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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).

Effective sealing of root canal systems is paramount in achieving favorable and enduring prognosis of root canal treatments (RCTs). Root canal sealers play a pivotal role in sealing the canal system. To date, there is a scarcity of clinical research investigating the implications and long-term performance of bioceramic (BC) sealers. This study aims to compare the treatment outcome of resin-based (RB) and BC root canal sealers. Retrospective data comparing clinical outcomes of 248 endodontically treated teeth was performed utilizing dental records and radiographic assessments. Clinical outcome of the RCTs using both types of sealers were measured by percentages of success rates. Chi square statistical test was used to analyze data at 0.01 and level of significance via SPSS software. Success rate of RCTs was not influenced by patient’s age, gender, tooth type and number of visits. There were no significant differences in the success rate amongst treatment types, obturation techniques, quality of restoration and the sealer type. BC and RB sealers revealed comparable clinical and radiographic outcomes with high success rates. The choice between BC and RB sealers should be guided by case-specific factors, including tooth’s anatomical considerations, patient’s dental health status, obturation techniques and clinician’s skills.

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 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.

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.

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.

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 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.

Objective The aim of this study was to evaluate the efficacy of supplementary techniques (ultrasonic tip/XP-endo Finisher R) in removing remaining filling materials (gutta-percha/AHPlus/BCSealer) from oval-shaped root canals during non-surgical endodontic retreatment. Material and methods Twenty-eight distal roots of human mandibular molars with single and oval-shaped canals were initially shaped with a R40 instrument and filled with gutta-percha points and AH Plus ( n  = 14) or BC Sealer ( n  = 14) followed by an initial micro-CT scanning. Initial filling material removal was performed in all 28 samples with an R50 instrument, and all samples submitted to a second micro-CT. Supplementary techniques with ultrasonic tips or XP-endo Finisher R instruments were performed in each sealer group, and all samples submitted to a third micro-CT. The volume of remaining filling material was calculated for the entire canal as well as for the coronal, middle, and apical thirds. Statistical analyses were performed using T, ANOVA 3-way, and Tukey tests. Results Lower values of remnant filling material were found for BC Sealer (16.06 ± 14.34) compared to AH Plus (28.30 ± 10.54) ( P  < 0.001), and considering the supplementary technique, lower values of remnant filling material were found for the ultrasonic tip (18.95 ± 11.05) compared to XP-endo Finisher R (25.41 ± 15.81) ( P  = 0.025). Ultrasonic instruments significantly reduced the percentage of remaining filling material for both AH Plus ( P  = 0.04) and BC Sealer ( P  = 0.02) while XP-endo Finisher R was effective for AHPlus only ( P  = 0.04). The remaining filling material was observed in all samples regardless the filling material or the supplementary technique employed. Conclusions Supplementary techniques increased filling material removal; however, none of them was able to render root canals completely free from root fillings. Ultrasonic tips should be considered a good option for endodontic retreatment, especially for bioceramic cases. Clinical relevance Supplementary instrumentation techniques are effective tools to reduce the amount of filling materials during root canal retreatment.

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.