Adhesion of Two New Glass Fiber Post Systems Cemented with Self-Adhesive Resin Cements.

The aim of this in vitro study was to evaluate the adhesion strength of two new fiber post systems (FiberSite™ Post and Cytec™ Blanco Post) cemented with two different adhesive resin cements (Panavia™ SA and Maxcem™ Elite). Root canals of sixty extracted human mandibular premolars were prepared using ProTaper Universal™ rotary files (Dentsply Sirona Endodontics, York, PA, USA). The root canals were irrigated with 5.25% sodium hypochlorite (NaOCl) during instrumentation. After root canal preparation, the canals were irrigated with 2 mL of 17% EDTA (1 min), followed by 2 mL of 5.25% (5 min) NaOCI, and 2 mL saline. The root canals were dried with paper points and divided randomly into two study groups (n = 30) according to the type of post system: Group 1, FiberSite™ Post (MegaDental, Partanna, Italy); and group 2, Cytec™ Blanco Post (Hahnenkratt, Königsbach-Stein, Germany), with one of the two adhesive resin cements: Subgroup A, Panavia™ SA Cement Plus Automix (Kuraray, Osaka, Japan); subgroup B, Maxcem™ Elite (Kerr, Orange, CA, USA). Following thermocycling, the adhesion strength was evaluated using the push-out adhesion (bond) strength test. Fractographic analysis was performed using stereomicroscope. The data were analyzed using two-way analysis of variance (p = 0.05). The adhesion strength values of both the posts were significantly higher when cemented with subgroup B (Maxcem™ Elite). The highest adhesion strength value was demonstrated by group 1B (FiberSite™ post cemented with Maxcem™ Elite cement). The type of post did not have a significant impact on the bond strength values for either cement material.