Objectives This study aimed to compare the intensity of postoperative pain following the final rinse using cold saline compared with room temperature saline and occlusal reduction. Materials and Methods A prospective, parallel, double-blinded randomized controlled trial was conducted on 69 first mandibular molars diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis. Single-visit root canal treatment was performed; access cavity preparations and chemomechanical preparations were carried out using the ProTaper Gold rotary system under copious irrigation using 3% sodium hypochlorite and 17% EDTA. The patients were divided into three groups (n = 23): control group: room temperature saline (25°C) final rinse without occlusal reduction; cryotherapy group: cold saline (2.5–4°C) final rinse without occlusal reduction; and occlusal reduction group: room temperature saline with occlusal reduction. Pain scores were recorded using the visual analog scale preoperatively and postoperatively via telephone at 6, 24, 48, 72 hours, and 7 days intervals. Age data were analyzed using one-way analysis of variance followed by Tukey's post hoc test. Pain score data were analyzed using Kruskal–Wallis' test followed by Dunn's post hoc test for intergroup comparisons and Friedman's test followed by Nemenyi's post hoc test for intragroup comparisons. Correlations were analyzed using Spearman's rank-order correlation coefficient. The significance level was set at p < 0.05 within all tests. Results Cryotherapy reduced postoperative pain compared with the control group with a statistically significant difference at 24 hours only (p = 0.016). At other intervals, no statistically significant difference in pain score was measured between all three groups (p > 0.05). After 7 days, all patients recorded a zero pain score. Conclusion Cryotherapy was as effective as the occlusal reduction in reducing postoperative pain in cases of symptomatic irreversible pulpitis with symptomatic apical periodontitis, significantly more than the control group.

Objective: To compare and evaluate the effect of ProTaper Ultimate root canal instrumentation on postoperative pain level of mandibular first molars showing symptomatic irreversible pulpitis and symptomatic apical periodontitis. Methodology: Forty patients referred to root canal treatment of the mandibular first molar were randomly divided into two equal groups according to the rotary file system used in the chemomechanical preparation: ProTaper Ultimate ( n = 20) and ProTaper Gold ( n = 20). After evaluating the preoperative pain score using the visual analog scale, the root canal treatment was performed in a single visit using a standardized protocol by a single operator. Postoperatively, the pain scores were recorded at 24‐, 72‐h, and 7‐day intervals. Statistical analysis was performed at a significance of 0.05. Results: No significant difference was shown between the ProTaper Ultimate and the ProTaper Gold groups in the intensity of postoperative pain at all time intervals. The postoperative pain score was zero at 7 days postoperatively for both groups. Conclusion: The ProTaper Ultimate files’ effect on postoperative pain is equivalent to that of the ProTaper Gold files. Clinical Relevance: The ProTaper Ultimate files’ effect on postoperative pain is equivalent to that of the ProTaper Gold files. ProTaper Ultimate and ProTaper Gold rotary file systems can be equally and safely used in single‐visit root canal treatment. Trial Registration: ClinicalTrials.gov identifier: NCT05747183

Background: Pain control remains a cornerstone in endodontic practice, particularly in cases of symptomatic irreversible pulpitis where achieving profound anaesthesia is often challenging. As the inferior alveolar nerve block (IANB) frequently fails to provide profound pulpal anaesthesia, optimizing pain control in such cases requires evidence‐based modifications to anaesthetic techniques and the use of supplemental approaches. Aim: This narrative review aims to synthesize current evidence on clinical strategies for improving pain management in mandibular molars with symptomatic irreversible pulpitis, with particular emphasis on enhancing the efficacy of IANB and supplemental injection techniques. Methods: A narrative review methodology was employed to synthesize clinical trials and systematic reviews published between 1975 and 2025. Results: Evidence indicates that increasing the anaesthetic volume and applying supplemental techniques, including intraligamentary, intraosseous and intrapulpal injections, significantly enhances anaesthesia success. Adjunctive measures such as cryotherapy and temperature modification of anaesthetic solutions further improve pain control. The integration of these methods provides a predictable and multimodal approach to managing endodontic pain in challenging clinical scenarios. Conclusion: Effective pain management in mandibular molars with symptomatic irreversible pulpitis relies on a comprehensive strategy that combines optimized anaesthetic volume and supplemental techniques. Intrapulpal anaesthesia remains essential for achieving pulpal anaesthesia when all other techniques fail. Continued clinical research is essential to refine these approaches and establish standardized protocols for achieving reliable anaesthesia in endodontic practice.

Objective: In cases of failed root canal treatment, rotary NiTi files enhance retreatment efficiency by facilitating effective removal of root canal filling materials while minimising procedural errors and preserving canal anatomy. To compare the efficiency of ProTaper Ultimate (PTUL) and ProTaper Gold (PTG) in the retreatment of root canals previously obturated with AH Plus or TotalFill Bioceramic sealer. Methods: Sixty extracted single-rooted teeth were prepared using the Reciproc R40 and then divided into 4 groups (n=15) according to the sealer used; AH Plus or TotalFill Bioceramic, and the retreatment file system, PTUL or PTG. The retreatment time was recorded, and the percentage of the residual filling material was assessed using a stereomicroscope. Statistical analysis was performed at a significance level of P < .05. Results: A significant interaction was observed between sealer type and retreatment file system for both retreatment time and the percentage of remaining filling material (P < .05). Overall, retreatment of TotalFill Bioceramic was significantly faster than AH Plus. Within the AH Plus groups, the PTG system was significantly faster than PTUL, whereas no time difference was noted between files for the TotalFill groups. Regarding filling material removal, the PTUL was significantly more effective at removing TotalFill Bioceramic compared to PTG, which left the highest amount of residual filling material. Conversely, both file systems demonstrated statistically similar efficacy in removing the AH Plus sealer. Conclusion: The optimal retreatment file system is heavily sealer-dependent; PTUL maximises the removal of TotalFill Bioceramic, whereas PTG expedites the removal of AH Plus without compromising cleanliness.

Background/Objectives: Artificial intelligence (AI) research in endodontics has grown quickly, but the strength of the evidence differs between applications. This narrative review with structured evidence mapping examined diagnostic imaging, canal morphology, outcome prediction, large language models (LLMs), robotics and augmented reality, and operational uses such as case-difficulty assessment, triage and scheduling. Methods: Two anchor reviews were combined with a documented PubMed search to 30 September 2026, and studies were classified by design, sample, reference standard, validation, and evidence of clinical utility. Results: Periapical lesion detection has the largest evidence base: one meta-analysis reported pooled sensitivity of 0.925 and specificity of 0.852, although most included studies were at risk of bias and none was prospective. Fracture detection relies mainly on ex vivo data and is sensitive to image resolution. Outcome models showed modest to moderate discrimination in single-centre data. LLM studies reported 40% to 100% correct, appropriate, or concordant responses across different benchmarks and scoring rules, and outputs varied on repeated querying. Difficulty-assessment and scheduling tools have appeared since 2020 but have not been evaluated prospectively in clinical workflow. Conclusions: Technical performance has not yet been shown to translate into clinical benefit, and AI in endodontics should currently be used only as clinician-supervised decision support.