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This randomized clinical trial aims to evaluate cryotherapy as a therapeutic option for pain prevention after endodontic treatment with and without foraminal enlargement, in patients with asymptomatic apical periodontitis.120 teeth of patients with preoperative Visual Analogue Scale score indicating zero were treated. Specimens were randomly allocated into 4 groups: Control, Cryotherapy (ICT), Foraminal Enlargement (FE), and Cryotherapy and Foraminal Enlargement (ICT + FE). Working length was determined with an Electronic Apex Locator (EAL). Cryotherapy groups passed through a final irrigation protocol using 20 ml (2.5 ℃) of cold saline solution delivered at working length for 5 min. In FE groups a #40 K-file was used up to the 0.0 mark on the EAL display. Obturation was performed and postoperative pain was checked at 6, 12, 24, 48, and 72 h and 7 days after endodontic treatment.All experimental groups showed an increase in the level of postoperative pain, which started to decrease after 12 h. Foraminal enlargement caused a statistically significant increase in postoperativepain compared to ICT and control groups within the first 6 h (p < 0.05). Cryotherapy did not influence postoperative pain, regardless of whether or not foraminal enlargement was performed.

To evaluate the impact of cooling the anesthetic solution prior to administering intra-pulpal anesthesia on the severity of intraoperative pain during root canal treatment in mandibular molars with symptomatic irreversible pulpitis and symptomatic apical periodontitis. Forty patients with mandibular molars diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis received root canal treatment by a single operator following a standardized technique. Patients received an intra-pulpal injection of 2% lidocaine with 1:100,000 epinephrine and were randomly and equally assigned to two groups based on the temperature of the cartridge. The room-temperature group received a cartridge that was kept at 25–26 °C while for the cryoanesthesia group, the cartridge was cooled to a temperature of 4–5 °C. The HP-VAS scale was used to evaluate the patients’ preoperative, intraoperative pre-injection, and intraoperative post-injection pain scores. The success rate was calculated by the lack of additional anesthesia following the intra-pulpal injection. Pain scores were statistically analyzed at a significance level of 0.05. Both the cryoanesthesia and the room-temperature groups were effective in significantly reducing the severity of intraoperative pain, where p  < 0.001 for both groups. The cryoanesthesia group showed a 100% success rate compared to 80% for the room-temperature group without a statistically significant difference ( p  = 0.106). The difference in pain score reduction in both groups, however, was statistically significant ( p  < 0.001). Cryoanesthesia yielded more profound pulpal anesthesia compared to the room temperature intra-pulpal injection.

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 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 aimed to evaluate the preventive and therapeutic effects of semiconductor laser on postoperative pain in root canal treatment and to compare the clinical efficacy of different laser application methods. Methods A total of 202 patients requiring root canal treatment at our hospital's dental department from January to December 2024 were selected and randomly divided into experimental and Control groups using a random number table. The Control group received conventional root canal treatment (58 cases); the experimental group received 810 nm semiconductor laser-assisted treatment based on conventional root canal therapy and was further divided into three subgroups according to different laser application methods: laser-activated irrigation group (LAI group, 48 cases), low-level laser therapy group (LLLT group, 48 cases), and combined application group (Combined group, 48 cases). The LAI group used laser as a root canal irrigation activation system; the LLLT group applied laser irradiation to the buccal and palatal mucosa externally; the Combined group applied both methods simultaneously. All patients received root canal treatment completed in a single visit, and 197 patients completed the 14-day follow-up. Visual Analogue Scale (VAS) was used to assess the patients' pain levels at 1, 2, 3, 7, and 14 days after the procedure, and the use of analgesics was recorded. Results Within 14 days after treatment, there were statistically significant differences in the mean VAS scores among the four groups ( P  < 0.05). The Control group had the highest pain scores, while the Combined group had the lowest. On the first day after treatment, the VAS scores of all experimental subgroups were significantly lower than the Control group ( P  < 0.001), with the LLLT group showing the best immediate pain relief effect. On days 2–3 after treatment, there was no significant difference in pain scores between the LAI and LLLT groups, but both were better than the Control group ( P  < 0.001). On day 7 after treatment, the Combined group had the most long-lasting analgesic effect, showing a significant difference compared to the Control group. By day 14, the differences among groups were no longer statistically significant ( P  > 0.05). Regarding analgesic use, the experimental groups required significantly less medication than the Control group ( P  < 0.001), with the Combined group using the least (0.53 ± 0.74 tablets). Moreover, multivariate analysis found that the size of periapical lesions, preoperative pain level, and laser treatment protocol were the main factors affecting postoperative pain. Conclusion Semiconductor laser can effectively reduce postoperative pain after root canal treatment and improve patient comfort. The combined application of laser-activated irrigation and low-level laser therapy techniques is the optimal pain prevention and control protocol, which can continuously provide analgesic effects for 14 days after treatment. As an adjunctive treatment, semiconductor laser effectively reduces discomfort in root canal treatment by enhancing root canal disinfection and promoting inflammatory tissue repair. This study provides scientific evidence for the rational application of semiconductor laser in clinical root canal treatment, which is of great significance for improving the success rate and patient satisfaction of root canal treatment.

Objectives This randomized clinical trial aimed to evaluate the effect of calcium hydroxide-based, calcium silicate-based and epoxy resin-based root canal sealers on postoperative pain (PP) after a single session of non-surgical endodontic retreatment of the teeth with chronic apical periodontitis. Materials and methods Ninety-six participants who had teeth with previously root canal treatment, asymptomatic, a single root and single canal, chronic apical periodontitis, were included in the study and then were randomly allocated to one of three experimental groups. ( n  = 32 per group).An endodontic specialist performed same retreatment protocols in a single visit. Participants were asked to rate the intensity of PP on a visual analogue scale at 6, 12, 24, and 48 h, and 3, 4,5, 6, and 7 days, and to mark whether they had taken analgesic (400 mg Ibuprofen) during the same periods after retreatment. All statistical analyses were performed using a software program (IBM SPSS Statistics, Version 22), and the significance level was set at P  < 0.05. Results There was no significant difference between the groups in PP and analgesic intake at any of the time intervals evaluated( P  > 0.05).A strong positive correlation was observed at 48 h and 96 h when the correlation between PP and analgesic intake was evaluated regardless of the type of root canal sealer. PP level was associated with age, gender, Periapical Index (PAI) score, and jaw type.( P  < 0 0.05). Conclusions Epoxy resin, Calcium silicate, and calcium hydroxide–based root canal sealers resulted in statistically similar postoperative pain levels. Clinical significance Each of the epoxy resin, calcium silicate, and calcium hydroxide-based root canal filling materials could be used safely in patients when considering PP. Trial registration ClinicalTrial.gov, NCT06803277, record date: 2025-01-17, retrospectively registered.

This trial assessed post-operative pain and healing of apical periodontitis following endodontic therapy with a reciprocating system compared to a crown-down technique with hand files and lateral compaction filling. One-hundred and twenty nonvital anterior teeth with apical periodontitis were randomly treated using either a reciprocating single file followed by matching-taper single-cone filling or a hand file and lateral compaction filling. Postoperative pain was assessed during the 7 days after the treatment, using a visual analogue scale and a verbal rating scale. Apical healing was assessed using the periapical index score after a 12-month follow-up. The hypothesis tested was that both protocols were equivalent and present similar effectiveness in healing periapical lesions. Data were analyzed through two one-sided tests, t-tests, as well as Mann-Whitney and Chi-squared tests (α = 0.05). Logistic regression was used to investigate the association of clinical and demographic factors with the success of treatment. Regardless of the assessment time, no difference in incidence (38%-43% at first 24h), intensity of postoperative pain, and incidence of flare-up (≈ 3%) was observed between the two endodontic protocols. Both protocols resulted in a similar healing rate of apical periodontitis. After 12 months, the success rate ranged from 73% to 78% and the difference between the treatments fell within the pre-established equivalence margin (-0.1; -0.41 to 0.2). Endodontic treatment combining a reciprocating single file with matching-taper single cone showed similar clinical effectiveness to the treatment using hand-file instrumentation and the lateral compaction filling.

ObjectiveThe concept of minimally invasive endodontics recommends less-invasive vital pulp therapy (VPT) modalities over more aggressive traditional endodontic approaches in mature permanent teeth with carious pulp exposure, including irreversible pulpitis (IP) cases. Consequently, VPT needs to be compared with root canal therapy (RCT) in terms of treatment outcomes. This randomized clinical trial compares the results of full pulpotomy using two calcium-silicate cements, i.e., mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) cement, with RCT in mature permanent teeth.Materials and methodsA total of 157 carious pulp exposure cases in two academic centers with/without established IP were selected/included/randomly appointed to three study arms; (i) RCT (n = 51) as the reference treatment, (ii) pulpotomy with ProRoot MTA (PMTA; n = 55), and (iii) pulpotomy with CEM cement (PCEM; n = 51) as two alternative VPT treatments. Two-year clinical/radiographic results were the outcomes of interest. Data were statistically analyzed through the analysis of variance, chi-square, Fisher exact test, and Kruskal–Wallis.ResultsAt 2-year recall, 147 teeth were examined (6.4% dropout). All molars, except for one, were clinically functional/symptom-free, and there was no statistical difference between the three study arms (p = 0.653). The radiographic success rates in RCT, PMTA, and PCEM arms were 98%, 100%, and 97.9%, respectively, without statistically significant differences (p = 0.544).ConclusionIn the management of mature permanent teeth with/without established IP, all experimental groups exhibited equivalent/comparable results.Clinical relevanceSimple VPT using MTA/CEM can be suggested/recommended as a viable advantageous alternative to RCT for the management of carious pulp exposures with/without sign/symptoms of IP.

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.