Background: Growth factors embedded in the extracellular matrix of the dentin play an important role in the migration, proliferation, and differentiation of dental pulp stem cells in regenerative endodontics. In regenerative endodontic treatments, the type of irrigation solution used is crucial for the release of growth factors (GFs) from the dentin matrix. This study evaluated the effectiveness of different irrigant activation techniques (IAT) using two different chelating agents, 17% ethylenediaminetetraacetic acid (EDTA) and 9% etidronic acid (HEDP), in terms of their GF release. Methods: Seventy-two mandibular premolar teeth were prepared to simulate an open apex. The root fragments were irrigated with 20 ml of 1.5% sodium hypochlorite and 20 ml of saline solution. Eight root fragments were randomly separated for the control group, and the remaining 64 fragments were randomly separated into eight groups based on two different chelating agents (17% EDTA and 9% HEDP) and four different IAT ((conventional needle irrigation (CNI), passive ultrasonic irrigation (PUI), sonic activation with EDDY, and XP-endo Finisher (XPF)). TGF-β1, VEGF-A, BMP-7 and IGF-1 release levels were determined using an ELISA, and statistical analysis was performed using the Kolmogorov–Smirnov test, ANOVA, and the Tukey test (p < .05). Results: Compared to the control group, the experimental groups showed significantly higher GF release when using EDTA or HEDP. Among the activation groups, the EDDY group triggered the highest GF release, and the CNI group triggered the lowest. Conclusions: IAT with EDTA and HEDP can increase GF release, with EDDY being the most effective IAT method. Using chelating agents with IAT may be beneficial in regenerative endodontic treatments.

This study aimed to evaluate the antibacterial efficacy of calcium hydroxide (Ca(OH)₂), Ca(OH)₂ + resveratrol (RV), Ca(OH)₂ + silver nanoparticles(AgNPs), and Ca(OH)₂ + salicylic acid (SA) against Enterococcus faecalis (E. faecalis) using culture methods and field emission scanning electron microscopy (FE-SEM). Fifty-four extracted single-rooted teeth were prepared with standardized internal resorption cavities and inoculated with E. faecalis (ATCC 29212). After 21 days of incubation, baseline bacterial counts were determined. The teeth were randomly assigned to five groups (n = 10) based on the applied medicament. After 14 days of incubation, bacterial counts were reassessed, and two samples from each group were analyzed using FE-SEM. Data were analyzed using one-way ANOVA and Duncan’s test (p < .05). All medicament groups significantly reduced bacterial counts (p < .001), with Ca(OH)₂ + RV, Ca(OH)₂ + AgNPs, and Ca(OH)₂ + SA demonstrating superior antibacterial activity compared to Ca(OH)₂ alone (p < .001). The saline group exhibited the highest bacterial counts (p < .001). Combining Ca(OH)₂ with RV, AgNPs, or SA significantly enhances antibacterial efficacy in internal root resorption cases. These combinations may serve as effective alternatives to Ca(OH)₂ alone in endodontic disinfection. Intracanal medicament application plays a vital role in eliminating microorganisms and enhancing the success of endodontic treatment, particularly in cases of internal root resorption. This study highlights the superior antibacterial efficacy of Ca(OH)₂ combined with RV, AgNPs, or SA against E. faecalis. These findings suggest that incorporating these adjuncts into intracanal medicaments may improve disinfection outcomes, offering potential clinical benefits in managing internal root resorption cases.

Kiraz G, et al. Restor Dent Endod. 2024 Feb;49:e10. https://doi.org/10.5395/rde.2024.49.e10

Root canal treatment, despite its high success rate, remains a challenging procedure due to anatomical complexities or procedural limitations, which may oc

Objectives: This randomized controlled clinical trial aimed to evaluate the effect of intracanal cryotherapy using cold saline (2.5 °C) as a final irrigant on postoperative pain and analgesic consumption following single-visit nonsurgical endodontic retreatment of asymptomatic mandibular premolars. Materials and methods: Sixty systemically healthy patients with asymptomatic apical periodontitis in previously treated single-rooted mandibular premolars were enrolled and randomly assigned to two groups ( n = 30 each). Both groups underwent standardized retreatment protocols, with the cryotherapy group receiving final irrigation with cold saline (2.5 °C) and the control group with room-temperature saline, both for 5 min. Postoperative pain was assessed using a 10-point Visual Analog Scale (VAS) at 6, 12, 24, 48, 72, and 168 h. Analgesic intake was also recorded. Statistical analysis was performed using the Chi-Square and Mann-Whitney tests with a significance level set at 0.05. Results: The cryotherapy group exhibited significantly lower pain scores at 6 h ( p = 0.014) and 12 h ( p = 0.028) postoperatively compared to the control group. No significant differences were observed at 24, 48, 72, or 168 h. Although fewer patients in the cryotherapy group reported analgesic use, this difference was not statistically significant ( p = 0.278). No adverse events were reported. Conclusions: Intracanal cryotherapy using cold saline effectively reduced short-term postoperative pain following endodontic retreatment but did not significantly influence long-term pain or analgesic intake. Clinical relevance: Intracanal cryotherapy offers a simple, low-cost adjunct that may effectively reduce early postoperative pain and improve patient comfort in single-visit retreatment.