Investigation of coronal leakage of root fillings after smear layer removal with EDTA or Nd:YAG lasing through capillary flow porometry

Objective: This study investigates the effects of Nd:YAG laser irradiation combined with different irrigation protocols on the marginal seal of root fillings. Background data: Limited information exists regarding the effects of morphologic changes to root canal (RC) walls after Nd:YAG laser irradiation after smear-layer removal with EDTA on the sealing ability of root fillings. Methods: The 75 root-filled teeth (5 × 15 teeth) were analyzed for through-and-through leakage by using capillary flow porometry (CFP). The RC cleaning procedure determined the assignment to a group: (1) irrigation with NaOCl 2.5% and EDTA 17% or standard protocol (SP), (2) SP + Nd:YAG lasing (dried RC), (3) NaOCl 2.5% + Nd:YAG lasing (dried RC), (4) SP + Nd:YAG lasing (wet RC), or (5) NaOCl 2.5% + Nd:YAG lasing (wet RC). Groups 1r to 5r consisted of the same filled teeth with resected apices up to the most apical point of the preparation length. Resection was performed after the first CFP measurement. Roots were filled with cold lateral condensation. CFP was used to assess minimum, mean flow and maximum pore diameters after 48 h, and immediately after these measurements, including root resection. Statistics were performed by using nonparametric tests (p > 0.05). An additional three roots per group were submitted to SEM of the RC wall. Results: Through-and-through leakage was observed in all groups. Statistically significant differences were observed in maximum pore diameter: 1r > 3r, and 1r > 5r; in mean flow pore diameter: 1r > 2r, 2r < 4r (p < 0.05). Typical Nd:YAG glazing effects were observed when the smear layer was present and exposed to the laser fiber (i.e., in the groups without use of EDTA) or when the fiber tip made direct contact with a smear-layer free RC wall. Conclusions: The reduction in through-and-through leakage is significantly higher with the Nd:YAG laser as smear-layer modifier than when smear layer is removed with an EDTA rinsing solution

Comparative efficacy of materials used in patients undergoing pulpotomy or direct pulp capping in carious teeth: A systematic review and meta-analysis.

OBJECTIVES Different materials have been used for capping the pulp after exposure during caries removal in permanent teeth. The purpose of this study was to collate and analyze all pertinent evidence from randomized controlled trials (RCTs) on different materials used in patients undergoing pulpotomy or direct pulp capping in carious teeth. MATERIALS AND METHODS Trials comparing two or more capping agents used for direct pulp capping (DPC) or pulpotomy were considered eligible. An electronic search of four databases and two clinical trial registries was carried out up to February 28, 2021 using a search strategy properly adapted to the PICO framework. Screening, data extraction, and risk of bias (RoB) assessment of primary studies were performed in duplicate and independently. The primary outcome was clinical and radiological success; secondary outcomes included continued root formation, tooth discoloration, and dentin bridge formation. RESULTS 21 RCTs were included in the study. The RoB assessment indicated a moderate risk among the studies. Due to significant clinical and statistical heterogeneity among the studies, performing network meta-analysis (NMA) was not possible. An ad hoc subgroup analysis revealed strong evidence of a higher success of DPC with Mineral Trioxide Aggregate (MTA) compared to calcium hydroxide (CH) (odds ratio [OR] = 3.10, 95% confidence interval [CI]: 1.66-5.79). MTA performed better than CH in pulp capping (both DPC and pulpotomy) of mature compared to immature teeth (OR = 3.34, 95% CI: 1.81-6.17). The GRADE assessment revealed moderate strength of evidence for DPC and mature teeth, and low to very low strength of evidence for the remaining subgroups. CONCLUSIONS Considerable clinical and statistical heterogeneity among the trials did not allow NMA. The ad hoc subgroup analysis indicated that the clinical and radiographic success of MTA was higher than that of CH but only in mature teeth and DPC cases where the strength of evidence was moderate. PROSPERO Registration: number CRD42020127239