Immediate clinical and microbiological evaluation of the effectiveness of 0.5% versus 3% sodium hypochlorite in root canal treatment: A quasi-randomized controlled trial

Temperature Changes of NaOCl after Irrigation Using Passive Ultrasonic Irrigation, Easy Clean, and XP-Endo Finisher: A Randomized Crossover Clinical Trial

The aim of this study was to evaluate the temperature changes of sodium hypochlorite (NaOCl) after the use of different activation techniques: passive ultrasonic irrigation (PUI), XP-Endo Finisher (XP), and Easy Clean (EC).Thirty patients were selected for this randomized crossover study and each patient received root canal treatment in maxillary incisor. Each tooth was subjected to three activation techniques in a random order in the final irrigation of the treatment. All irrigation was performed using a 2.5% NaOCl solution, with the solution's temperature stabilized at 21°C (baseline) in the syringe. No agitation was used as a control before the use of the devices. After each activation technique, the intracanal temperature was measured using a K-type thermocouple. Statistical analyses were performed using Kruskal-Wallis and Dunn tests.Temperatures remain in the range of 21.0 to 21.2°C at baseline and were higher in the control (29.5-34.1°C), PUI (29.9-34.2°C), EC (29.8-35.6°C), and XP (29.9-34.7°C) groups. The temperature average of the baseline period was inferior to those observed in all groups; moreover, despite of temperature changes among the control and all experimental groups no difference between them were identified.The temperature increase caused by activation with PUI, EC, and XP was similar and did not exceed the levels observed when no agitation was performed.

Effects of Sequential Antimicrobial Phases on Root Canal Microbiome Dynamics in Two-Visit Treatment of Primary Apical Periodontitis: A Longitudinal Experimental Study

BACKGROUND

Effective management of primary apical periodontitis depends on understanding the dynamic interactions within the root canal microbiome. This study aimed to investigate the effect of sequential antimicrobial phases on the root canal microbiome during a two-visit treatment approach, with a focus on calcium hydroxide medication.

METHODS

Samples were collected from three teeth across four treatment phases: initial infection (S1), after chemomechanical preparation (S2), after intracanal medication (S3), and after a final flush (S4). DNA was extracted, and the V3-V4 regions of the 16S rRNA gene were sequenced using Illumina MiSeq. Sequencing data were analyzed with QIIME 2, and differentially abundant taxa were identified using linear discriminant analysis effect size (LEfSe).

RESULTS

While microbial community composition did not differ significantly between phases, the Firmicutes/Bacteroidetes ratio decreased after the antimicrobial stages. LEfSe analysis revealed higher abundances of Lactobacillales, Arthrobacter, and Veillonella in the untreated (CMP) group. Bifidobacterium longum was relatively more abundant in the intracanal medication (ICM) phase, and Dorea formicigenerans was more abundant in the final-flush (FF) phase.

CONCLUSIONS

Although calcium hydroxide treatment did not induce statistically significant changes in overall root canal microbial composition, trends such as a reduction in the Firmicutes/Bacteroidetes ratio and a relative increase in Bifidobacterium longum numbers suggest potential ecological shifts. The observed relative increase in Bifidobacterium longum numbers may represent a hypothesis-driven observation reflecting indirect ecological effects rather than direct pH modulation. While visual patterns (e.g., PCA clustering) were observed, they lacked statistical support. Further studies with larger sample sizes are needed to validate these observations and assess the potential role of beneficial bacteria in root canal treatments.

The use of 0.5% or 3% NaOCl for irrigation during root canal treatment results in similar clinical outcome: A 6-year follow-up of a quasi-randomized clinical trial

AIM

To evaluate the 6-year outcome of root canal treatment irrigated with 0.5% or 3% sodium hypochlorite (NaOCl).

METHODOLOGY

The baseline trial was designed as a quasi-randomized clinical trial. Patients referred for root canal treatment to an endodontic specialist clinic were recruited to the study (n = 298). The concentration of NaOCl was allocated quasi-randomized to 271 subjects (0.5% [n = 139], 3% [n = 132]). Bacterial sampling was performed immediately before root canal filling. Samples were cultured and evaluated as growth or no growth. Patients were invited to a clinical and radiological follow-up >5 years postoperatively. The clinical outcome measurements were tooth survival, cumulative incidence of endodontic retreatments, patients' assessment of pain, clinical findings and radiological signs of apical periodontitis (AP).

RESULTS

Tooth survival was 85.6% in the 0.5% NaOCl group and 81.1% in the 3% NaOCl group (p = .45). There was no record of retreatment in 94.4% in the 0.5% NaOCl group and in 92.2% in the 3% NaOCl group (p = .76). The percentage of asymptomatic cases were 87.8% in the 0.5% group and 85.3% in the 3% NaOCl group (p = .81). Absence of clinical signs of AP was seen in 86.6% in the 0.5% NaOCl group and in 83.6% in the 3% NaOCl group (p = .80). Absence of radiological signs of AP was seen in 74.0% in the 0.5% NaOCl group and 64.1% in the 3% NaOCl group (p = .20). Subjects with positive culture before root filling reported subjective pain with a significantly higher frequency as compared to negative-culture subjects (p = .014).

CONCLUSIONS

The use of 0.5% or 3% NaOCl for irrigation during root canal treatment resulted in similar clinical outcomes 5-7 years postoperatively. Persisting bacteria immediately before root filling may predict future episodes of subjective pain.

Patient-related predictors of post-operative pain following root canal treatment: A structural model analysis

AIM

The pathways to post-operative pain are complex and encompass factors that extend beyond the treatment protocol employed. This study aimed to identify patient-related predictors of post-operative pain following root canal treatment.

METHODOLOGY

A total of 154 patients received a single-visit root canal treatment for asymptomatic necrotic mandibular molars. Before treatment, dental anxiety, dental fear and sense of coherence (SOC) were measured as predictors for each patient using validated questionnaires. Other measured predictors included gender, age, previous negative experiences at the dental offices and prior root canal treatment. Post-operative pain was assessed using the Numeric Rating Scale at multiple time-points over 30 days. Structural equation analysis was employed to evaluate the direct and indirect effects of patient-related predictors on a theoretical model of post-operative pain. The irrigant solution was also included in the model, as it was the only aspect that varied in the treatment protocol (sodium hypochlorite 2.5% and 8.25%).

RESULTS

Dental anxiety (coefficient 0.028; p < .01), dental fear (coefficient 0.007; p = .02) and irrigant solution (coefficient 0.004; p = .03) exerted a direct effect on post-operative pain. SOC exerted an indirect effect on post-operative (coefficient 0.006; p = .01) through dental anxiety and dental fear. Moreover, previous negative experiences (coefficient 0.048; p = .04) exerted an indirect effect on post-operative pain through dental anxiety.

CONCLUSIONS

Dental anxiety, dental fear, previous negative experiences and SOC are patient-related predictors of post-operative pain following root canal treatment. These factors should be taken into consideration in clinical practice, as patients with these characteristics may be at an increased risk of experiencing post-operative pain.

Effectiveness of supplementary antimicrobial procedures in disinfecting lateral canals as evaluated by a novel ex vivo analytical approach

This ex vivo study devised an analytical ex vivo method for infection/disinfection of simulated lateral canals located in the middle and apical segments of the root. The antibacterial effects of supplementary approaches were tested in this model. Extracted mandibular premolars had their main root canals enlarged and then two lateral canals (100 μm in diameter) were created in the root, one in the apical and the other in the middle portion. Micro-computed tomography was used for specimen selection and to confirm the quality of the simulated ramifications. The specimens were contaminated with a mixed bacterial culture from subgingival bacterial biofilm added to pure Enterococcus faecalis strain ATCC 29212 grown overnight, using special strategies to facilitate culture medium penetration within the lateral canals. The following procedures were tested for disinfection: NaOCl/passive ultrasonic irrigation (PUI), NaOCl/XP-endo Finisher, ozonated water/continuous ultrasonic irrigation (CUI), and NaOCl/conventional irrigation with 30-G needles (control). Bacteriological samples were taken from the main canal before (S1) and after (S2) each supplementary protocol, and also from each lateral canal after treatment (S3). DNA extracted from the samples was subjected to quantitative real-time polymerase chain reaction. All S1 main canal samples were positive for bacterial presence. Bacterial counts in the main root canal substantially decreased by 99.2% after PUI, 99.1% after ozone/CUI, 99% after XP-endo Finisher, and 96% in the control group (P < 0.01 for all groups). There were no significant differences between groups (P > 0.05). The same was observed when comparing the effects of the supplementary approaches in the apical and middle lateral canals (P > 0.05). Only a few lateral canals showed no detectable bacteria. The method proposed here proved effective for ex vivo infection/disinfection studies. All supplementary approaches induced a substantial bacterial reduction in the main canal, with no significant differences between them. However, in terms of lateral canal disinfection, none of the tested approaches showed significant effects when compared to the control group.

Sodium Hypochlorite Concentration and Postendodontic Pain - Unveiling the Optimal Balance: A Systematic Review and Meta-Analysis

INTRODUCTION

This study systematically reviewed literature regarding the effect of different concentrations of sodium hypochlorite (NaOCl) used during root canal treatment (RCT) on postendodontic pain (PEP) and rescue analgesia.

METHODS

Following registration with PROSPERO (CRD42023388916), a search was conducted using PubMed, Scopus, Web of Science, and Embase databases. Randomized controlled trials of patients receiving RCT which assessed PEP at different time intervals were included. Following data extraction and Cochrane risk of bias assessment 2, meta-analyses were performed to evaluate PEP during the first 48 hours along with rescue analgesic intake. The certainty of the evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach.

RESULTS

Five randomized controlled trials with 674 patients were included. One study exhibited a low risk of bias, while 4 raised some concerns. Patients treated with low concentrations of NaOCl (≤3%) were significantly less likely to report PEP at 24 hours (OR = 2.32; [95% CI, 1.63-3.31]; P < .05) and 48 hours (OR = 2.49; [95% CI, 1.73-3.59]; P < .05) as compared with high concentrations of NaOCl (≥5%). Furthermore, with low concentrations of NaOCl, significantly lesser moderate-severe PEP was reported at 24 hours (OR = 2.32; [95% CI, 1.47-3.62]; P < .05) and 48 hours (OR = 2.35; [95% CI, 1.32-4.16]; P < .05) and lesser analgesia was needed (OR = 2.43; [95% CI, 1.48-4.00]; P < .05).

CONCLUSIONS

While PEP can be influenced by several factors, low certainty evidence suggests that when NaOCl is used as an irrigant during RCT, PEP may be less likely with lower concentrations of NaOCl. Moderate certainty evidence indicates that lesser analgesia may be required with lower concentrations of NaOCl. These results should be cautiously interpreted.

New Insights Regarding the Use of Relevant Synthetic Compounds in Dentistry

Worldwide, synthetic compounds are used for both in-office and at-home dental care. They are a valuable resource for both prophylactic and curative treatments for various dental problems, such as tooth decay, periodontal diseases, and many more. They are typically preferred due to their broad range of actions and ability to produce targeted, rapid, and long-lasting effects. Using a 0.12% chlorhexidine mouthwash is capable of reducing the plaque index from 47.69% to 2.37% and the bleeding index from 32.93% to 6.28% after just 2 weeks. Mouthwash with 0.1% OCT is also highly effective, as it significantly lowered the median plaque index and salivary bacterial counts in 152 patients in 5 days compared to a control group (p < 0.0001), while also reducing the gingival index (p < 0.001). When povidone-iodine was used as an irrigant during the surgical removal of mandibular third molars in 105 patients, it resulted in notably lower pain scores after 2 days compared to a control group (4.57 ± 0.60 vs. 5.71 ± 0.45). Sodium hypochlorite is excellent for root canal disinfection, as irrigating with 1% NaOCl completely eliminated the bacteria from canals in 65% patients. A 0.05% CPC mouthwash proved effective for perioperative patient care, significantly decreasing gingival bleeding (p < 0.001) and suppressing Streptococcus levels even one week post-surgery. Lastly, a 6% H2O2 paint-on varnish and 6% H2O2 tray formulations successfully bleached the teeth of 40 patients, maintaining a noticeably whiter appearance up to the 6-month follow-up, with significant color differences from the baseline (p < 0.005). Synthetic compounds have a large research base, which also provides a greater awareness of their mechanism of action and potential adverse effects. For a better understanding of how they work, several methods and assays are performed. These are protocolary techniques through which a compound's efficacy and toxicity are established.

Postoperative pain after endodontic treatment using 8.25% vs 2.5% sodium hypochlorite in necrotic mandibular molars with apical periodontitis: A randomized double-blind clinical trial

BACKGROUND

This study aimed to evaluate whether the use of 8.25% sodium hypochlorite (NaOCl), compared with the use of 2.5% NaOCl, leads to higher postoperative pain after endodontic treatment.

METHODS

A total of 154 patients were randomly assigned into 2 groups: 8.25% and 2.5% NaOCl. A single-visit endodontic treatment was performed using a standard protocol, varying only the NaOCl concentration. Postoperative pain was assessed using the numeric rating scale at multiple times over 30 days. Overall pain scores over time were explored via multilevel mixed-effects negative binomial regression. The need for pain medication was recorded and compared between groups via the Mann-Whitney U test.

RESULTS

The use of 8.25% NaOCl increased postoperative pain scores over time by 3.48 times compared with the use of 2.5% NaOCl (incident rate ratio [IRR], 3.48; 95% CI, 1.57 to 7.67). Furthermore, the 8.25% NaOCl group exhibited higher pain incidence than the 2.5% NaOCl group during the 12-hour through 3-day period, with scores at these times ranging from 2.21 (IRR, 2.21; 95% CI, 1.35 to 3.62) through 10.74 (IRR, 10.74; 95% CI, 3.74 to 30.87) higher. No difference was detected in the number of analgesic capsules administered between groups.

CONCLUSIONS

The use of 8.25% NaOCl resulted in higher postoperative pain than the use of 2.5% NaOCl, with pain scores increasing by 3.48 times when this solution was used. Furthermore, the 8.25% NaOCl group exhibited higher pain incidence than the 2.5% NaOCl group during the 12-hour through 3-day period.

PRACTICAL IMPLICATIONS

The use of 8.25% NaOCl during endodontic treatment can increase postoperative pain significantly. This clinical trial was registered at the Brazilian Registry of Clinical Trials database (RBR-6vq3hc4).

Microbiological assessment of success and failure in pulp revitalization: a randomized clinical trial using calcium hydroxide and chlorhexidine gluconate in traumatized immature necrotic teeth

Aim

To compare differences in the disinfection efficacy of calcium hydroxide (CH) and chlorhexidine gluconate (CHD) dressings in pulp revitalization (PR) of traumatized immature necrotic teeth; to investigate the microflora in successful/failed PR and whether bacterial persistence influences the outcomes of PR.

Methods

Microbiological assessment of the average bacterial load (CFU/sample) and bacterial diversity (taxa/sample) was performed on 41 teeth at three timepoints (S2-before, S3-after debridement and S5- after root canal dressing).

Results

The primary microflora was more diverse in successful cases than in failed. Decreases in CFU/sample and taxa/sample occurred S2 - S3, though new increases occurred at S5 in the CHD subgroup (successful and failed) and CFU/sample in the CH subgroup (failed). At S5, the successful cases showed more bacterial decreases. No specific species was associated with the outcomes with no statistical differences between the disinfection efficacy.

Conclusions

There were no statistical differences in CH and CHD efficacy. At S5, microflora persisted in both successful and failed outcomes, but the abundance and diversity increased significantly only in the failed cases. The successful outcomes presented higher diversity and higher decreases of the primary microflora at S5 than the failed outcomes. The abundance and diversity increased significantly at S5 only in failed cases.

Global survey of endodontic practice and adoption of newer technologies

AIM

To investigate current endodontic practices, adoption of technologies and continuing education attendance within specialist endodontic practice globally and to identify geographic trends.

METHODOLOGY

A web-based survey of endodontic association members in Australia, Britain, Canada, Italy, New Zealand and the USA on routine treatment preferences, armamentarium and education attendance was conducted. Chi-squared, independent sample t-tests, Cochran's Q test and McNemar's test were performed.

RESULTS

The survey was completed by 543 endodontists or endodontic post-graduate students. Almost all respondents used the dental operating microscope (DOM, 91.3%), engine-driven nickel-titanium instruments (NiTi, 97.6%), electronic apex locators (EAL, 93.0%), cone-beam computed tomography (CBCT, 91.2%) and calcium silicate-based materials (CSBMs, 93.7%). Dental dam was always used by 99.1%. Over half used irrigation adjuncts (81.8%), warm vertical compaction (74.6%) and heat-treated NiTi (60.2%). Geographic comparison between AP (Asia-Pacific, n = 78), AM (Americas, n = 402) and EM (Europe and Middle East, n = 63) was performed. AM and EM preferred single-visit treatment more (p < .001) and used higher sodium hypochlorite concentrations than AP. AM had more access to CBCT in the workplace (86.6%) than AP (65.4%, p < .001) and used CBCT for routine preoperative assessment (39.6%) more than EM (7.3%, p < .001). Almost all of EM used irrigation adjuncts (95.2%), more than AM (78.1%, p = .001). AP used steroid/antibiotic medicaments most (p < .001) and had the highest attendance at continuing education programmes.

CONCLUSION

Several endodontic-specific armamentaria have reached almost complete adoption within global specialist endodontic practice, whilst the continued uptake of newer technologies should be followed over time. Some practising philosophies varied significantly across different geographic regions.

Prevalence of postoperative pain after endodontic treatment using low and high concentrations of sodium hypochlorite: a systematic review and meta-analysis

OBJECTIVES

To determine the prevalence of postoperative pain after endodontic treatment using low (LC) and high (HC) concentrations of sodium hypochlorite (NaOCl).

MATERIALS AND METHODS

Six databases and the grey literature were searched to identify randomized clinical trials that evaluated postoperative pain after endodontic treatment using NaOCl. NaOCl concentrations were dichotomized into 'LC' (0.5% to 3%) and 'HC' (≥ 5%) and a proportion meta-analysis was applied to determine the postoperative pain prevalence: overall and according to pain intensity and postoperative time. The prevalence of patients using pain control medication was also determined. A significance level of 5% and a random effect model were applied for data analysis. Between-study heterogeneity was assessed by I2 index. Risk of bias (RoB) was assessed using the Cochrane Risk-of-Bias 2.0 tool. The certainty of evidence was assessed using the GRADE approach.

RESULTS

Ten studies were included in the review and eight in the meta-analysis. The overall prevalence of postoperative pain was 45% in LC and 39% in HC. The prevalence of pain in LC and HC after 24 h was 25% and 40%, respectively. After 48 h, the prevalence decreased to 10% in LC and 25% in HC. 'Absent pain' was the most prevalent score. The prevalence of patients who used medication was 9% in LC and 15% in HC. Three studies were classified as 'high RoB', five as 'low RoB', and two as 'some concerns'. The certainty of evidence was very low.

CONCLUSIONS

The overall prevalence of postoperative pain after endodontic treatment using LC and HC of NaOCl was 45% and 39%, respectively.

CLINICAL RELEVANCE

Postoperative pain is common after endodontic treatment using NaOCl, but tends to decrease over time.

Factors that affect the outcomes of root canal treatment and retreatment-A reframing of the principles

This paper undertakes a broad and comprehensive synthesis of relevant clinical, biological, biomechanical, technical and healthcare services data to understand the factors affecting outcomes of periapical healing after root canal (re)treatment. The medical and dental evidence-based era (1980-present) is contextualized with the earlier evidence drive in endodontics (1911-1940) triggered by the focal infection era. The current evidence-based approach has a sharper focus on evidence quality and derivation of practice guidelines. Contrary views question whether guideline-driven, or expertise-development-driven endeavours would best serve outcome improvement in society. The endodontic discipline functions in a broad healthcare framework and sustains industrial, economic and trend pressures that may be deemed to influence outcomes. The nature of root canal treatment and the challenges in determining the factors that affect its outcomes is discussed. The factors potentially affecting periapical healing after root canal treatment are classified into pre-operative, intra-operative and postoperative groups. These categories subsume multiple elements with interactive influences, creating a complex picture, further confounded by some apparently surprising, counter-intuitive and contradictory findings. The technical versus biological conundrum in root canal treatment continues to cause cognitive dissonance. However, due reflection and cross-discipline-synthesis resolve the apparent data conflicts into a very simple, consistent and plausible picture of how root canal treatment works and the key factors that affect periapical healing. Root canal retreatment is considered mainly in the context of its differences from primary treatment as the majority of factors influencing outcomes are common to both. The exceptional difference is that retreatments have a proportionately reduced probability of healing by virtue of compromised apical root canal ramification access or modified host/infection interactions. Root canal (re)treatment outcomes are dominantly influenced by the nature of prior dynamic host/infection interaction (pre-operative patient factors) and how the direction of this dynamic is influenced by two factors: (1) the active efficacy of the operators' root canal treatment protocol to sustain a microbial ecological shift (intra-operative treatment factors) and dampen periapical inflammation; and (2) the passive ability of the functional tooth (and its restoration margin) to maintain its integrity to resist infection reversal (postoperative restorative factors).

Advances in the Role of Sodium Hypochlorite Irrigant in Chemical Preparation of Root Canal Treatment

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.

Influence of the root canal filling technique on the success rate of primary endodontic treatments: a systematic review

Objectives

This study aimed to investigate the influence of different obturation techniques compared to cold lateral compaction on the success rate of primary non-surgical endodontic treatments.

Materials and Methods

Systematic searches were performed for studies published up to May 17th, 2022 in MEDLINE/PubMed, Cochrane Library, Web of Science, Scopus, EMBASE, and Grey Literature Reports. Randomized clinical trials and nonrandomized (nonrandomized clinical trials, prospective or retrospective) studies that evaluated the success rate of primary non-surgical endodontic treatments obturated with the cold lateral compaction (control) and other obturation techniques were included. The revised Cochrane risk of bias tools for randomized trials (RoB 2) and nonrandomized studies of interventions (ROBINS-I) were used to evaluate the risk of bias. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool was used to evaluate the certainty of evidence.

Results

Eleven studies (4 randomized clinical trials (RCTs), 4 prospective, and 3 retrospectives) were included. Two RCTs were classified as having some concerns risk of bias and 2 as a low risk of bias. Two nonrandomized studies were classified as having a critical risk of bias and 5 as having a moderate risk of bias. The GRADE analysis demonstrated a very low to moderate certainty of evidence.

Conclusions

This systematic review generally evidenced no differences in the success rate of primary non-surgical endodontic treatments when the cold lateral compaction technique and other obturation techniques are performed. Further well-designed studies are still necessary.

Present status and future directions - irrigants and irrigation methods

Irrigation is considered the primary means of cleaning and disinfection of the root canal system. The purpose of this review was to set the framework for the obstacles that irrigation needs to overcome, to critically appraise currently used irrigants and irrigation methods, to highlight knowledge gaps and methodological limitations in the available studies and to provide directions for future developments. Organization of bacteria in biofilms located in anatomic intricacies of the root canal system and the difficulty to eliminate them is the main challenge for irrigants. Sodium hypochlorite remains the primary irrigant of choice, but it needs to be supplemented by a chelator. Delivery of the irrigants using a syringe and needle and activation by an ultrasonic file are the most popular irrigation methods. There is no evidence that any adjunct irrigation method, including ultrasonic activation, can improve the long‐term outcome of root canal treatment beyond what can be achieved by instrumentation and syringe irrigation. It is necessary to redefine the research priorities in this field and investigate in greater depth the penetration of the irrigants, their effect on the biofilm and the long‐term treatment outcome. New studies must also focus on clinically relevant comparisons, avoid methodological flaws and have sufficiently large sample sizes to reach reliable conclusions. Future multidisciplinary efforts combining the knowledge from basic sciences such as Chemistry, Microbiology and Fluid Dynamics may lead to more effective antimicrobials and improved activation methods to bring them closer to the residual biofilm in the root canal system.

The effect of solution and gel forms of sodium hypochlorite on postoperative pain: a randomized clinical trial

Objectives

The aim of this study is to evaluate the effect of using gel and solution forms of NaOCI during the chemomechanical preparation of the root canals on postoperative pain at different time intervals.

Methodology

114 patients with mandibular molar teeth and symptomatic irreversible pulpitis were included in the study. All patients were divided into two groups based on the irrigant used during root canal preparation (n=57): Group 1, 5.25% NaOCI, Group 2, 5.25% NaOCI gel. All groups were filled with gutta-percha and AH Plus root canal sealer using single-cone technique. VAS scale (1-10) was used for postoperative pain assessment. After endodontic treatment, all patients were asked to record their postoperative pain levels at the 6th, 24th, 48th, 72nd hours, and 1 week later. The data were analyzed using Chi-Squared, Independent Samples T, Cochran Q and Friedman tests.

Results

Statistically significant difference was not found between the distributions of pain levels at different times according to the groups (p>0.050). A statistically significant difference was observed between the distributions of pain levels measured at different times in the solution group (p<0.001). A statistically significant difference was found between the distributions of pain levels measured at different times in the gel group (p<0.001). In both groups, highest postoperative pain levels occurred in the first 6 hours. Pain levels of the gel group as 38,5% mild, 17.3% moderate, 5.8% severe and pain levels of the solution group were obtained as 46.2% mild, 26.9% moderate, 9.6% severe at the 6th hour.

Conclusions

The use of the gel form of NaOCI during the chemomechanical preparation of the root canals showed similar postoperative pain when compared to the solution form.

Can Probiotics Emerge as Effective Therapeutic Agents in Apical Periodontitis? A Review

Apical periodontitis (AP) is a biofilm-associated disease initiated by the invasion of dental pulp by microorganisms from the oral cavity. Eradication of intracanal microbial infection is an important goal of endodontic treatment, and this is typically accomplished by mechanical instrumentation and application of sodium hypochlorite and chlorhexidine. However, these agents are tissue-irritating at higher concentrations and cytotoxic. Certain probiotics have been found effective in controlling marginal periodontitis, as evidenced by reduction of pathogenic bacterial loads, gains in clinical attachment levels, and reduced bleeding on probing. In vitro studies have shown inhibitory activity of some probiotics against endodontic pathogens. Similarly, in vivo studies in rats have demonstrated a positive immuno-modulatory role of probiotics in AP, as manifested by decreased levels of proinflammatory markers and increased levels of anti-inflammatory markers. A role for probiotics in effecting a reduction of bone resorption has also been reported. This review provides an outline of current research into the probiotic management of AP, with a focus on understanding the mechanisms of their direct antagonistic activity against target pathogens and of their beneficial modulation of the immune system.

Postoperative Pain After the use of Sodium Hypochlorite gel and Solution Forms: A Randomized Clinical Study

OBJECTIVE

The present study aimed to compare the effect of sodium hypochlorite (NaOCl) gel and solution forms on postoperative pain level.

METHODS

Fifty-two patients were divided into two groups according to the root canal irrigation solution. In the NaOCl solution group, the root canals were irrigated with 2 mL of 5.25% NaOCl between each pecking motion. In the NaOCl gel group, 5.25% NaOCl gel was used according to the manufacturer's instructions. The root canal treatments were completed and the participants were given instructions to record postoperative pain levels on 24, 48, and 72 hours and 1 week after treatment using VAS.

RESULTS

Intergroup analyses revealed that the NaOCl gel group resulted in significantly less postoperative pain than the NaOCl solution group on day 1.

CONCLUSION

It can be concluded that using NaOCl gel during root canal preparation results in less postoperative on day 1 when compared with the NaOCl solution.

Quantitative Assessment of the Efficacy of Two Different Single-file Systems in Reducing the Bacterial load in Oval-Shaped Canals: A Clinical Study

INTRODUCTION

This randomized clinical study compared the in vivo antibacterial efficacy of Reciproc Blue (RB), XP-endo Shaper (XP-S), and XP-endo Shaper associated with XP-endo Finisher (XP-F) systems in infected oval-shaped root canals with primary apical periodontitis.

METHODS

In this study, 28 human teeth with a single root and a single canal were randomly assigned to 2 groups according to the instrumentation technique: group 1, RB (n = 14) and group 2, XP-endo (XP-S and XP-F, n = 14). The single-rooted teeth were prepared by reciprocating and rotary nickel-titanium instruments with 5.25% sodium hypochlorite irrigation. Samples were collected from the canal at the baseline (S1), after chemomechanical preparation (S2), and after XP-F instrumentation (S3). The DNA extracts were subjected to quantitative analysis for total bacterial counts by quantitative real-time polymerase chain reaction. The data were analyzed using the analysis of variance test, and the level of significance was set at 5%.

RESULTS

All samples tested positive for the presence of bacteria at baseline, and the bacterial counts substantially reduced after treatment procedures (P < .01). The results showed no statistical difference between RB and XP-S instrumentation with respect to the bacterial reduction (P > .05). A marked bacterial reduction was observed after the use of the XP-F instrument (P < .01).

CONCLUSIONS

The XP-S and RB systems sharply reduced the bacterial load in oval-shaped root canals with primary apical periodontitis. XP-F used as a supplementary instrument to chemomechanical preparation promoted a significantly higher bacterial reduction.