Postoperative pain intensity after using different instrumentation techniques: a randomized clinical study

Postoperative pain is a frequent complication associated with root canal treatment, especially during apical instrumentation of tooth with preexisting periradicular inflammation OBJECTIVES: The aim of this clinical study was to evaluate the influence of the instrumentation techniques on the incidence and intensity of postoperative pain in single-visit root canal treatment. MATERIAL AND METHODS: Ninety patients with single root/canal and non-vital pulps were included. The patients were assigned into 3 groups according to root canal instrumentation technique used; modified step-back, reciprocal, and rotational techniques. Root canal treatment was carried out in a single visit and the severity of postoperative pain was assessed via 4-point pain intensity scale. All the participants were called through the phone at 12, 24 and 48 h to obtain the pain scores. Data were analyzed through the Kruskal–Wallis test. RESULTS: There was significant difference between all groups (p<0.05). The modified step-back technique produced postoperative pain significantly lower than the rotational (p=0.018) and reciprocal (p=0.020) techniques. No difference was found between the reciprocal and rotational techniques (p=0.868). Postoperative pain in the first 12 h period (p=0.763) and in the 24 h period (p=0.147) was not significantly different between the groups. However, the difference in the 48 h period was statistically different between the groups (p=0.040). CONCLUSION: All instrumentation techniques caused postoperative pain. The modified step-back technique produced less pain compared to the rotational and reciprocal techniques

Is the bonding of self-adhesive cement sensitive to root region and curing mode?

Abstract Objectives To evaluate the influence of two curing techniques on the degree of conversion (DC) of resin cements and on bond strength (BS) of fiber posts in different regions of root dentin. Material and Methods Twenty single-rooted premolars were endodontically treated, and the post spaces were prepared. The roots were randomly divided into two groups (n=10), according to the activation mode of the resin cement RelyX&#8482; U200 (3M ESPE Saint Paul, MN, USA): conventional (continuous activation mode) and soft-start activation mode (Ramp). The posts (WhitePost DC/FGM) were cemented according to the manufacturer&#8217;s recommendations and, after one week, the roots were cross-sectioned into six discs each of 1-mm thickness, and the cervical, medium, and apical thirds of the root canals were identified. The DC was evaluated under micro-Raman spectroscopy and the BS was evaluated by the push-out test. The data were analyzed by two-way ANOVA and Tukey&#8217;s test (&#945;=0.05). Results Neither the activation mode nor the root regions affected the DC of the resin cement. Higher BS was achieved in the soft-start group (p=0.036); lower BS was observed in the apical third compared to the other root regions (p<0.001). Irrespective of the activation mode and root region, the mixed failure mode was the most prevalent. Conclusion The BS of fiber posts to root canals can be improved by soft-started polymerization. The DC was not affected by the curing mode

Comparative evaluation of push-out bond strength of Neo MTA Plus with Biodentine and white ProRoot MTA

Objective: The aim of this in vitro study was to evaluate the bond strength of a new calcium silicate cement, Neo MTA Plus (Avalon Biomed Inc. Bradenton, FL, U.S.A) by comparing ProRoot MTA and Biodentine. Material and Methods: Sixty dentin slices were instrumented to achieve a diameter of 1.3 mm. Group 1: white ProRoot MTA, group 2: Biodentine, group 3: Neo MTA Plus–G (powder mixed with gel), group 4: Neo MTA Plus–W (powder mixed with distilled water) were loaded into cavities. The push-out bond strength values were measured. Data were analyzed using Welch ANOVA with Bonferroni correction p = 0.05. Failure modes (adhesive, cohesive, and mixture) were analyzed. Results: The highest bond strength value was recorded in Neo MTA Plus mixed with gel (5.23 ± 1.78 MPa), whereas white ProRoot MTA (2.57 ± 0.66 MPa) had the lowest. Bond strength values of Neo MTA Plus mixed either with gel or with distilled water were statistically different from both white ProRoot MTA and Biodentine (2.61 ± 0.70 MPa) (p < 0.05). Adhesive failure was predominantly observed in all groups. Conclusion: Neo MTA Plus could be considered as alternatives to the ProRoot MTA and Biodentine due to its better performance in bonding to root dentin. © 2016 Informa UK Limited, trading as Taylor & Francis Group

Effect of Calcium Hydroxide Dressing on the Dentinal Tubule Penetration of 2 Different Root Canal Sealers: A Confocal Laser Scanning Microscopic Study

Introduction: The purpose of this study was to evaluate the effect of calcium hydroxide (Ca[OH]2) dressing on the dentinal tubule penetration of epoxy resin–based sealer (AH 26; Dentsply Maillefer, Ballaigues, Switzerland) and tricalcium silicate–based sealer (BioRoot RCS; Septodont, Saint Maurdes Fosses, France). Methods: Fifty-two single-rooted mandibular premolars were used. Four samples were assigned as the positive control. Twenty-four samples received Ca(OH)2 labeled with rhodamine B, whereas the rest did not. Ca(OH)2 was removed with passive ultrasonic activation and copious irrigation 2 weeks later. Samples were further subdivided into 2 groups, and root canal fillings were performed with a single ProTaper F4 gutta-percha cone (Dentsply Maillefer) combined with 1 of the tested sealers labeled with fluorescein green. After 2 weeks, samples were transversely sectioned at the apical, middle, and coronal levels. The penetration depth and percentage were evaluated via imaging software. Statistical analysis was performed using Kruskal-Wallis, Siegel Castellan post hoc, and Mann-Whitney U tests at P =.05. Results: The mean dentinal tubule penetration depth and percentage values were lowest in the apical third for both sealers. BioRoot RCS showed higher penetrability in all thirds compared with AH 26 (P &lt;.05) despite Ca(OH)2 dressing remnants (P &lt;.05). Ca(OH)2 placement resulted in a shorter dentinal tubule penetration depth with BioRoot RCS statistically in the middle and coronal thirds (P &lt;.05), whereas it did not affect the percentage (P &gt;.05). Conclusions: Passive ultrasonic activation and copious irrigation were insufficient in removing Ca(OH)2 from root canals. BioRoot RCS presented higher dentinal tubule penetration than AH 26 even in the presence of Ca(OH)2 residues. Ca(OH)2 remnants decreased both dentinal tubule penetration depth and the percentage of the tested sealers; however, a more drastic effect was observed for AH 26. © 2018 American Association of Endodontist

Fracture Resistance of Teeth with Simulated Perforating Internal Resorption Cavities Repaired with Different Calcium Silicate–based Cements and Backfilling Materials

Introduction: This study assessed the fracture resistance (FR) of teeth with simulated perforating internal resorption cavities repaired with different calcium silicate–based cements (CSCs) and backfilling materials. Methods: Ninety-six mandibular premolar teeth were used. Twelve of the teeth were assigned as negative control group. Remaining roots were instrumented with rotary files, and standardized internal resorption cavities were prepared on the middle half of roots with burs. Twelve of the samples were not further interfered and were assigned as a positive control group. The apical 4 mm of the remaining 72 root canals was obturated with single-cone technique and divided into 6 groups according to CSCs used for repairing of cavities and backfilling materials as follows: MTA + MTA, MTA + gutta-percha/sealer, Biodentine + Biodentine, Biodentine + gutta-percha/sealer, MTA Plus + MTA Plus, and MTA Plus + gutta-percha/sealer. Specimens were embedded in acrylic resin and then subjected to fracture testing. The forces when the fracture occurred were analyzed with analysis of variance and Bonferroni tests at P = .05. Results: No significant difference was found among CSCs irrespective of backfilling materials (P > .05). Groups MTA + gutta-percha/sealer, Biodentine + gutta-percha/sealer, and MTA Plus + gutta-percha/sealer showed significantly lower FR compared with groups MTA + MTA, Biodentine + Biodentine, and MTA Plus + MTA Plus, respectively (P < .05). The highest FR was observed in group Biodentine + Biodentine, and the lowest was in group MTA Plus + gutta-percha/sealer. FR of positive control group was statistically lower than groups completely filled with CSCs (P < .05), whereas FR of negative control group was statistically higher than the groups combined with gutta-percha and sealer (P < .05). Conclusions: The backfilling with CSCs may be a preferable material rather than gutta-percha/sealer combination for the roots with perforated internal resorptions. © 2018 American Association of Endodontist