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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.

Background To evaluate the clinical efficacy and outcomes of C-Root SP bioceramic-based sealers combined with different obturation techniques in nonsurgical root canal treatment for older patients. Methods This prospective, single-center, single-blind, parallel, randomized clinical trial included 240 patients aged ≥ 60 years. Patients were randomly divided into four treatment groups. Group A: C-Root SP combined with single-cone (SC); Group B: C-Root SP combined with warm vertical compaction (WVC); Group C: C-Root SP combined with cold lateral condensation (CLC); Group D: iRoot SP combined with SC (Control). All teeth were subjected to root canal filling using the corresponding methods 7–10 days after root canal preparation and medication. The duration of obturation was recorded. Periapical radiographs were obtained immediately after obturation to determine the length of root canal filling, and postoperative pain on days 1, 2, and 7 was documented. The treatment outcomes based on clinical signs and symptoms as well as periapical index (PAI) were analyzed at 1 year postoperatively. Results Groups A and D exhibited significantly higher filling efficiency than groups B and C ( P  < 0.001). No significant differences were observed in the length of obturation between the groups ( P  > 0.05). Postoperative pain decreased over time in all groups, with group A showing significantly lower pain rates on day 1 than the other groups ( P  < 0.05). After 1 year, all groups exhibited considerable reductions in the PAI scores, with success rates ranging from 91.23 to 94.83%; however, no significant differences were observed between them ( P  > 0.05). Conclusions C-Root SP combined with different obturation techniques yielded similar outcomes to iRoot SP combined with the SC technique in terms of filling length, success rate, and changes in PAI scores. The SC technique demonstrated significant advantages in terms of clinical efficiency and may reduce early postoperative pain when combined with C-Root SP. Trial registration The study was retrospectively registered in chictr.org.cn with the identifier: ChiCTR2400092580 on 11/19/2024.

ObjectivesTo evaluate the efficacy of passive ultrasonic irrigation (PUI) and super short pulse (SSP) and shock wave–enhanced emission photoacoustic streaming (SWEEPS) modes of Er:YAG laser–activated irrigation (LAI) with two different laser tips, in removing filling remnants after conventional retreatment in severely curved root canals.Materials and methodsThe study sample consisted of 40 extracted molars with curved mesiobuccal root canals. The canals were instrumented with ProTaper Next and filled with an epoxy resin–based sealer and gutta-percha using continuous wave vertical compaction and warm injection back-filling. After retreatment with ProTaper Universal Retreatment system and sodium hypochlorite (NaOCl), all samples were randomly divided into four groups (n = 10) according to the final irrigation technique: PUI, LAI/SSP, SWEEPS/flat-tip, and SWEEPS/radial-tip, using 6 mL of 3% NaOCl for an activation time of 3 × 30 s. The samples were subjected to micro-CT scans after root canal filling, retreatment, and final irrigation. The filling material volume and percentage reduction were calculated.ResultsAll tested irrigation techniques were successful in the elimination of the filling remnants after the retreatment (p < 0.001). The LAI/SSP group showed a higher reduction rate than the SWEEPS/flat-tip group (p = 0.032). No significant differences were found between the other groups (p > 0.05).ConclusionAll tested techniques improved the removal of filling material during retreatment in curved canals. LAI/SSP showed slightly better results than other techniques.Clinical relevanceThe study highlights the need for additional activated irrigation after the retreatment of curved root canals. The choice between PUI and LAI is not decisive for success.

Objectives This 2-part randomized parallel triple-blind clinical trial adopts a unique model assessing clinically-set hydraulic calcium silicate-based sealers (HCSBS) after different root canal dryness protocols and obturation techniques. Methods For the first phase of the study, 24 teeth scheduled for orthodontic extractions were allocated into four groups according to the canal dryness protocol and the obturation technique. G1 (CLC-AHP): cold lateral compaction (CLC) with AH Plus sealer, G2 (CLC-ES-SD): CLC with Endosequence (ES) after standard canal(s) dryness (SD); G3 (SC-ES-SD): matching single-cone (SC) with ES after SD; G4 (SC-ES-PD): as G3 but after partial canal(s) dryness (PD). Teeth were extracted after one month of clinical service and examined for intracanal voids by micro-CT (2D & 3D). For the 2nd phase, another 24 teeth were allocated into four groups according to the root canal dryness protocol and the HCSBS used (ES or CeraSeal (CeS)). Teeth were extracted after one month and sectioned vertically for energy dispersive X-ray (EDX)/scanning electron microscope (SEM) examination. One-way ANOVA with Games-Howell post-hoc test and Chi-square test with multiple z-tests were used for statistical analysis. Results SC-PD showed the highest percentage of voids ( p  < 0.05). MicroCT scans as well as EDX/SEM examination showed that PD resulted in significantly larger interfacial gaps ( p  < 0.001) with more hydration products at the sealer/dentin interface than SD. Conclusions Both tested dryness protocols allowed the hydration of HCSBS and the formation of hydration products, thus standard dryness is recommended to reduce the incidence of intracanal voids. Clinical relevance When using the single-cone obturation technique, intentional root canal moisture negatively affects the performance of HCSBS. Protocol Registration http://www.clinicaltrials.gov, ID: NCT05808062.

Background This study aims to investigate the effects of using EDTA, phytic acid (IP6), chitosan, and proanthocyanidin (PAs) as final irrigation solutions on the push-out bond strength (PBS) of root canal filling. Materials methods In the present study, 56 extracted human incisors were utilized. All teeth were decoronated at the cementoenamel junction. Following the root canal chemomechanical preparation, the teeth were randomly divided into 7 groups according to the final irrigation procedures: Group 1: Control, Group 2: EDTA, Group 3: IP6, Group 4: Chitosan, Group 5: EDTA + PAs, Group 6: IP6 + PAs, Group 7: Chitosan + PAs. The root canals were filled using the cold lateral condensation technique with gutta-percha and resin-based root canal sealer. Samples were obtained horizontally cut from the apical third of the teeth and subjected to push-out bond strength (PBS) using a universal testing machine. Data was statistically analyzed using one-way ANOVA and post hoc Tukey HSD test ( α =  0.05). Results The highest value was obtained in Group 6 (12.14 ± 0.47 MPa), and the lowest value in Group 1 (5.80 ± 0,44 MPa) ( P  < 0.05). Group 6 has shown a higher PBS value than Group 5 (11.72 ± 0.14 MPa) and Group 7 (11.94 ± 0.42 MPa) ( P  > 0.05). There were statistically significant differences between all other groups, except Groups 3 and 4 ( P  < 0.05). The failure type was mostly adhesive, and no cohesive failures were observed. Conclusion The use of EDTA, IP6, and chitosan for final irrigation has enhanced the bond strength values of resin-based root canal sealer to dentin. Furthermore, the use of PAs after EDTA, IP6, and chitosan increased the bond strength values more than when these solutions were used alone.

Background This randomized clinical trial aimed to evaluate the effect of intracanal cryotherapy with 2–4 °C normal saline irrigation on post-operative pain after single-visit non-surgical root canal retreatment. Methods Forty-six single-rooted, single-canal teeth requiring non-surgical root canal retreatment were randomly assigned to two groups ( n  = 23): a cryotherapy group and a control group. All the treatments were completed during a single visit. A combination of nickel-titanium and stainless-steel files was used for the removal of gutta-percha and root canal preparation, and irrigation was performed using 5.25% NaOCl and 17% EDTA. The cryotherapy group had a final irrigation temperature of 2–4 °C for 5 min before root canal obturation, whereas the control group received irrigation at room temperature. Post-operative pain levels were assessed via the Numerical Rating Scale at 6, 18, 24, 48, 72, and 168 h (up to 7 days). The number of analgesics consumed at the same intervals was also recorded. Statistical analysis was performed using the Chi-Square test, Mann-Whitney test, and Independent Samples test, with the significance level set at 0.05. Results There was a statistically significant difference in post-operative pain between the cryotherapy group and the control group at 6 h after treatment ( P  < 0.05). However, post-operative pain levels were not significantly different at 18, 24, 48, 72, or 168 h after treatment ( P  > 0.05). Additionally, there was no statistically significant difference between the groups in terms of analgesic intake ( P  > 0.05). Conclusion Intracanal cryotherapy can effectively reduce short-term post-operative pain, but it has no effect on long-term pain or the need for analgesics.

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

Background Postoperative pain has remained a challenge for clinicians. This randomized superiority trial compared the levels of postoperative pain following the use of gutta-percha (GP) and sealer or mineral trioxide aggregate (MTA) as root canal filling materials in teeth with asymptomatic apical periodontitis. Methods A total of 119 patients were initially evaluated in this two-arm, parallel-group, single-blind, superiority randomized trial. The inclusion criteria were participants aged 18–65 years with single-canal premolars diagnosed with asymptomatic apical periodontitis. The participants were finally divided into two groups using the permuted block randomization method. In the GP group (N = 46), the cleaned and shaped root canals were filled with gutta-percha and AH Plus sealer, while in the MTA group (N = 48), the cleaned and shaped root canals were filled with an MTA apical filling and a coronal gutta-percha and sealer. Patient pain level was measured 6, 12, 24, 48, and 72 h postoperatively using a 10-point visual analog scale (VAS). The data were analyzed by the chi-square, independent t, Friedman, and Mann-Whitney U tests. Results The mean of VAS scores decreased significantly over time in both groups (P < 0.001). The mean VAS scores were significantly lower in the MTA filling group than in the other group (P < 0.05). Female patients reported higher VAS scores at 6- and 12-hour periods in both groups (P < 0.05). Conclusion MTA as a root canal filling material might be a valuable option for clinicians due to its low postoperative pain. Trial registration The trial protocol was registered at the Registry of Clinical Trials (IRCT20191104045331N1).

Background Evaluating the effect of different obturation techniques on postoperative pain level and radiographic healing on non-surgical endodontic retreatment (NSER) applied in a single visit in teeth with a single root canal and apical periodontitis (AP). Materials and methods Sixty-three teeth from 50 systemically healthy patients (mean age 34.19 ± 9.75 years; 27 women, 23 men) were included in the study. Residual root canal filling materials were removed. All teeth were randomly divided into three groups according to the obturation technique: cold lateral compaction (CLC), continuous wave compaction (CWC), and thermoplasticized gutta-core (TGC). Pain status was evaluated using the Numerical Pain Rating Scale (NRS) in all cases. Periapical index (PAI) scores were recorded in preoperative and postoperative 6-month on the periapical radiographs. Data were analyzed as statistically (IBM, Armonk, NY, USA). The significance level was determined as p  < 0.05. Results It was found that more postoperative pain occurred in the 3rd-hour interval after CLC and CWC compared to the 7th-day interval ( p  < 0.05). There was no difference in postoperative pain between obturation techniques in all evaluated time intervals ( p  > 0.05). There was no difference in the PAI scores recorded at six months between obturation techniques for all periods ( p  > 0.05). Similar radiographic improvement was observed in all obturation techniques at 6-months ( p  > 0.05). Conclusion CLC, CWC, and TGC root canal obturation techniques were found to have similar efficacy after NSER in a single visit in teeth with AP at six months. Trial registration The research was retrospectively registered on the website www.clinicaltrials.gov with the registration number NCT06226740 on 26/01/2024.

Background and Objective: Despite a plethora of studies conducted to date, researchers continue to investigate the best sealer and obturation technique combinations. The aim of this study is to compare the apical seal provided by two bioceramic sealers (Endoseal and Endosequence) with that provided by a calcium hydroxide sealer (Sealapex), and to evaluate the effect of different obturation techniques (cold lateral condensation, continuous wave compaction and single cone) on the apical seal under a stereomicroscope. Materials and Methods: A total of 110 single-rooted mandibular premolar teeth were decoronated, cleaned and shaped using the Endosequence filing system to tip size 30/0.04 taper. Canals were irrigated with 5.25% NaOCl and 17% EDTA. The samples were randomly divided into 11 groups (9 experimental and 2 control groups) according to the designated sealer and technique. Samples were stored in an incubator for 7 days at 37 °C under 100% humidity. Samples were coated with nail varnish except for apical 2 mm and vertically placed in 0.2% rhodamine B dye solution for 48 h. Samples were split longitudinally and viewed under a stereomicroscope at 40× magnification. Results: Insignificant results were obtained between obturation techniques (p = 0.499) whereas statistically significant results were attained based on the type of endodontic sealer (p < 0.001). The overall lowest mean apical microleakage and best sealing ability was demonstrated by Sealapex (2.59 ± 1.20 mm) and amongst techniques by continuous wave compaction (3.90 ± 2.51 mm). Conclusions: Endosequence produced the best apical seal with the continuous wave compaction technique, whereas Endoseal did so with the bioceramic-coated single-cone technique. For the Sealapex sealer, the most effective apical seal was observed using cold lateral condensation. The quality and effectiveness of apical seal differed with the type of endodontic sealer and obturation technique used, and vice versa.