The aim of this study was to compare postoperative pain following total pulpotomy (TP) and root canal treatment (RCT) in mature molar teeth with irreversible pulpitis. To compare the traditional pulpitis classification system with the Wolters system in evaluating postoperative pain. Eighty mandibular molars with irreversible pulpitis were included and classified according to the Wolters (moderate/severe pulpitis). The teeth were randomly assigned to two groups (RCT or TP). RCT was performed following standardized protocols. TP was performed to the level of the canal orifices, and hemostasis was achieved with 2.5% sodium hypochlorite. A 3 mm layer of MTA was placed as the pulpotomy material. The teeth were restored with glass ionomer cement followed by composite. Pain scores were recorded preoperatively and, at 6, 12, 24, 48, and 72 h and 7 days after the interventions. The data were statistically analyzed using the Mann-Whitney U test, the Friedman test, the Wilcoxon signed-rank test, and the Spearman’s correlation test. The significance level was set at 0.05. Sixty-four patients were analyzed at the one-week follow-up and all were diagnosed as irreversible pulpitis according to the AAE; 22 teeth were classified as moderate and 42 teeth were classified as severe pulpitis according to Wolters. There was no significant difference between TP and RCT in pain scores in moderate pulpitis patients (p > 0.05). There was a significant difference between TP and RCT at 24 and 72 h of severe pulpitis; higher pain scores were observed in the RCT (p < 0.05). In patients with moderate pulpitis, the TP procedure allowed symptom relief more quickly than RCT. In patients with severe pulpitis, TP provided for significantly lower pain scores compared to RCT at both 24 and 72 h. The study was retrospectively registered with ClinicalTrials.gov (NCT05923619). Date of Registration: 06/16/23.

The aim of this study was to evaluate the efficacy of supplementary techniques, including conventional needle irrigation (CNI), EDDY (ED), EndoActivator (EA), passive ultrasonic irrigation (PUI), and XP-Endo Finisher R (XP-FR), in removing residual filling materials from oval-shaped root canals during non-surgical endodontic retreatment. Sixty human mandibular premolar teeth were initially prepared using an R25 instrument and filled with gutta-percha points and Bioserra sealer. The initial filling material removal was performed with PTUR D1 (30/0.09) and D2 (25/0.08) files, and the root canals were finally shaped with an R40 instrument. The samples were randomly divided into 5 groups (n = 12) according to the irrigation activation techniques. Residual filling materials in the apical, middle, and coronal thirds were examined using a scanning electron microscope. Statistical analyses were performed using Kruskal-Wallis tests, with a significance level set at p < 0.05. In the ED and XP-FR groups, residue scores decreased from apical to coronal (p < 0.05). ED, PUI, and XP-FR showed significantly lower residue scores in all root thirds compared to CNI (p < 0.05) and in the middle third compared to EA (p < 0.05). EA showed lower scores only in the coronal third compared to the CNI group (p < 0.05). ED, PUI, and XP-FR did not show statistically significant differences, all activation techniques demonstrated better efficacy than the EA and CNI.

Background: This study aimed to compare the effect of different obturation techniques with root canal sealers on the residual filling material after retreatment using SEM. Material and Method: Sixty (60) single rooted mandibular premolars were selected and instrumented with rotary files using the Mtwo system up to file size 30/.05 taper. The samples were randomly divided to two groups based on the type of sealer and three sub-groups (n=10) based on the obturating technique used. The root fillings were removed using the PTUR system files and the specimens were longitudinally sectioned while digital images were obtained from the root canals with SEM. The time required to reach working lenght were recorded. Results: There was no difference in terms of the smear score when comparing both sealer and obturation technique groups in the apical third. Smear scores were significantly affected by the type of sealer and obturation technique in the medium and coronal thirds of root canals (p<0.05). Higher smear scores were obtained with GFB than AH Plus (p<0.05). The time required to reach working length with GFB was longer than AH Plus (p<0.05). Conclusion: Residual filling material was observed in all samples, regardless of the root canal sealer or the obturation technique used. There was a significantly lower smear scores in the AH Plus groups as compared to the GFB.

This clinical study aims to compare postoperative pain after single-visit root canal treatment of teeth with asymptomatic apical periodontitis using epoxy-resin-based AH Plus and calcium silicate-based Endosequence BC sealers with or without sonic activation. This study included 72 individuals with one first or second mandibular premolar tooth with asymptomatic apical periodontitis. They were randomly divided into four groups according to the root canal sealer (AH Plus or Endosequence BC) and activation protocol (sonic activation or non-activation) (n = 18). The participants were ask to rate their postoperative pain intensity on a NRS scale as none, minimal, moderate, or severe after 24 h, 48 h, 72 h, and 7 days following treatment. Patients were also asked to record the number of prescribed analgesic medication tablets (400 mg of ibuprofen) taken. Statistical analysis were performed using the Mann-Whitney U test, the Friedman test, the Spearman’s correlation test, the Chi-square test. Significance level was established at 0.05. There was no statistically significant difference in postoperative pain scores or analgesic intake between AH Plus and Endosequence BC sealers regardless of the activation protocol (p > 0.05). There was no statistically significant difference in postoperative pain scores between the sonic activation and non-activation groups (p > 0.05). A weak positive correlation was detected between Endoactivator sonic activation and sealer extrusion (r = 0.36). AH Plus and EndoSequence BC root canal sealers showed similar results in terms of prevalance and intensity of postoperative pain. Sonic activation and non-activation groups had similar postoperative pain scores. The study was retrospectively registered with ClinicalTrials.gov (NCT06403293). Date of Registration: 07/05/24.

This study aimed to evaluate the effects of different irrigation solutions and activation systems on smear layer removal. Ninety mandibular canines were instrumented using T-Endo Must files (#40.04) and randomly assigned to nine groups (n = 10) according to the final irrigation protocol: Group 1a (17% EDTA, Needle), Group 1b (5% GA, Needle), Group 1c (10% GA, Needle), Group 2a (17% EDTA, EDDY), Group 2b (5% GA, EDDY), Group 2c (10% GA, EDDY), Group 3a (17% EDTA, XP-F), Group 3b (5% GA, XP-F), and Group 3c (10% GA, XP-F). Smear layer removal was evaluated using scanning electron microscopy. A three-way analysis of variance with Bonferroni correction was performed to assess the effects of the independent variables and their interactions, and Tukey’s post hoc test was used for pairwise comparisons. Statistical significance was set at p < 0.05. Root section, irrigation solution, and activation system each significantly affected smear scores (p < 0.0001). A significant two-way interaction was observed between root section and irrigation solution (p = 0.025). Smear scores increased from the coronal to the apical third of the root canal. Both 5% and 10% GA significantly reduced smear scores compared with 17% EDTA (p < 0.05), and activation using EDDY and XP-F resulted in significantly lower smear scores compared with needle irrigation (p < 0.05). Both 5% and 10% GA resulted in lower smear scores, while irrigation activation with EDDY and XP-F significantly enhanced smear layer removal.

This study aimed to evaluate the effects of access cavity design and activation procedures on the penetration depth and bond strength of calcium silicate-based sealers to dentin, while also distinguishing the influence of the root level as an anatomical reference point. Sixty-six mandibular molars were randomly divided into two groups based on the access cavity design (traditional (TEC) or conservative (CEC)). The distal root canals were prepared using Reciproc files (40.06). The fluorescent calcium tracer Fluo–3 was added to the calcium silicate- based sealer CeraSeal to evaluate sealer penetration into dentinal tubules in confocal laser scanning microscopy (CLSM).Each access cavity group was further divided into three subgroups according to the sealer activation technique (Non-activation (NA), EDDY, XP-Endo Finisher (XP-F)) (n = 11). Root slices of 2.0 mm thickness (± 0.1 mm) were obtained at 3–5 mm and 8–10 mm from the root apex for CLSM to evaluate the percentage of sealer penetration. The bond strength was assessed with an Instron machine. Statistical analysis was performed using three-way ANOVA with Bonferroni correction, with the significance level set at 0.05. There were no significant interaction effects among the independent variables (access cavity design, activation procedures and root level) (P > 0.05); however, each variable individually showed a significant main effect on both the percentage of sealer penetration and bond strength (P < 0.001). A significant main effect of access cavity design was observed, with TECs exhibiting significantly higher values than CECs in both outcomes (P < 0.001). Similarly, the root level significantly influenced results, with greater sealer penetration and bond strength at 9 mm compared to 4 mm (P < 0.001). The activation procedure also had a significant impact (P < 0.001). Post hoc comparisons using the Bonferroni correction revealed that both EDDY and XP-F significantly improved sealer penetration and bond strength compared to no activation (NA) (P < 0.001). However, no statistically significant difference was observed between EDDY and XP-F (P > 0.05). The TEC design, the use of EDDY and XP-Endo Finisher activation techniques and the examination of coronal root levels resulted in a greater percentage in sealer penetration and higher values of bond strength. Clinical Trial Number: Not applicable.