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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 Post-obturation pain is frustrating to both patients and dentists. Its incidence may change with the use of contemporary endodontic techniques. This randomised clinical trial aims to compare the incidence of post-obturation pain at one and seven days after single-visit and multiple-visit non-surgical endodontic treatments. Methods Patients who required primary endodontic treatment in the two clinical trial centres in Hong Kong (HK) and in Beijing (PK) were recruited. Three HK dentists and three PK dentists performed endodontic treatments on 567 teeth using the same procedures and materials, either in a single visit or over multiple visits, using either core carrier or cold lateral condensation for obturation. Results The attrition rate was 5.1 %, and a total of 538 teeth were evaluated. Among these teeth, 232 (43 %) were operated in HK, 275 (51 %) were treated in a single visit, and 234 (43 %) were treated using core carrier obturation. Logistic regression analysis showed that teeth with apical periodontitis (OR = 0.35, 95 % CI = 0.21–0.57, p  < 0.01) and less pre-operative pain (OR = 1.10, 95 % CI = 1.03–1.18, p  < 0.01) had lower incidences of post-obturation pain after one day. The incidences of post-obturation pain after one day for single-visit and multiple-visit treatments were 24.7 % (68 of 275) and 33.5 % (88 of 263), respectively ( p  = 0.50). The incidences of post-obturation pain after seven days for single-visit and multiple-visit treatments were 4.0 % (11 of 275) and 5.3 % (14 of 263), respectively ( p  = 0.47). Conclusions There was no significant difference in the incidences of post-obturation pain after one day and seven days with single-visit or multiple-visit endodontic treatments. Trial registration ChiCTR-IOR-15005989

Background This study aims to investigate the effects of using EDTA, phytic acid (IP6), chitosan, and proanthocyanidin (PAs) as final irrigation solutions on the push-out bond strength (PBS) of root canal filling. Materials methods In the present study, 56 extracted human incisors were utilized. All teeth were decoronated at the cementoenamel junction. Following the root canal chemomechanical preparation, the teeth were randomly divided into 7 groups according to the final irrigation procedures: Group 1: Control, Group 2: EDTA, Group 3: IP6, Group 4: Chitosan, Group 5: EDTA + PAs, Group 6: IP6 + PAs, Group 7: Chitosan + PAs. The root canals were filled using the cold lateral condensation technique with gutta-percha and resin-based root canal sealer. Samples were obtained horizontally cut from the apical third of the teeth and subjected to push-out bond strength (PBS) using a universal testing machine. Data was statistically analyzed using one-way ANOVA and post hoc Tukey HSD test ( α =  0.05). Results The highest value was obtained in Group 6 (12.14 ± 0.47 MPa), and the lowest value in Group 1 (5.80 ± 0,44 MPa) ( P  < 0.05). Group 6 has shown a higher PBS value than Group 5 (11.72 ± 0.14 MPa) and Group 7 (11.94 ± 0.42 MPa) ( P  > 0.05). There were statistically significant differences between all other groups, except Groups 3 and 4 ( P  < 0.05). The failure type was mostly adhesive, and no cohesive failures were observed. Conclusion The use of EDTA, IP6, and chitosan for final irrigation has enhanced the bond strength values of resin-based root canal sealer to dentin. Furthermore, the use of PAs after EDTA, IP6, and chitosan increased the bond strength values more than when these solutions were used alone.

Background To evaluate the clinical efficacy and outcomes of C-Root SP bioceramic-based sealers combined with different obturation techniques in nonsurgical root canal treatment for older patients. Methods This prospective, single-center, single-blind, parallel, randomized clinical trial included 240 patients aged ≥ 60 years. Patients were randomly divided into four treatment groups. Group A: C-Root SP combined with single-cone (SC); Group B: C-Root SP combined with warm vertical compaction (WVC); Group C: C-Root SP combined with cold lateral condensation (CLC); Group D: iRoot SP combined with SC (Control). All teeth were subjected to root canal filling using the corresponding methods 7–10 days after root canal preparation and medication. The duration of obturation was recorded. Periapical radiographs were obtained immediately after obturation to determine the length of root canal filling, and postoperative pain on days 1, 2, and 7 was documented. The treatment outcomes based on clinical signs and symptoms as well as periapical index (PAI) were analyzed at 1 year postoperatively. Results Groups A and D exhibited significantly higher filling efficiency than groups B and C ( P  < 0.001). No significant differences were observed in the length of obturation between the groups ( P  > 0.05). Postoperative pain decreased over time in all groups, with group A showing significantly lower pain rates on day 1 than the other groups ( P  < 0.05). After 1 year, all groups exhibited considerable reductions in the PAI scores, with success rates ranging from 91.23 to 94.83%; however, no significant differences were observed between them ( P  > 0.05). Conclusions C-Root SP combined with different obturation techniques yielded similar outcomes to iRoot SP combined with the SC technique in terms of filling length, success rate, and changes in PAI scores. The SC technique demonstrated significant advantages in terms of clinical efficiency and may reduce early postoperative pain when combined with C-Root SP. Trial registration The study was retrospectively registered in chictr.org.cn with the identifier: ChiCTR2400092580 on 11/19/2024.

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 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.

Objectives This study aimed to explore whether using sonic irrigant activation during endodontic treatment favors periradicular repair in teeth with apical periodontitis. Materials & methods One clinician treated 140 posterior (either premolar or molar) asymptomatic teeth with periapical lesions: 70 were randomly assigned to the sonic activation with EndoActivator (EA) group, and 70 were treated by conventional needle irrigation (CNI). Both groups underwent chemomechanical root canal preparation using 35/04 diameter rotary files and 2.5% NaOCl as the irrigant. NaOCl was sonically activated in the EA group, and the final irrigation with NaOCl was performed using a 30-gauge side-perforated needle in the CNI group. All root canal obturations were performed with lateral compaction. All patients were followed up for 12 months. Success was determined based on both healed and healing cases. The chi-square or Fisher’s exact test was used to compare success rates and outcome-influencing factors between groups. Results The recall rate was 131 (94%). At 12 months, 50 teeth (77%) were considered healed, 12 teeth (18%) as healing, and three (5%) as failed in the EA group, while 43 teeth (65%) were considered healed, 17 (26%) as healing, and six (9%) as failed in the CNI group. Verbal Rating Scale scores were significantly lower in the EA group than in the CNI group on postoperative days 1 ( p  < 0.0001) and 2 ( p  = 0.0002). Postoperative Periapical Index scores were significantly lower in the EA group than in the CNI group ( p  = 0.0023). Postoperative lesion sizes were also significantly smaller in the EA group (0.7 [0.2–11.7] mm) than in the CNI group (1.7 [0.5–11.5] mm; p  = 0.0118). While the success rate was higher in the EA group (62 [95%]) than in the CNI group (60 [91%]), the difference was not significant ( p  = 0.492). Conclusions The periradicular repair of posterior teeth with apical periodontitis demonstrated the efficacy of EndoActivator on treatment outcomes and reduced postoperative pain. These results suggest the adjunctive use of sonic activation to enhance the decontamination of the root canal system during the chemomechanical stage. Clinical relevance This clinical trial is the first to evaluate the effects of sonic activation on postoperative healing. Sonic activation with the EndoActivator can reduce postoperative pain and accelerate the healing of the periapical tissues.

ObjectivesTo evaluate the efficacy of passive ultrasonic irrigation (PUI) and super short pulse (SSP) and shock wave–enhanced emission photoacoustic streaming (SWEEPS) modes of Er:YAG laser–activated irrigation (LAI) with two different laser tips, in removing filling remnants after conventional retreatment in severely curved root canals.Materials and methodsThe study sample consisted of 40 extracted molars with curved mesiobuccal root canals. The canals were instrumented with ProTaper Next and filled with an epoxy resin–based sealer and gutta-percha using continuous wave vertical compaction and warm injection back-filling. After retreatment with ProTaper Universal Retreatment system and sodium hypochlorite (NaOCl), all samples were randomly divided into four groups (n = 10) according to the final irrigation technique: PUI, LAI/SSP, SWEEPS/flat-tip, and SWEEPS/radial-tip, using 6 mL of 3% NaOCl for an activation time of 3 × 30 s. The samples were subjected to micro-CT scans after root canal filling, retreatment, and final irrigation. The filling material volume and percentage reduction were calculated.ResultsAll tested irrigation techniques were successful in the elimination of the filling remnants after the retreatment (p < 0.001). The LAI/SSP group showed a higher reduction rate than the SWEEPS/flat-tip group (p = 0.032). No significant differences were found between the other groups (p > 0.05).ConclusionAll tested techniques improved the removal of filling material during retreatment in curved canals. LAI/SSP showed slightly better results than other techniques.Clinical relevanceThe study highlights the need for additional activated irrigation after the retreatment of curved root canals. The choice between PUI and LAI is not decisive for success.

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.

Background This study aimed to evaluate the effect of different temporary filling (TF) materials and pre-endodontic build-up on upper premolar teeth fracture resistance (FR). Methods 90 premolar teeth were selected. Except for 5 randomly selected teeth in the negative control group (group 1, intact teeth), mesio-occluso-distal cavities were prepared for the remaining teeth. The canals were shaped with OneCurve (#25/0.6) files. Irrigation was performed with sodium hypochlorite and ethylenediaminetetraacetic acid. Then calcium hydroxide was placed into the canals. Five teeth were selected as the positive control group (group 2, Temporary filling material not applied). The remaining 80 teeth were then randomly divided into 4 groups. TF was performed with Cavit G in group 3 and Voco Clip F in group 5. In groups 4 and 6, cavities were built up with composite, and TF was performed with Cavit G in group 4 and Voco Clip F in group 6. A Universal testing machine was used for FR testing. A two-way ANOVA test was performed for statistical analysis. Results The FR of the group 1 was higher than the other groups ( p  < 0.05). The FR of groups 4 and 6 was significantly higher than groups 3 and 5 ( p  < 0.05). Group 2 has the lowest FR ( p  < 0.05). The most common type of fractures were restorable fractures. There is a significant difference between the experimental groups ( p  < 0.05). Conclusion During endodontic treatment, placing TF materials after pre-endodontic build-up until the permanent restoration is completed increases the FR of the teeth.