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In root canal treatment, post-operative endodontic pain is considered as a common post-operative complication. Knowledge about its causes helps the clinician in proper instrument and technique selection to decrease its incidence. Therefore, the aim of this randomized clinical trial was to compare the post-operative pain occurrence after single visit root canal preparation using ProTaper Universal rotary system or M-Pro rotary system. Eighty patients with symptomatic irreversible pulpitis in mandibular first molars were allocated into two groups. In group A ( n  = 40): root canal preparation was performed using ProTaper Universal system and in group B ( n  = 40): root canal preparation was performed using M-Pro rotary system. Pain level was assessed by the patient using the numerical rating scale (NRS) at 24 h and 7 days postoperatively. The patients were advised to take the prescribed analgesics in case of emergency need. Data and statistical analysis showed that there was significant decrease in pain in both groups after 24 h and after 7 days. Insignificant difference was found between ProTaper Universal group and M-Pro group after 24 h and after 7 days. Insignificant difference was found in analgesics intake between both groups after 24 h and after 7 days. Trial registration: The trial protocol was registered at https://ClinicalTrials.gov (NCT06777381), registered January 15, 2024.

Background Postoperative pain is a common complication following endodontic treatment, often caused by acute inflammatory responses in the periapical tissues. Several factors contribute to this, including inadequate instrumentation, apical extrusion of debris during canal preparation, and other aspects of the procedure. Advances in technology have led to the development of nickel-titanium (NiTi) instruments that have shown potential to reduce postoperative discomfort. The purpose of this study was to evaluate postoperative pain in patients undergoing endodontic treatment with different NiTi systems. Methods This randomized clinical trial will include 128 patients between the ages of 18 and 50 years with a diagnosis of pulp changes in molars without pain or radiographic lesions requiring endodontic treatment. Patients will be randomized to receive root canal preparation with the rotary ProTaper Ultimate rotary system or the Reciproc Blue reciprocating single-file system. The primary outcome will be the intensity of postoperative pain measured by a numerical rating scale (NRS-10 cm) in 24 h postoperatively. Secondary outcomes will include the intensity of postoperative pain measured by a visual analog scale (VAS-0–10 cm) at 6 and 12 h and spontaneous pain, occlusion sensitivity, and quality of life, assessed by the OHIP-14 questionnaire. Discussion Our null hypothesis is that there will be no significant difference in postoperative pain between the two systems. The results of this study will provide information on the incidence and intensity of postoperative pain after instrumentation of root canal instrumentation with different NiTi systems and may help improve patient outcomes and quality of life. Trial registration Brazilian Clinical Trials Registry (REBEC): RBR-10kbw6nx. Registered on April 6, 2024.

Objective This study investigated the associations among endodontic instruments, ultrasonic tips and various final irrigation protocols for removing intracanal and intratubular biofilms in long oval canals. Methodology One hundred mandibular premolars inoculated with Enterococcus faecalis were divided into two groups: the control group (CG: n  = 10), which received no treatment; and the test groups ( n  = 30), which included saline (SS), sodium hypochlorite (2.5% NaOCl) and chlorhexidine (2% CHX). The samples were prepared with Reciproc ® Blue 25/0.08, Flatsonic, Clearsonic and Reciproc Blue 40/0.06. Each test group was divided into three subgroups ( n  = 10): conventional irrigation (CI) with syringes and needles, passive ultrasonic irrigation (PUI) and continuous ultrasonic irrigation (CUI) with an Irrisonic tip. The root canals were examined using confocal laser scanning microscopy. Mann‒Whitney and Kruskal‒Wallis tests followed by Dunn post hoc tests ( p  < 0.05) were used for statistical analysis. Results NaOCl and CHX were effective for intracanal and intratubular decontamination. Saline showed significant decontamination in the intratubular areas when CUI was used. The CI method was the least effective for intracanal decontamination. Conclusion The use of Flatsonic and Clearsonic ultrasonic tips is promising for root canal disinfection. Clinical relevance The disinfection techniques in endodontic treatment focus on the removal of biofilms from long oval canals, which is crucial for effective cleaning during root canal procedures.

Objective To evaluate the performance in endodontic retreatment and pericervical dentin preservation using ProDesign Logic (PDL), Reciproc Blue (RB), and WaveOne Gold (WOG) NiTi systems in first (MB1) and second (MB2) mesiobuccal root canals of maxillary molars, using cone-beam computed tomography (CBCT) and micro-computed tomography (micro-CT). Materials and methods MB1 and MB2 canals were prepared, filled, and randomized into four groups ( n  = 8). MB1 were retreated using PDL up to file 40/0.05 or RB R40 (40/0.06), while MB2 were retreated using PDL up to file 35/0.05 or WOG (35/0.06). Micro-CT scans were performed before and after retreatment to assess the remaining filling material, canal transportation, and canal centralization. Dentin removal and remaining dentin were measured at four levels below the furcation through CBCT scans analyzed with the e-Vol DX software, with micro-CT serving as the reference standard. Results RB was more effective than PDL in removing MB1 filling material, while PDL outperformed WOG in the apical third of MB2 ( p  < 0.05). Overall, CBCT measurements for dentin removal were consistent with micro-CT in MB1 but occasionally underestimated in MB2 ( p  < 0.05). A significant reduction in MB2 danger zone dentin thickness below 0.5 mm was observed after retreatment ( p  < 0.05). Conclusions RB was more effective in retreating MB1, while PDL was more efficient in the apical third of MB2. A substantial decrease in dentin thickness in the MB2 danger zone was noted after retreatment, regardless of the NiTi system or imaging modality used. Overall, CBCT scans provided consistent assessments of dentin. Clinical relevance Selecting appropriate NiTi systems minimizes dentin removal in MB1 and MB2 danger zones, reducing the risk of perforation in the furcation area. CBCT reliably assesses dentin thickness, aiding clinical decisions and improving endodontic retreatment outcomes.

Background Precise knowledge of the apical construction, which determines the end of the area for canal preparation and filling, is essential for the success of root canal treatment and the management of postoperative pain. For this purpose, devices based on various methods that determine the working length (WL) are used. However, it is still controversial which method provides the most accurate measurements. Aim To investigate the compatibility of the electronic apex locator (EWL) and simultaneous working length determination (SWL) methods in single-root teeth in comparison with the radiographic working length determination (RWL) method and to determine which one produced more effective results in terms of postoperative pain. Materials & methods One hundred patients scheduled for root canal treatment (RCT) were randomly assigned to one of the three groups according to the working length measurement method (EWL, SWL or RWL). After WL determination with assigned method, root canals were prepared and then obturated. Age, gender, simplified oral hygiene index (OHI-S), oral and dental examinations and Visual Analogue Scale (VAS) results of all participants were recorded. The incidence and intensity of postoperative pain were rated on a Visual Analogue Scale (VAS) by patients 6, 12, 24, 48 h and 7 days after RCT. The number of analgesic tablets (400 mg Ibuprofen) taken by patients was also recorded. Data were analyzed using the chi-square, One- way ANOVA and Kruskal-Wallis tests. Bland-Altman and Passing-Bablock regression analysis were used as method comparison techniques. Results It was determined that the number of patients receiving analgesia and the total number of analgesia doses were higher in EWL and RWL groups compared to SWL group ( p  < 0.0001). When the WL values at which the treatment was applied were compared in the patient groups; WL values of EWL group were statistically lower than SWL group ( p  < 0.01). While there was no difference between the preoperative VAS scores of the groups ( p  = 0.7590), the postoperative 6th and 12th hour VAS scores of SWL group were lower than those of EWL and RWL groups ( p  = 0.005 and p  = 0.0002, respectively). Again, the VAS scores of SWL group at the 24th and 48th postoperative hours were lower than those of RWL group ( p  < 0.05). According to the Bland-Altman and Passing-Bablock regression analysis results, although there was no statistically significant difference between the EWL and SWL methods ( p  = 0.471), the bias value of -0.1190 was well below the acceptable total error (0.1648). Additionally, a strong relationship was found between EWL and SWL methods ( r  = 0.9698, r 2  = 0.9406, p  < 0.001). Therefore, statistically these two methods were considered compatible with each other. It was determined that there was a statistically significant bias (0.340, p  < 0.0001) between the RWL and SWL methods, exceeding the total error. Conclusions As a result, it was determined that the SWL method, which is used to determine working length for the success of endodontic treatment, can be used as an alternative to the EWL method thus producing more effective results in the management of postoperative pain. However, in addition to the method used, the technology of the device developed for this method should not be ignored. Clinical relevance Precise knowledge of the apical construction, which determines the end of the area for canal preparation and filling, is essential for the success of root canal treatment and the management of postoperative pain. For this purpose, devices based on various methods that determine the working length are used. However, it is still controversial which method provides the most accurate measurements. This study found that the simultaneous working length determination method can be used as an alternative to the electronic working length determination method and produces more effective results in the management of postoperative pain. Another important outcome of this study is that the Total Allowable Error (TEa) for the electronic apex locator method, which is accepted as the reference, has been calculated for the first time. Other methods have been evaluated according to this reference method. This is a first in literature.

Background This study used micro-computed tomography (µCT) to assess the post space preparation systems [Rebilda (VOCO), RelyX (3M)] and preparations of varying lengths to create root dentin cracks. Methods Forty extracted maxillary first premolars with two roots were randomly divided into four groups. Teeth were decoronated to a length of 18 mm. Following root canal treatment, first µCT scans were performed. Post spaces were prepared with Rebilda post drills at 1/2 of the working length (WL) in Group 1 and at 2/3 of the WL in Group 2, while post spaces were prepared with RelyX post drills at 1/2 of the WL in Group 3 and at 2/3 of the WL in Group 4. After post space preparation, second µCT scans were performed. Dentinal cracks were detected by comparing the first and second µCT scan images, which were classified as “newly formed cracks”, “advanced cracks” and “completed cracks”. The chi-square test was used to compare among the groups, with a p-value of < 0.05 considered statistically significant. Results No statistically significant differences were observed between the groups for completed and advanced cracks ( P  > 0.05). In terms of newly formed cracks, the Rebilda-2/3 group showed more cracks than the RelyX-1/2 group, and the RelyX-2/3 group had more cracks than the RelyX-1/2 group ( P  < 0.05). Conclusion Completed and advanced cracks were observed in all groups, while no newly formed cracks were detected in the RelyX-1/2 group. The type of post drill and the preparation length are crucial factors in preventing the development of root dentinal cracks. Preparing 1/2 of the canal length may be a safer preparation length, and the RelyX drill may pose less risk of inducing root dentinal cracks.

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 Ni-Ti instruments with varying design features may lead to different levels of postoperative pain, which is a significant clinical concern, particularly in previously asymptomatic teeth. Therefore, the purpose of this randomized clinical trial is to compare postoperative pain following instrumentation with TruNatomy versus ProTaper Next Ni-Ti systems in mandibular molars with asymptomatic apical periodontitis. Methods 90 healthy participants were randomly assigned to two groups: TruNatomy (TN) or ProTaper Next (PTN) instruments. After single-visit root canal treatments, participants were asked to rate their postoperative pain levels at 6, 12, 24, 48, and 72 h and seven days later, using the Numerical Rating Scale (NRS) through an online questionnaire. In cases of pain, 400 mg of ibuprofen was prescribed. Data from 80 participants were finally included in the analysis. Data were analyzed using the Mann-Whitney U, Friedman, and Fisher’s Chi-Square tests ( p  < 0.05). Results There was no statistically significant difference in postoperative pain intensity at 6, 12, 24, and 48 h and seven days between the groups ( p  > 0.05). At the 72-hour time point, TN group showed statistically higher postoperative pain intensity ( p  < 0.05). No statistically significant differences in the incidence of postoperative pain were observed at any of the time points ( p  > 0.05). Analgesic intake and flare-up incidence were not significantly different between the groups ( p  > 0.05). Conclusion Postoperative pain levels were not significantly influenced by the type of rotary Ni-Ti instrument. Both TN and PTN instruments led to low-level and similar postoperative pain intensity, minimal analgesic use, and a low incidence of flare-ups in teeth with asymptomatic apical periodontitis. Trial registration ClinicalTrials.gov ID NCT06545773, Registration Date 8 August 2024 (retrospectively registered).

ObjectivesThis study compared canal transportation and centering ratio produced after instrumentation with a single heat-treated reciprocating system, WaveOne Gold (WOG; Dentsply Sirona, Tulsa, OK, USA) and a single heat-treated rotary instrument, XP-endo Shaper (XPS; FKG, La Chaux-de-Fonds, Switzerland), using micro-computed tomographic (micro-CT) imaging, and evaluated the ability of double-digital radiography (DDR) to detect canal transportation.Materials and methodsMesial root canals of mandibular molars with severe curvature (25–70°) were randomly assigned to either WOG or XPS groups for preparation. Centering ratio was measured by micro-CT imaging, while canal transportation was measured by micro-CT and DDR methods at 3, 5, and 7 mm from the apex. Data were statistically compared between groups using the t test (α = 5%).ResultsThe micro-CT method showed that XPS’s shaping ability regarding the centering ability (P = 0.030) and canal transportation (P = 0.028) was significantly better than WOG only at the 7-mm level. The DDR technique detected no difference in canal transportation between groups at any level (P > 0.05); however, a significant difference between evaluation methods was detected at the 5-mm level in the WOG group (P = 0.023).ConclusionsMicro-CT technique revealed a significantly better centering ability and less canal transportation with XPS compared to WOG. The DDR technique was not capable of detecting the significant difference between the tested groups.Clinical relevanceRoot canal curvatures may lead to procedural errors during endodontic treatment. Thus, differences on the shaping ability of single heat-treated reciprocating and rotary systems should be known.

ObjectivesThis study aimed to compare WaveOne Gold with ProTaper and RaCe systems regarding remaining filling material, apical transportation (AT), and working time (WT) after (i) filling removal and (ii) shaping of curved canals.MethodsThirty mesiobuccal canals of maxillary molars were prepared and filled. After 30 days, they were randomly assigned into three groups (n = 10), according to the instruments used for filling removal and shaping, respectively: WOG—WaveOne Gold Primary and Medium; PTG—ProTaper Retreatment and ProTaper Next; RCG—D-RaCe and RaCe. Micro-CT analysis assessed the residual filling material and AT. WT was recorded. Data were statistically analyzed (α = .05).ResultsThere was no significant difference between groups in the amount of filling material at any evaluated moment (P > .05). All groups presented low AT values. The WT was similar in all groups in filling removal (P > .05), and in shaping step WOG was faster than PTG and RCG (P < .05).ConclusionsNeither system could completely remove the filling material. The instruments evaluated were safe and the reciprocating system was faster than the rotary systems in shaping the canals.Clinical relevanceThis study provided consistent information on filling material removal capacity of WaveOne Gold. Considering that all tested systems were safe, WaveOne Gold may be an alternative with cost-effectiveness and shorter learning curve for endodontic retreatment.