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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.

This study aimed to assess the apical extrusion of debris during instrumentation of primary canines using three endodontic file types. Forty-five extracted primary canines were randomly assigned to three instrumentation groups ( n  = 15): Hand K-files; and the motorized Kedo-S files and XP-endo Shaper files. The apically extruded debris produced during the procedure was collected and dried in pre-weighed Eppendorf tubes, and the mass of debris was calculated. The time required for the endodontic procedure was also recorded. Analysis of variance (ANOVA) and Tukey’s post hoc test were used with a significance level set at 5%. XP-endo Shaper and Kedo-S files extruded significantly less debris compared with hand K-files with means of 0.84 ± 0.31 and 1.20 ± 0.67 mg respectively, compared to 2.13 ± 0.31 mg ( p  < 0.0001). No significant difference was found between the two motorized files. Less time was required to complete the procedure with the XP-endo Shaper compared to the hand K-files ( p  < 0.0001) and Kedo-S files ( p  < 0.0001). Within the limitations of the present study, it may be concluded that motorized files extruded less debris and required less instrumentation time compared to traditional K-files, which could benefit paediatric patients with root canal treatment needs.

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 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).

Objectives The aim of this study is to evaluate the posttreatment pain after instrumentation of root canals with a single-file reciprocating (RECIPROC, VDW, Germany) or rotary (One Shape, MicroMega, France) file system. Materials and methods Six hundred forty patients were assessed for eligibility, and 624 patients were included in this study. The teeth were randomly allocated to one of the instrumentation protocols. The teeth underwent routine root canal treatment after which patients were discharged with a questionnaire to gather data about the incidence (yes/no), nature (mild, moderate, or severe), and duration of pain (days). The data were analyzed using statistical analyses (preoperative pain scores by Mann-Whitney U test, incidence and intensity of pain by chi-squared test, intake of analgesics, and duration of pain by Student’s t test) with P  = 0.05. Results Pain analysis was performed for 605 patients (311 males and 294 females) as 5 patients were excluded due to sealer extrusion and 14 were lost to follow-up. The mean age of the patients was 31 ± 2 years. There was significant difference in the incidence of postoperative pain ( P  < 0.001). There was significant difference in the number of patients who had mild ( P  = 0.001), moderate ( P  = 0.002), and severe ( P  = 0.001) pain between the two groups. Intensity of pain showed significant difference, with patients in the One Shape group (40.5 %) reporting more values of severe pain ( P  = 0.002); the percentage of patients who took analgesics was significantly higher in the One Shape group (40.5 %) than in the Reciproc group (19.3 %) ( P  = 0.002). There was no significant difference in the duration of postoperative pain between the two groups when the pain was mild ( P  = 0.301), but One shape showed significantly longer duration of moderate ( P  = 0.001) and severe pain ( P  = 0.002). Conclusions Reciproc showed significantly less intensity and duration of posttreatment pain compared to One Shape. Clinical relevance Reciprocation movement offers a more predictable and safer approach of root canal preparation, in addition to producing less postoperative pain. The need for patients to take analgesics may reduce following this approach.

Background Use of magnifying loupe may increase the efficiency of dental care. This clinical trial compared the time in performing non-surgical endodontic therapy with or without the use of a magnifying loupe. Methods Patients who required primary endodontic treatment in clinical trial centres at the University of Hong Kong (HKU) in Hong Kong and Peking University (PKU) in Beijing were invited to participate in this study. Two HKU dentists and 2 PKU dentists, forming 2 pairs of dentists with similar years of clinical experience, performed endodontic treatments according to the same procedures and used the same materials, either in single or multiple visits. They had no prior experience with the use of a magnifying loupe. One dentist from each pair was trained to use a magnifying loupe ( x 2.5). The treatment time was recorded. Results Eighty-four PKU patients with a mean age of 42.8 years and 98 HKU patients with a mean age of 46.0 years were recruited in this study. Ninety-six teeth were treated with a magnifying loupe and 86 teeth were treated without a magnifying loupe. The results showed that treatment time was not associated with age, gender, tooth vitality, or the presence of apical radiolucency or sinus tract. The results of ANCOVA revealed the treatment time was associated with the clinic (HKU or PKU), root canal system (single or multiple), presence of preoperative pain, treatment visit (single or multiple), the use of a magnifying loupe, and the experience of the operator. Conclusion In this study, the use of a magnifying loupe could significantly reduce the endodontic treatment time. Trial registration Clinical Trials ChiCTR-IOR-15005988 registered 15 February 2015.

Objectives The purpose of this prospective, randomized, double-blind study was to compare postoperative pain of root canal treatment in patients with asymptomatic mandibular molar teeth with necrotic pulp and periapical lesion using three different instrumentation techniques: hand, multi-file rotary (ProTaper Universal), and reciprocating single-file (Wave-One) instrumentation techniques. Materials and methods Ninety-six patients who fulfilled specific inclusion criteria were assigned to three groups according to the root canal instrumentation technique used: Hand (G1), ProTaper Universal (G2), and Wave-One (G3). One-visit root canal treatment was carried out, and the severity of the postoperative pain was assessed by the Heft-Parker visual analogue scale 6, 12, 18, 24, 48, and 72 h after treatment. Data were analyzed by Kruskal-Wallis, χ 2 , Cochrane Q , one-way ANOVA, and Spearman’s correlation analyses ( α  = 0.05). Results The patients in group 3 reported significantly lower postoperative pain levels at 6, 12, and 18 h compared with the patients in the two other groups ( P  < .05). In addition, the patients in group 2 reported significantly lower postoperative pain levels at 6 and 12 h compared with the patients in group 1 ( P  < .05). There were no significant differences in postoperative pain between the three groups at other time intervals ( P  > .05). The analgesic consumption was significantly higher in group 1 ( P  < .05), but no difference was seen between the two other groups ( P  > .05). Clinical relevance Postoperative pain was significantly lower in patients undergoing root canal instrumentation with the Wave-One file compared with the ProTaper Universal and hand files.

Purpose: The purpose of this study was to compare the antimicrobial efficacy of the EndoVac system and conventional needle irrigation to eliminate E faecalis in primary molar root canals. Study Design: 60 extracted human primary second molar roots were instrumented up to an apical size .04/35 and randomly divided into two groups; Group 1: conventional needle (n=30) and Group 2: EndoVac (n=30), and four subgroups (two experimental subgroups; (a) 2.5% sodium hypochlorite (NaOCl) + ethylenediaminetetraacetic acid (EDTA) (n=20), (b) ozonated water (OW) + EDTA (n=20), and control groups (c) 5.25% NaOCl (n=10) and (d) saline (n=10). All roots were sterilized and then inoculated with E.faecalis. Before and after final irrigation procedures, root canals were sampled and the grown colony forming units (CFUs) were counted. Data were analyzed by Kruskall-Wallis and Mann-Whitney U tests using a 0.05 significance level. Results: The EndoVac reduced more bacteria than the conventional needle did but it was not statistically significant (p>0.05). NaOCl alone or followed by EDTA totally eliminated bacteria. OW + EDTA showed higher reduction of bacteria but could not totally eliminate bacterias. Conclusions: In the context of bacterial elimination, the EndoVac was not significantly better than the conventional needle. Although, there were fewer CFU/mg when using EndoVac, there was not any statistically significant superiority to conventional needle irrigation. An OW+EDTA regimen showed antibacterial effect in the primary molar root canals but it was significantly less effective than NaOCl+EDTA.

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).