Evaluation of postoperative pain in patients using 8.25 % sodium hypochlorite compared with 5.25 % sodium hypochlorite using sonic and ultrasonic activation methods after single visit root canal treatment: an in-vivo study

To evaluate the penetration depth of irrigants into root dentin after manual, ultrasonic, and sonic activation using the dye penetration method under light microscope. Ninety-two extracted single-rooted human teeth were used in the age range of 14-18 years. After access opening, root canals were instrumented. Canals were irrigated with preheated 5% sodium hypochlorite (NaOCl). Teeth were divided into four groups-group I, control group without activation; group II, manual dynamic activation; group III, ultrasonic activation; and group IV, sonic activation. About 1% methylene blue dye was used, which was activated for 30 seconds using the respective activation method. Cross sections of apical 1 mm were prepared from the apical third. Each section was examined under a light microscope to check the penetration depth of dye in a micrometer at the apical third level. There was a statistically highly significant difference seen for the values between the groups (p < 0.01) with higher values in group IV and least in group I, revealing that group IV had higher penetration depth compared to other groups. The use of needle irrigation with the use of EndoActivator (sonic agitation method) has enhanced irrigation in the apical third. As during biomechanical preparation and irrigation with the traditional method of needle and syringe, canals remain inadequately disinfected at the apical third level. So, this study was done to assess whether the advanced methods of activation are more effective than commonly used techniques in their ability to penetrate dentinal tubules. Dadhich S, Srivastava H, Raisingani D, et al. Comparative Evaluation of Penetration Depth of Irrigants into Root Dentin after Manual Sonic and Ultrasonic Activation using Dye Penetration Method under Light Microscope: An In Vitro Study. Int J Clin Pediatr Dent 2023;16(S-3):S253-S257.

Effect of EDTA, Sonic, and Ultrasonic Activation on the Penetration of Sodium Hypochlorite into Simulated Lateral Canals: An In Vitro Study

One of the main debates that have occurred in Endodontics is about the amount of sessions required to complete an appropriate treatment. There are very different philosophies regarding this matter. Objective: to the aim of this study was to investigate the Endodontists’ point of view regarding single and multiple visit root canal treatment, identifying the basis on which the choice is made and how the information necessary for the choice is acquired. Material and methods: Endodontists registered in the dental practice board of Florianópolis/SC were contacted, and if they agreed to participate, they were interviewed using a questionnaire. The following topics were addressed: demographics, current clinical procedures, treatment rationales and preferences. Forty-three endodontists agreed to participate in the study. Results: Single visit endodontic treatment is carried out in 59.5% of biopulpectomy cases, 31.0% of necropulpectomy cases without lesion and only 11.9% in necropulpectomy cases with periapical lesion. The presence of vital pulp (81.4%) and a canal without exudate (93.0%) are the most important criteria for carrying out single visit endodontic treatment. The most used intracanal medication was calcium hydroxide. The lack of studies comparing long-term success on single visit endodontic treatment is considered an important issue to determine this therapy. Conclusion: It can be concluded that Florianopolis-Brazil endodontists prefer multiple visit over single visit root canal treatment in pulp necrosis cases. When pulp vitality is not compromised there is an increase in the number of endodontists who choose single visit root canal treatment.

Aim:This prospective randomized clinical study (1) investigated the prevalence of post-obturation pain after single visit root canal treatment and (2) evaluated the influence of factors affecting the pain experience.Materials and Methods:One thousand three hundred and twenty eight (1328) patients were included in this study. Conventional single visit root canal treatment was carried out. The chemicomechanical preparation of root canals was done by a rotary protaper system with a combination of hand instruments. Post-operative pain was recorded by each patient by using visual analogue scale in well-defined categories at three time intervals, 12 h, 24 h, and 48 h. The data were analyzed using Fisher's exact test.Results:The prevalence of post-obturation pain (severe) within 48 h after treatment was 4% (n = 54) but less as compared to the pain experienced after 12 h (9%) and 24 h (8.6%). The factors that significantly influenced post-obturation pain experience were: Age (Fishers exact test = 46.387, P = 0.0), gender (Fishers exact test = 23.730, P = 0.0), arch (Fishers exact test = 11.710, P = 0.001), and presence of pre-operative pain (Fishers exact test = 67.456, P = 0.0).Conclusion:The presence of post-operative pain was low (4%). The important prognostic determinants of post-obturation pain were: Old age, female, mandibular teeth, and presence of pre-operative pain. The vital condition of the tooth does not affect the intensity and frequency of post-obturation pain.

The aim of this study was to evaluate the efficacy of sonic and ultrasonic activation of epoxy-amine resin-based root canal sealer (2Seal; VDW GmbH, München, Germany) on penetration of the sealer into lateral canals compared to non-activated filling. Thirty-six single-rooted human anterior teeth were decoronated and prepared, using the ProTaper rotary system (Dentsply Maillefer, Ballaigues, Switzerland) to F4. After the completion of the clearing procedures, lateral canals were created at 2, 4, and 6mm from the working length. The specimens were randomly divided into a control group (non-activated sealer application) and two experimental groups that received a sealer application with either sonic or ultrasonic activation. The root canals were filled using cold lateral compaction and images were obtained from each lateral canals at 40× magnification using a stereomicroscope. The sealer penetration was evaluated using a four-grade scoring system. The data were evaluated statistically using the Kruskal-Wallis and Mann-Whitney U tests with a 95% confidence level (P=0.05). The ultrasonic activation resulted in a better sealer penetration compared with the non-activated and sonically activated groups (P<0.001). Sonic activation also resulted in better sealer penetration compared to the non-activated group (P<0.001). The use of the ultrasonic activation of an epoxy-amine resin-based sealer promoted greater sealer penetration into the lateral canals. Sonic activation was not effective as ultrasonic activation, but was more effective than the non-activated group. The ultrasonic activation of an epoxy-amine resin-based sealer could be beneficial in filling procedures.

Background: Achieving effective disinfection of the root canal system is essential for the long-term success of endodontic treatment. Enterococcus faecalis, known for its resistance and ability to survive in harsh environments, is a key contributor to persistent root canal infections. Although commonly used irrigants like sodium hypochlorite (NaOCl), chlorhexidine (CHX), and EDTA are effective to a degree, their limitations—such as cytotoxicity or lack of substantivity—have led to growing interest in alternative solutions. Chitosan nanoparticles (CNPs), due to their biocompatibility and antimicrobial properties, offer a promising option. Aim: This in vitro study aimed to evaluate the antimicrobial efficacy of a chitosan nanoparticle solution in root canal disinfection and compare its performance with standard irrigants—NaOCl, CHX, and EDTA—when activated using both sonic and ultrasonic techniques. Materials and Methods: Sixty freshly extracted, single-rooted human teeth were prepared and inoculated with E. faecalis biofilms over 21 days. The specimens were divided into six groups based on the irrigant and activation method: Group I – NaOCl with sonic activation, Group II – CHX with sonic activation, Group III – EDTA with sonic activation, Group IV – CNP with sonic activation, Group V – CNP with ultrasonic activation, and Group VI – saline with sonic activation (control). Microbial samples were collected before and after irrigation, and the number of viable bacteria was assessed by counting colony-forming units (CFUs). Results: All experimental groups showed a significant reduction in bacterial counts compared to the control. NaOCl showed the highest antimicrobial effectiveness, followed closely by CNP activated ultrasonically. CNPwith sonic activation also demonstrated strong antibacterial activity, performing better than EDTAand comparable to CHX. Ultrasonic activation improved the performance of CNPs compared to sonic activation. Conclusion: Chitosan nanoparticles showed promising antibacterial effects against E. faecalis, especially when combined with ultrasonic activation. These findings suggest that CNPs could serve as a safe and effective alternative to traditional irrigants in root canal therapy. Further clinical research is needed to confirm their potential in real-world settings

Evaluation of Postoperative Pain Following Sonic and Ultrasonic Root Canal Irrigation Activation Protocols in Patients with Non-vital Teeth Associated with Apical Periodontitis (Randomized Clinical Trial

Background: Pre-emptive analgesia is an anti-nociceptive treatment which reduces the postoperative pain by preventing the processing of altered afferent input. As most of the patients present with pain preoperatively have higher levels of released local inflammatory mediators. Thus, pretreatment analgesia decreases the establishment of central sensitization, a mechanism by which spinal neurons increase their response to peripheral nociceptive impulse. Objective: This systematic review aims to compare and evaluate the postoperative pain levels and analgesic intake on preoperative oral administration of NSAIDs in single visit root canal treatment. Data Sources: The present review was done according to PRISMA guidelines and was registered in the PROSPERO (Centre for Reviews and Dissemination University of York; http://www.crd.york.ac.uk/PROSPERO). Registration number - CRD42020195775. The research question was formulated based on the PICO strategy. A comprehensive electronic literature search was conducted across PubMed/Medline, Scopus and Cochrane Database independently by two reviewers. Study Eligibility Criteria: Articles published from January 1990 to May 2019 that focused on preemptive strategies in single visit root canal treatment were included in the present review. Based on specified inclusion and exclusion criteria’s, the selected articles were subjected to quality assessment, and the risk of bias was evaluated. Methods: A total of 6 articles were included, out of which three were hand searched. The overall risk of bias of included studies was moderate, and the study limitations were high. Results: Among the studies included, Ibuprofen was considered as the best drug of choice in single visit endodontics. Limitations: The present review was assessing only the effectiveness of NSAIDs in single visit root canal treatment. But ideally comprehensive literature should search on effectiveness in both single and multiple visit root canal treatments. Conclusion: The present systematic review concluded that ibuprofen was considered to be an effective drug in single visit root canal treatment.

Background: This study was conducted to provide clinicians with evidence regarding whether single visit root canal treatment is better than multiple visits by accessing pain experienced by patients after treatment. There is ongoing debate among dentists and patients on this topic to minimize multiple appointments but there is a lack of consensus. Objective: To compare pain after single versus multiple visits endodontic treatment after 24 hours of follow-up. Methodology: This study was conducted on 66 participants divided into two groups: 33 in a single visit “(Group SV)” and 33 in multiple visits “(Group MV)” for endodontic treatment. Patients within the age range 20-40 years, with irreversible pulpitis in premolars having completely formed foramina were included. Patient’s demographic data like age and gender along with the history of postoperative pain (its severity, episodes, and aggravating factors) were recorded. The Chi-square test was used to compare post-operative pain between two groups. Results: The mean age of the sample was 31.09±6.67 years. There were 51.52% (n=34) females and 48.48% (n=32) males. Overall, a total of seven patients (10.6%) reported postoperative pain. From the SV group, four cases (12.12%) reported with pain; and from the MV group, only three cases (9.09%) reported with pain. The difference was not statistically significant (p&gt;0.99). The difference between single and multiple visits’ endodontic treatment for the episode (p=0.58), duration (p=0.706), severity (p=0.183) and aggravating factors (p=0.693) of postoperative pain were not statistically significant. Conclusion: The history of 24hrs post-operative pain in patients with single or multiple visit RCT in premolars does not vary significantly. Therefore, for premolar teeth, single-visit endodontic treatment can be a viable option to reduce the number of patient visits.

To assess the effects of different irrigation activation systems on postoperative pain using a Visual Analog Scale (VAS), using new laser irrigation activation system shock wave-enhanced emission photoacoustic streaming (SWEEPS), photon-induced photoacoustic streaming (PIPS), passive ultrasonic irrigation activation techniques, compared with the conventional irrigation (CI) method. Sixty patients suffering from symptomatic irreversible pulpitis in maxillary or mandibular molars were enrolled and randomly assigned to four different irrigation activation groups (n = 15) after chemomechanical root canal preparation. Preoperative and postoperative pain scores were recorded using VAS. The data were collected and subjected to statistical analysis using IBM SPSS 20.0 software at a level of significance being 0.05. We observed that mean pain scores decreased with time in all patients in all groups. The decrease in pain score was found to be statistically significant (P < 0.05) among both the genders in Group 3 (PIPS) and Group 4 (SWEEPS). Postoperatively, pain scores decreased significantly using Group 4 (SWEEPS), followed by Group 3 (PIPS), Group 2 (ultrasonic activation), and Group 1 (conventional needle irrigation). No significant relation was observed statistically between pain scores and age groups among all groups, except for preoperative score in Group 3 and age groups. Postoperative scores were lower in laser-activated irrigation systems as compared to the other activation systems. The highest pain scores were observed in case of CI method, at pre- and post-operative periods.

Context:Hermetic seal between gutta-percha and dentin is created by endodontic sealers. Sonic or ultrasonic activation (UA) of sealers may improve their penetration into tubules and strength, which could be evaluated by testing the bond at dentine-obturation interface.Aims:To compare and evaluate the effect of ultrasonic and sonic activation on push-out bond strength of three different endodontic sealers, namely AH Plus, MTA Fillapex, and Endosequence BC.Settings and Design:An experimental in vitro study design.Methodology:Ninety extracted human premolars were decoronated to 16 mm and instrumented with ProTaper Gold to size F3. Samples were grouped based on three sealers – AH Plus, MTA Fillapex, and Endosequence BC Sealer and further subdivided by ultrasonic, sonic, and no activation of sealers followed by lateral compaction obturation. Filled roots were sliced into 2 mm discs from each third. A Universal Testing Machine was used to measure pushout bond strength (POBS).Statistical Analysis Used:Kruskal–Wallis analysis of variance/One-way ANNOVA; and post hoc Bonferroni test applied to bond strength values.Results:Ultrasonic and sonic activation enhanced bond strength, significantly in the AH Plus and MTA Fillapex groups, with the coronal third showing greatest improvements. AH Plus consistently demonstrated superior bond strength, followed by Endosequence BC, and finally MTA Fillapex. No significant change in bond strength of Endosequence BC post activation.Conclusions:Among the tested materials, AH Plus demonstrated the greatest bond strength, with UA notably enhancing coronal bonding, while activation showed minimal impact in the apical third across all sealers.

Objective: To compare the clinical efficacy of 2.5% non-heated sodium hypochlorite and 2.5% heated sodium hypochlorite as irrigation to control postoperative pain in single visit root canal treatment. Study Design: Comparative analytical study Place and Duration: Operative dentistry department of Liaquat University of Medical and Health Sciences, Jamshoro for 6 months duration from March 2017 to September 2017. Material and Methods: A total of 60 patients with single rooted maxillary and mandibular permanent teeth were randomly allocated into two groups. 30 patients were in group A and treated with non heated sodium hypochlorite solution and 30 patients in group B were treated with 2.5% heated sodium hypochlorite solution. In both groups, the level of pain was measured postoperatively after 48 hours by using Heft Parker visual Analog Scale of 10 and information was collected on Performa. Results: The average age of the patients was 28.62±6.06 years. There were 40(66.7%) male and 20(33.3%) female. Pain was reduced in both groups but there were no significant difference in reduction of pain between groups (p=0.640). Conclusion: Severity of pain was not statistically significant between groups. At 48 hours, Pain was reduced in both groups but there were no significant difference in reduction of pain between groups. Heated sodium hypochlorite to relieve postoperative pain, it should be new trend for recommendation for treatment of irreversible pulpitis in single visit root canal treatment. Key Words: Root canal, Heated sodium hypochlorite, Postoperative pain.

Aim: The purpose of this study was to determine clinical success rate of single visit verses multiple visit root canal treatment in cariously exposed vital primary molars.Material& methods: 40 children in age group of 4 to 7 years were divided equally into two treatment groups and recall visits were carried out after one week, one month and three months and six months.Results: Statistically no significant difference was found.Conclusion: Multiple visit and single visit root canal treatment demonstrated almost equal success but most important aspect for success in pulpectomy cases is the indication of each case and then its subsequent treatment, be it multiple or single visit root canal treatment.

Postoperative Pain after Endodontic Treatment under Irrigation with 8.25% Sodium Hypochlorite and Other Solutions: A Randomized Clinical Trial

To evaluate the effect of ultrasonic and sonic activation on physicochemical properties of AH Plus, MTA Fillapex, ADSeal, GuttaFlow Bioseal, and GuttaFlow 2 sealers. Three experimental groups were formed: no activation (NA), ultrasonic activation (UA), and sonic activation (SA). The sealers were manipulated according to the manufacturers' instructions. A 3-mL syringe was adapted to receive 1 mL of sealer. Activation was performed with a 20/.01 ultrasonic insert (20 s/1W) in the UA group. A size 35.04 sonic tip was used (20 s/10,000 cycles/min-1) in the SA group. The molds for physicochemical analysis were filled and evaluated according to ANSI/ADA specification no. 57: setting time (ST), flow (FL), dimensional change (DC), solubility (SB), and radiopacity (RD). Statistical analysis was performed by Kruskal-Wallis, one-way ANOVA, and Tukey's tests (P<0.05). Regarding ST, only AH Plus and GuttaFlow 2 in the NA group met the ANSI/ADA standards. All FL values were greater than 20 mm in diameter, as determined by ANSI/ADA. The tested sealers and protocols did not comply with the ANSI/ADA standards for DC. As for SB, only MTA Fillapex, regardless of the activation protocol, did not follow the ANSI/ADA standards. All of the investigated sealers, regardless of the activation protocol, presented radiographic density higher than 3 mm Al, as proposed by ANSI/ADA. UA and SA promoted changes in the physicochemical properties of the evaluated root canal sealers, mainly in ST and F. Thus, it is important to evaluate the physicochemical properties of endodontic sealers associated with activation techniques prior to clinical application in order to determine whether the properties follow the parameters set by ANSI/ADA, ensuring safety and quality of root canal filling.