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Objective. Nd:YAP laser has several potentialities of clinical applications in endodontics. The aim of our study is to determine the safety range of irradiation parameters during endodontic application of Nd:YAP laser that can be used without damaging and overheating the periodontal tissue. Material and Methods. Twenty-seven caries-free single-rooted extracted human teeth were used. Crowns were sectioned to obtain 11 mm root canal length. Temperature increases at root surfaces were measured by a thermocouple during Nd:YAP laser irradiation of root canals at different energy densities. Canal irradiation was accomplished with a circular and retrograde movement from the apex until the cervical part of the canal during 10 seconds with an axial speed of 1 mm/s. Each irradiation was done in a canal irrigated continuously with 2.25% NaOCl solution. Results. Periodontal temperature increase depends on the value of energy density. Means and standard deviations of temperature increases at root surfaces were below 10°C (safe threshold level) when the average energy densities delivered per second were equal to or below 4981 J/cm2 and 9554 J/cm2, respectively, for irradiations using a fiber diameter of 320 μm and 200 μm. Conclusions. Within the limitations of this study and under specific irradiation conditions, Nd:YAP laser beam may be considered harmless for periodontal tissues during endodontic applications.

Advanced irrigation techniques, such as the XP-endo Finisher file and sonic EDDY system, have been introduced to overcome the limitations of conventional needle irrigation by enhancing irrigant penetration and disinfection. However, their influence on post-operative pain remains under investigation. This study aimed to evaluate the effect of these techniques on post-operative pain following single-visit root canal treatment. Thirty patients requiring endodontic treatment for asymptomatic vital maxillary central incisors or canines were enrolled. All procedures were performed in a single visit using the ProTaper Universal rotary system. Irrigation was carried out with 2.5% sodium hypochlorite (NaOCl). Participants were randomly assigned into three equal groups based on the final irrigation protocol: Group I – conventional needle irrigation (control), Group II – XP-endo Finisher file, and Group III – sonic EDDY activation. Post-operative pain was assessed using a Visual Analogue Scale (VAS) at 8, 24, and 48 h, and at 1 and 2 weeks. Data were statistically analyzed with significance set at P  ≤ 0.05. Pain scores significantly decreased overtime in all groups. While between-group differences were not statistically significant, within-group reductions were significant. Group II exhibited the lowest pain levels, followed by Group III, while Group I reported the highest. Additionally, female participants had significantly higher odds of reporting pain. The XP-endo Finisher and sonic EDDY systems resulted in better pain reduction over time than conventional needle irrigation, with XP-endo Finisher being most effective. Clinical relevance: Advanced irrigation systems may enhance patient comfort and compliance by reducing post-operative pain after endodontic therapy. Clinical trial registration: The study protocol was registered on https://beta.clinicaltrials.gov identifier: NCT05450003 on (08/07/2022).

Irrigation of root canal system is of great significance to the success of endodontic treatment, where sodium hypochlorite (NaOCl) is the most widely used irrigant in chemical preparation. NaOCl functions by eliminating bacterial biofilms and dissolving organic tissue, which may vary according to several factors such as the microbiology of root canal infection and the concentration of the irrigant. It has been proposed that the effectiveness of NaOCl could be enhanced via several methods, including heating the irrigant, applying in conjunction with certain reagents, or activating by agitation techniques. Despite its antibacterial and tissue-dissolving capacities, NaOCl should be used with caution to avoid detrimental effect due to its cytotoxicity and negative effect on dentin properties. In this narrative review, we discussed the factors that affect the properties of NaOCl, the methods to improve its efficacy, and the side effects that might occur in clinical practice.

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.

Key Points Highlights the importance of irrigation in endodontics. Provides an overview of solutions used in the irrigation of the root canal. Outlines old and new equipment for irrigation. Irrigation is a key part of successful root canal treatment. It has several important functions, which may vary according to the irrigant used: it reduces friction between the instrument and dentine, improves the cutting effectiveness of the files, dissolves tissue, cools the file and tooth, and furthermore, it has a washing effect and an antimicrobial/antibiofilm effect. Irrigation is also the only way to impact those areas of the root canal wall not touched by mechanical instrumentation. Sodium hypochlorite is the main irrigating solution used to dissolve organic matter and kill microbes effectively. High concentration sodium hypochlorite (NaOCl) has a better effect than 1 and 2% solutions. Ethylenediaminetetraacetic acid (EDTA) is needed as a final rinse to remove the smear layer. Sterile water or saline may be used between these two main irrigants, however, they must not be the only solutions used. The apical root canal imposes a special challenge to irrigation as the balance between safety and effectiveness is particularly important in this area. Different means of delivery are used for root canal irrigation, from traditional syringe-needle delivery to various machine-driven systems, including automatic pumps and sonic or ultrasonic energy.

The success of endodontic treatment relies on the cleaning, disinfection, and sealing of the root canal system. This study evaluated the effects of four different irrigation techniques on smear layer removal, dentinal tubule penetration, and interfacial adaptation of a bioceramic root canal sealer. Eighty-four sound single-rooted lower premolars were decoronated, prepared to medium size WaveOne Gold reciprocating files, and divided randomly into four groups: group I conventional needle irrigation, group II heat activation, group III Diode laser activation, and group IV XP-endo Finisher file activation. Half of the samples (n = 40) were used to assess smear layer removal, while the other forty-four teeth were used to measure the sealer's penetration and interfacial adaptation after obturation with Bio_C sealer and gutta-percha; the assessments were done using scanning electron microscopy (SEM) and confocal laser scanning microscope (CLSM). No statistically significant differences were found between irrigation activation groups related to smear layer removal assessment (p-value>0.05), while the XP-endo Finisher file activation group showed significantly the highest sealer penetration in the apical third, and the best adaptation in the middle third. Irrigation activation can enhance the penetration of the sealer and interfacial adaptation.

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.

Background Postoperative pain is a common occurrence following root canal treatment, with reported incidence ranging from 3% to 58%. Contributing factors include insufficient canal debridement, extrusion of debris, and limitations in irrigation. While mechanical instrumentation aids in reducing microbial load, effective irrigation is essential for cleaning anatomically complex areas. The XP-Endo Finisher (XPF) is an innovative instrument designed to enhance irrigation efficacy. This study aimed to compare postoperative pain outcomes following final irrigation with either the XP-Endo Finisher or conventional needle irrigation in patients diagnosed with symptomatic irreversible pulpitis. Methods A double-blind randomized controlled trial was conducted on 80 systemically healthy patients aged 18 years and above, presenting with symptomatic irreversible pulpitis and preoperative pain scores ≤ 3 on the Numerical Rating Scale (NRS-11). Participants were randomly assigned to two equal groups: final irrigation using either the XP-Endo Finisher or traditional needle irrigation. Patients with recent analgesic use, non-restorable teeth, or known NSAID allergies were excluded. Root canal therapy was completed in two visits. Postoperative pain levels were recorded at 6 h, 12 h, 24 h, and daily up to 7 days using the NRS-11. Statistical analysis involved descriptive statistics, normality checks, and non-parametric tests for group comparisons. Results At 6 h, the difference in pain scores between the groups was not statistically significant (XP-Endo Finisher: 2.40 ± 1.77; Needle: 1.73 ± 1.52; p  = 0.090). However, significantly lower pain was reported in the XP-Endo Finisher group at 12 h ( p  = 0.044) and on day 2 ( p  = 0.027). No significant differences were observed from day 3 to day 7. Analgesic intake was comparable across both groups ( p  > 0.05). Conclusions The XP-Endo Finisher resulted in reduced early postoperative pain compared to needle irrigation at specific time points, although both methods showed similar outcomes in long-term pain resolution and analgesic consumption. Improved irrigant activation may influence short-term postoperative comfort. Trial registration This trial was retrospectively registered with the Kasturba Hospital Institutional Ethics Committee (KH IEC) under registration number 860/2020, dated 19/03/2021. It was also registered in the Clinical Trials Registry - India (CTRI) under registration number CTRI/2021/04/032667, dated 08/04/2021.

Objectives The purpose of this study was to assess the efficacy of different final irrigation activation methods in removing debris and smear layer in the apical, middle, and coronal portion of straight root canals. Material and methods Straight root canals of 58 freshly extracted mandibular premolars were used. Root canals were prepared to size 40.06. Irrigation was performed using 3% sodium hypochlorite. Samples were divided into four equal groups ( n  = 12) according to the irrigation activation techniques: (A) manual irrigation (MI), (B) EndoActivator (EA) (Dentsply Maillefer, Ballaigues, Switzerland), (C) sonic activation EDDY (EDDY; VDW, Munich, Germany), and (D) passive ultrasonic irrigation (PUI). Ten teeth served as negative controls. Roots were split longitudinally, and the canal walls were subjected to scanning electron microscopy. The presence of debris and smear layer at coronal, middle, and apical levels were evaluated using a 5-point scoring system and statistically analyzed using Kruskal-Wallis and chi-square tests. Results Canal cleanliness decreased from coronal to apical ( P  = 0.035). Significantly more debris was removed with EA, EDDY, and PUI compared to MI ( P  < 0.001; total values), but no differences were observed in the different portions of the root canals ( P  > 0.05). Smear layer removal with PUI, EA, and EDDY was not significantly different ( P  > 0.05), but only EDDY and PUI were superior to MI ( P  < 0.01). Conclusion All activation methods created nearly debris-free canal walls and were superior compared to manual irrigation ( P  < 0.001). EDDY and PUI also showed significantly better smear layer scores compared to manual irrigation. Clinical relevance The sonic activation system EDDY performed equally as well as PUI, and both methods were significantly superior compared with manual irrigation in straight root canals with regard to debris and smear layer removal.

The objective of this study was to assess the impact of immediate and delayed post- space preparation on the push-out bond strength (PBS) of fiber posts by employing two root canal obturation techniques: continuous wave of condensation (CWC) and single-cone (SC) obturation. Forty-eight human maxillary premolar teeth were instrumented, and the samples were divided into four groups according to the obturation technique and the time of post-space preparation. SC and CWC underwent immediate post-space preparation; and CWC and SC underwent delayed post-space preparation. The smear layer and dentine tubules from the apical, middle, and cervical regions of the samples were observed via scanning electron microscopy (SEM) and the %VoidsVol of the medium 4-mm fiber posts of each group was calculated via micro-computed tomography (CT). Each post space of the root was subsequently cut into slices, resulting in three 1-mm slices at 3 different depths (apical to the cervical region) and subjected to a push-out test. The failure mode was assessed. The data were analysed via the Shapiro-Wilk test, one-way analysis of variance and Bonferroni correction tests. In terms of depth from the apical to the cervical region, SC following immediate post-space preparation exhibited greater bond strength than did CWC following delayed post-space preparation. SEM images revealed that the smear layer was completely visible. In the SC with immediate post-space preparation group, the smear layer could be partially removed from the apical, middle and cervical regions of the samples and the outlines of the dentine tubules were visible. The percentage volume of the voids of the medium 4-mm fiber posts of the four groups and the samples in the three directions were not significantly different. No significant differences were observed in the CWC or SC obturation technique regardless of the time of post-space preparation or in immediate or delayed post-space preparation with different obturation techniques. SC followed by immediate post-space preparation provided better bond strength of fiber posts to intraradicular dentine than did CWC followed by delayed post-space preparation.