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Introduction: Pulpectomy has been a treatment of choice in all necrotic primary teeth. Advancing technology has brought the rotary system to reduce the manual dexterity and improve the quality of treatment for pulpectomy. Advancing technology in pediatric dentistry should be used for the better treatment protocol. Aim: The aim of this study is to compare the obturation quality and instrumentation time after root canal instrumentation with rotary Kedo-S files, hand K-files, and H-files in primary molars. Materials and Methods: A randomized control trial where pulpectomy was performed on 75 primary molars equally distributed for instrumentation with K-file, H-files rotary Kedo-S files, respectively. The instrumentation time and obturation quality were noted. Results: Kedo-S files showed the least instrumentation time with better obturation quality as compared to other two groups (P < 0.001). Conclusion: Pediatric rotary files Kedo-S has better obturation quality in minimum instrumentation time.

Objective This study examined how system-matching gutta-percha (GP) cones in conjunction with calcium silicate-based sealers (CSBS) affect the sealing quality of canals prepared with variable taper nickel titanium (NiTi) files, using confocal laser scanning microscopy (CLSM) and micro-computed tomography (micro-CT). Materials and methods Forty-eight extracted human mandibular premolars were instrumented using the ProTaper Ultimate and divided into four groups based on GP cone (system-matching vs. non-matching) and sealer type (PlanB vs. TotalFill). Obturation was performed using the single-cone technique. Sealers were mixed with Fluo-3 dye for CLSM visualization. Micro-CT was used to quantify voids and gaps, while CLSM evaluated sealer penetration area and depth at the coronal, middle, and apical thirds. Results There were no significant differences in overall voids and gaps percentages between the cone systems ( p  = 0.66). System-matching cones however, significantly enhanced sealer penetration into dentinal tubules in terms of area, average, and maximum depth, especially in the apical third ( p  ≤ 0.001). PlanB demonstrated greater penetration area than TotalFill ( p  = 0.039). Conclusion The use of system-matching versus non-matching gutta-percha cones does not significantly affect the overall occurrence of voids and gaps in root canal fillings. However, system-matching cones improve sealer penetration into dentinal tubules, which differs among calcium silicate–based sealers. This emphasizes the importance of both cone fit and sealer selection in optimizing the quality of the single-cone obturation technique. Clinical relevance In canals prepared with variable taper NiTi files, both the compatibility of gutta-percha cones and the properties of calcium silicate–based sealers play a key role in enhancing the quality of the single-cone obturation technique.

This study evaluated the extent to which obturation materials bypass fractured endodontic instruments positioned in the middle and apical thirds of severely curved simulated root canals using different obturation techniques. Sixty resin blocks with simulated root canals were used, each with a 50° curvature, a 6.5 mm radius of curvature, and a length of 16.5 mm, prepared to an ISO #15 diameter and taper. Canals were shaped using ProTaper Universal files (Dentsply Maillefer) attached to an X-smart Plus endo motor (Dentsply), set at 3.5 Ncm torque and 250 rpm, up to size S2 at working length. To simulate fractures, F2 and F3 files were weakened 3 mm from the tip, then twisted to break in the apical and middle sections of the canal, respectively. All samples were sealed with GuttaFlow 2 and divided into three groups (n = 20/group) according to obturation technique: A) single cone, B) lateral condensation with a rotary spreader, and C) softcore obturators. Each group was then divided into two subgroups (n = 10) based on the instrument fracture location (1 = apical, 2 = middle). The linear intrusion of obturation materials through the fractured instruments was measured using ImageJ software and analyzed statistically with ANOVA, Tukey tests, and independent t-tests, with significance set at p<0.05. Material bypass in group B1 (3.27 ± 0.63 mm) was significantly greater than in group A1 (2.39 ± 0.44 mm) and group C1 (2.91 ± 0.77 mm). In group C2, bypass (5.76 ± 0.64 mm) was significantly higher than in group A2 (3.82 ± 0.2 mm) and group B2 (2.27 ± 0.96 mm). Additionally, bypass in group A2 was greater than in group B2, and group B1 had more bypass than B2, while group C2 exceeded C1. The lateral condensation technique with a rotary spreader and softcore obturators increased the bypass of obturation materials through fractured instruments in simulated curved canals. These techniques may thus enhance material flow in endodontic procedures involving instrument fractures.

Background and Objectives: Endodontic success depends on eliminating infection and creating a durable seal to prevent recontamination. The goal of this study was to assess the impact of different ISO sizes on the obturation quality using two reciprocating single-file systems, WaveOne® Gold and Procodile®, in two different canal morphologies. Material and Methods: Overall, 140 root canals from human permanent teeth were randomly assigned to 14 groups based on selected ISO sizes and straight and curved canal curvatures, and the two file systems, WaveOne® Gold files in ISO sizes 20, 25, and 45, and Procodile® files in ISO sizes 20, 25, 40, and 45, were employed for canal preparation. These 140 canals were obturated using corresponding gutta-percha points and AH-Plus sealer and the quality of the obturation was assessed after sectioning the roots (apical, middle, coronal third) by evaluating the resulting 420 sections under a digital fluorescence microscope with regard to the proportion of gutta-percha, sealer, and unfilled areas. The results were analyzed using nonparametric tests. Results: For both systems, there was a significant difference in the percentage of gutta-percha-filled areas (PGFA, p < 0.001) and sealer-filled areas (PSFA, p < 0.001 among the different ISO sizes). However, no significant difference was observed in the percentage of unfilled areas (PUA, p = 0.354). ISO 40 demonstrated the best results, with the highest percentage of gutta-percha-filled areas (87%) and the lowest percentages of sealer-filled areas (13%) and voids (0.5%). In contrast, the lowest percentages of gutta-percha filled areas were observed in root canal fillings with ISO 20 (81%) and ISO 25 (81%). Regarding both reciprocating file system sizes, ISO 45 in WaveOne® Gold and ISO 40 in Procodile® demonstrated significantly improved (p < 0.05) filling quality, with PGFA of 85% and 87%, respectively. The differences between both systems were not significant. Conclusions: The results presented suggest that larger sizes provide better filling results, especially in the apical region. These results underline the importance of selecting appropriate preparation sizes adjusted to the initial anatomical specifications to optimize root canal obturation and ensure a high quality and durable seal.

Background Primary teeth are necessary for mastication, speech, and guiding the eruption of permanent teeth. Dental caries often requires pulpectomy treatment to preserve these teeth. The success of pulpectomy depends on root canal obturation quality. This study aimed to compare the filling quality of zinc oxide-eugenol (ZOE) and Endoflas using lentulo and reverse rotary techniques, assessed by micro-computed tomography. Methods An in vitro study was conducted on 32 extracted human primary mandibular second molars. Teeth were randomly divided into four groups ( n  = 8) based on obturation material (ZOE or Endoflas) and technique (lentulo spiral or reverse rotary file). After standard canal preparation, obturation was performed. Micro-computed tomography assessed the quality of obturation by measuring the percentage of void and filling volume. Statistical analysis was performed using analysis of variance (ANOVA) test ( p  < 0.05). Results The lowest total void percentage was observed in the (ZOE + Lentulo) group (22.61 ± 9.00), and the highest in the (Endoflas|+Lentulo) group (35.97 ± 5.90). ZOE obturation resulted in lower voids (24.09 ± 8.50) compared to Endoflas (30.70 ± 8.50). The reverse rotary technique showed non significant lower voids (25.50 ± 7.60) than Lentulo (29.29 ± 10.10) ( p  = 0.181). A significant interaction effect was observed between material and technique in term of total voids ( p  = 0.021). (ZOE + Lentulo) group showed the highest filling volume (76.50 ± 9.10), while (Endoflas + Lentulo) had the lowest (64.02 ± 5.90). ZOE yielded higher filling volume (75.47 ± 8.50) compared to Endoflas (69.22 ± 8.50), with a significant material effect ( p  = 0.034), but no significant effect of technique ( p  = 0.138). Conclusion ZOE + Lentulo technique provided the most root canal obturation quality, while Endoflas + Lentulo showed the least quality. The root canal filling quality was more influenced by the obturation material than the technique used.

Objectives To investigate the effectiveness of instrumentation using Protaper Next (PN; Dentsply Sirona, Maillefer, Ballaigues, Switzerland) and Waveone Gold (WG; Dentsply Sirona, Maillefer, Ballaigues, Switzerland) systems on the area of untouched surface (US), accumulated hard tissue debris (AHTD), and the filling ability of two obturation techniques on the volume percentage (vol%) of voids within C-shaped root canals of mandibular first premolars. Methods A total of 64 mandibular first premolars with C-shaped canals were scanned, matched, and subsequently assigned to two shaping groups ( n  = 32): PN and WG. After instrumentation, the specimens were randomly allocated into two obturation subgroups ( n  = 16): continuous wave compaction (CWC) and single-cone (SC) techniques. The US% and AHTD% post- instrumentation, as well as the vol% of voids after obturation, were calculated from micro-computed tomography. Data were analyzed using comparisons for two groups (PN vs. WG) or two subgroups (CWC vs. SC) at α = 0.05. Results The untouched canal wall area was 18.75% and 22.69% in the PN and WG groups ( p  > 0.05), respectively. The apical third had higher US% than the coronal third ( p  < 0.05) in the two shaping groups. Instrumentation with WG left more debris (26.48%) than PN (8.36%) in the apical 1–3 mm ( p  < 0.05). In PN and WG group, the vol% of voids had no significant difference between the CWC and SC subgroups ( p  > 0.05). The apical region had significantly more voids than the coronal region of canal space in the two obturation subgroups regardless of which system was applied ( p  < 0.05). Conclusions Both PN and WG systems showed similar performance on US after instrumenting C-shaped canals of the mandibular first premolar. WG left significantly more AHTD compared with PN in the apical region. In PN or WG group, SC yielded similar obturation quality when compared with CWC. Both CWC and SC obturation techniques provided inferior filling quality in the apical region than that observed in the coronal region.

Background and Objectives: The access cavity design and instrumentation system could affect the remaining root canal obturation materials in root canal retreatment. This study aimed to evaluate the efficiency of two different multi-file systems in removing obturation materials with two different access cavities utilizing micro-CT scanning. Materials and Methods: Conservative access cavity (CAC) preparation was performed for 80 mandibular premolars. Then, root canal preparation was employed followed by obturation. The retreatment process began by dividing the samples into two separate groups: conservative (CAC) and traditional (TAC) access cavities. Subsequently, these groups were assigned to eight distinct subgroups (n = 10): Group 1; TAC and ProTaper retreatment system (PTR) with ProTaper Next (PTN); Group 2, TAC and PTR + ProTaper Ultimate (PTUL); Group 3, TAC and PTN; Group 4, TAC and PTUL; Group 5, CAC and PTR + PTN; Group 6, CAC and PTR + PTUL; Group 7, CAC and PTN; and Group 8, CAC and PTUL. The samples underwent micro-CT scans before and after the retreatment process, and the volume and percentages of remaining root canal filling material were calculated. Statistical analysis of the data was performed, and significance was determined at the 5% level. Results: The influence of the access cavity design (p = 0.500), the ProTaper system (p = 0.138), and the interaction of these variables (p = 0.513) was insignificant. However, group 3 (TAC and PTN) showed the highest percentage of remaining obturation materials at 29.53%, contrasting with group 6 (CAC and PTR + PTUL). Conclusions: Neither retreatment procedure succeeded in completely removing filling materials. Nevertheless, the impact of access cavity design, different multi-file systems, and their interaction on the remaining root canal obturation materials was deemed insignificant.

Objectives The aim of this study was to compare the efficacy of rotary and reciprocating techniques for removing filling material from root canals, using micro-computed tomography (micro-CT) imaging. Materials and methods The distal root canals of 42 human mandibular molars were instrumented with hand files up to size 40 according to a step-down technique and obturated with gutta-percha and an epoxy resin-based sealer using Tagger’s hybrid technique. Teeth were divided into six groups ( n  = 7) according to the instruments used for removal of filling material: group PTUR (Protaper Universal Retreatment), group W40 (WaveOne 40.08), group R40 (Reciproc 40.06), group R50 (Reciproc 50.05), group W25/W40 (WaveOne 25.08/40.08), and group R25/R40/R50 (Reciproc 25.08/40.06/50.05). Teeth were scanned with a micro-CT device before and after use of the instruments to calculate the percentage of remaining filling material. Data were compared using one-way ANOVA and Fisher’s LSD test at 5 % significance level. Results The mean percentage of remaining filling material was significantly lower when canals were retreated with the set of instruments R25/R40/R50 and single instruments W40 and R50 compared with the set of instruments W25/W40 ( P  < 0.05), which promoted material compaction in the apical region. Conclusion None of the retreatment techniques removed the root fillings completely. PTUR instruments performed equally effective regarding filling removal compared with W40, R40, R50, W25/W40, and R25/R40/R50. For WaveOne, the use of a single instrument (size 40, taper 0.08) was more effective in removing filling material, while for Reciproc showed similar cleaning ability using single instrument or combination of instruments. Clinical relevance The results of this in vitro study provide consistent information on filling material removal capacity of mechanized systems during retreatment at the different root canal thirds.

ObjectivesTo evaluate and compare the obturation quality of mineral trioxide aggregate (MTA) and Biodentine placed with hand condensation or indirect ultrasonic activation technique in teeth models simulating perforating internal root resorption (IRR) using micro-computed tomographic (micro-CT) imaging.Materials and methodsStandardized models with perforating IRR cavities were created using 40 extracted single-rooted human teeth and randomly divided into four groups (n = 10). The specimens were obturated with either MTA or Biodentine and the placement technique applied was either hand condensation or indirect ultrasonic activation. Micro-CT scans were performed for the volumetric analysis of voids and filling materials in the resorption cavities and apical portion of the specimens. Data were analyzed using one-way analysis of variance and paired t test.ResultsNo significant difference was observed between the groups in terms of the percentage volume of filling materials (p > 0.05). The apical portion of the specimens significantly presented less percentage volume of filling materials than the resorption cavities in each group (p < 0.05).ConclusionsNo placement technique produced void-free fillings in teeth with perforating IRR. There was no significant difference between the obturation quality of Biodentine and MTA. The obturation quality in the apical portion of the root canals was inferior than that in the resorption cavities.Clinical relevanceThe obturation of the apical region of teeth with perforating IRR is challenging irrespective of the material type and placement technique.

Background Post-obturation pain is frustrating to both patients and dentists. Its incidence may change with the use of contemporary endodontic techniques. This randomised clinical trial aims to compare the incidence of post-obturation pain at one and seven days after single-visit and multiple-visit non-surgical endodontic treatments. Methods Patients who required primary endodontic treatment in the two clinical trial centres in Hong Kong (HK) and in Beijing (PK) were recruited. Three HK dentists and three PK dentists performed endodontic treatments on 567 teeth using the same procedures and materials, either in a single visit or over multiple visits, using either core carrier or cold lateral condensation for obturation. Results The attrition rate was 5.1 %, and a total of 538 teeth were evaluated. Among these teeth, 232 (43 %) were operated in HK, 275 (51 %) were treated in a single visit, and 234 (43 %) were treated using core carrier obturation. Logistic regression analysis showed that teeth with apical periodontitis (OR = 0.35, 95 % CI = 0.21–0.57, p  < 0.01) and less pre-operative pain (OR = 1.10, 95 % CI = 1.03–1.18, p  < 0.01) had lower incidences of post-obturation pain after one day. The incidences of post-obturation pain after one day for single-visit and multiple-visit treatments were 24.7 % (68 of 275) and 33.5 % (88 of 263), respectively ( p  = 0.50). The incidences of post-obturation pain after seven days for single-visit and multiple-visit treatments were 4.0 % (11 of 275) and 5.3 % (14 of 263), respectively ( p  = 0.47). Conclusions There was no significant difference in the incidences of post-obturation pain after one day and seven days with single-visit or multiple-visit endodontic treatments. Trial registration ChiCTR-IOR-15005989