Access Opening Research Articles

Comparative evaluation of efficacy of guided endodontic technique with and without sleeve for access cavity preparation: An In Vitro study

BackgroundCalcific metamorphosis in root canals is common and presents challenges in gaining access. Guided endodontics offers a solution to overcome these difficulties. The PriciGuide® system is a patented guided endodontic technique claiming superior precision compared to sleeve-based guides. This study aims to compare deviation between the PriciGuide® system and the guide with sleeve. MethodsA patient with calcified canal underwent CBCT scanning to obtain a DICOM file. Using the DICOM file, 3D models were printed. The patient's cast was scanned to obtain an STL file. Using DICOM and STL files, the guide with sleeve was designed using BlueSkyBio software and 3D printed. The PriciGuide® system was obtained from Roots to Cusps® Private Limited. Access opening was performed using conventional method, guide with sleeve and guide without sleeve (PriciGuide® system).Samples underwent radiograph scans to measure coronal, apical, and angular deviations, as well as procedural time. ResultsOne-Way ANOVA and Post Hoc Bonferroni's test revealed that coronal, apical, and angular deviations were lowest in the guide without sleeve group. However, access opening times were similar in both guided technique groups. ConclusionsThe PriciGuide® system offers precise access cavity preparation for calcified canals, showing minimal deviation compared to the sleeve-based guides. It facilitates accurate root canal access regardless of the dentist's experience level. This study utilized 3D-printed teeth that do not fully replicate the complexities of natural teeth, further research is needed to validate the PriciGuide® system's performance on natural teeth and assess deviation using CBCT for a more comprehensive evaluation.

Comparison of Bromelain and Diclofenac in the Management of Postoperative Pain and Quality of Life Following Root Canal Therapy: A Randomized Controlled Trial.

Aim This study aimed to compare the analgesic efficacy and adverse effects of oral bromelain and diclofenac in relieving postoperative pain and improving postoperative quality of life in patients with irreversible pulpitis in mandibular first molars after root canal therapy. Materials and methods A simple randomized double-blinded clinical trial was carried out. One hundred patients with symptomatic pulpitis requiring root canal therapy of mandibular first permanent molars were randomly divided into two groups after obtaining informed consent. After access opening, preparation of the root canal and temporization, Group I (n=50) patients received oral bromelain 200 mg and Group II (n=50) received oral diclofenac sodium 50 mg, respectively. The patients were asked to rate their pain on a visual analog pain intensity scale (VAS) and rate their quality of life using the postoperative quality of life (POQoL) questionnaire after 6, 12, 24, 48, and 72 hours. Results Bromelain and diclofenac were equally effective for postoperative analgesia, but diclofenac showed immediate pain relief and improved quality of life at 6 hours. After 12 hours bromelain showed similar effects in managing pain and postoperative quality of life with less adverse effects. Conclusions When compared to diclofenac, bromelain has the same analgesic efficacy after 12 hours but a lower risk of adverse effects in patients receiving root canal therapy for postoperative pain. Diclofenac is more effective in immediate postoperative pain relief and improvement in quality of life for patients with moderate to severe pain.

Eruption Cyst: A Case Report

An eruption cyst (EC) is a benign, nonodontogenic lesion. It appears as a Semi-spherical swelling in the mucosa overlying an erupting tooth. This condition occurs when the dental follicle separates from the crown, leading to the formation of a fluid-filled space. Eruption cysts usually have an epithelial lining and are encased in fibrous connective tissue. In a case involving an eleven-year-old girl, a painless, dome-shaped swelling was observed in the lower left posterior region of her jaw. This was diagnosed as an eruption cyst associated with tooth 35. An inferior alveolar nerve block was administered under local anesthesia. An access opening on tooth 75 was made and horizontal incision was given to drain the cystic fluid. Post-operative care included antibiotics and pain management. Follow-up visits showed significant healing, and subsequently pulpectomy and placement of a stainless-steel crown on tooth 75 was carried out. This case highlights the importance of conservative management for eruption cysts in pediatric patients, ensuring effective treatment while minimizing discomfort.

Research on the evolution and venting characteristics of gasoline–air mixture explosions in confined pipeline trench spaces

In recent years, international energy cooperation has become more extensive, and the safe and reliable transportation of oil and gas resources has become increasingly important. However, storage and transportation sites can have confined spaces in engineering practice, which can lead to safety problems. There is a risk of gasoline–air mixture explosions in confined spaces such as pump rooms, valve operation rooms, and inspection wells, particularly in Class B and Class C pipeline trench areas that utilize non-sand-filled trenches or where the local depth exceeds 2.0 m. These locations are equipped with doors, manholes, or ventilation openings for personnel access within oil storage zones. To investigate the combustion characteristics of gasoline–air mixture explosions in such confined spaces, experimental research was conducted on a simulation platform (L/D = 15, V = 0.015 m3). The findings reveal the following: (1) the most hazardous initial gasoline–air mixture volume fraction for ignition at the upper ignition point is 1.7%; (2) the morphology of the internal flame evolves through four distinct stages, with the post-explosion flame shapes resembling “brush-like” and “mushroom cloud” formations; (3) low YCH = 1.1%, medium YCH = 1.7%, and high YCH = 2.3% volume fractions of hydrocarbons were selected to analyze the progression of the explosion development process; (4) the external overpressure distribution during venting explosions, with varying initial gasoline–air mixture volume fractions, conforms to the function y = ae−bx as the distance L varies, with venting pressure waves exhibiting a trend of exponential decay.

Evaluation of Marginal Adaptation of SDR Plus, Fiber-Reinforced and Nanofilled Composites in Endodontically Treated Teeth: A Scanning Electron Microscopic Study.

Endodontically treated teeth (ETT) undergo structural changes, including a reduction in water content and loss of dentin elasticity, which can compromise their mechanical properties. One critical factor influencing the long-term prognosis of a restored ETT is the marginal adaptation of the restorative material. The present study compared the marginal adaptability of Smart Dentin Replacement (SDR) Plus, fiber-reinforced, and nanofilled composites in ETT using scanning electron microscopy (SEM). Cavities were made in 30 recently extracted maxillary premolars distributed into three experimental groups depending on the restorative material used: group 1 as SDR Plus (Dentsply Sirona, Charlotte, North Carolina, USA), group 2 as fiber-reinforced composite (EverX, GC Corp., Tokyo, Japan), and supra nanofilled composite (Estelite Sigma Quick, Tokuyama Dental Corp., Tokyo, Japan). Standardized access openings were performed, and endodontic treatment was completed in all teeth. Specific composite restoration techniques were applied according to the manufacturer's instructions. After thermocycling for 30 days, the restored teeth were sectioned and viewed using SEM (Labindia Instruments Pvt. Ltd., Maharashtra, India) to measure the width of the marginal gap. The data were analyzed using statistical software. The mean marginal gap width varied significantly among the groups. Group 1 had a lower mean marginal gap of 2.99 μm, group 2 exhibited the highest mean marginal gap of 10.24 μm, and group 3 had a mean marginal gap of 5.51 μm. Overall, group 2 consistently showed significantly larger marginal gaps than the other groups. Within the limitations of this study, SDR Plus demonstrated better marginal adaptation than fiber-reinforced and supra-nanofilled resins in the coronal restoration of ETT. Fiber-reinforced composites demonstrated the maximum marginal gap, followed by nanofilled composites. Thus, SDR Plus may be recommended as a suitable restorative material to enhance the longevity and success of endodontic treatments.

Antimicrobial efficacy of 2% chlorhexidine gel, triphala, and Azadirachta indica as intracanal medicaments against Enterococcus faecalis: A randomized clinical trial

Abstract Context: Concerns about adverse reactions and the development of antibiotic resistance have prompted an alternative treatment strategy that utilizes traditional medicinal herbs. Aim: This randomized control trial assessed the antimicrobial efficacy of 2% chlorhexidine (CHX) gel, Triphala, and Azadirachta indica as intracanal medicaments against Enterococcus faecalis. Materials and Methods: Forty patients with nonvital teeth and single root canals were selected (n = 10). Following the initial access opening, the first microbial samples (S1) were collected using paper points. Second microbial samples (S2) were collected following the chemo-mechanical preparation and 1 week after introducing the intracanal medicaments. Group I: 2% CHX, Group II: A. indica, Group III: Triphala, and Group IV: Calcium hydroxide (Ca(OH)2). S1 and S2 samples were collected, and bacterial growth was observed using the colony-forming unit (CFU) count. Statistical Analysis: Comparison of the difference in CFU count among four groups was performed using one-way ANOVA test (P < 0.05) followed by post hoc Tukey test. Results: Reduction in CFU count postmedication S2 from S1 in each group was statistically significant. Percentage reduction in CFU count was highest in Triphala group followed by A. indica and 2% CHX group. Percentage reduction in CFU count was least in Ca(OH)2 group. The post hoc pairwise comparison of % reduction in CFU count among four groups showed that the percent reduction was highest in Triphala group. Conclusion: Triphala has considerable antimicrobial efficacy against E. faecalis.

Effectiveness of mechanical vs. chemomechanical methods in removing intracanal calcium hydroxide medication: a randomised trial.

To compare the mechanical and chemomechanical methods for removing calcium hydroxide medication from the root canal system. The triple-blind, randomised clinical trial was conducted at the Department of Operative Dentistry and Endodontics, School of Dentistry, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan, from December 16, 2022, to June 15, 2023, and comprised patients having necrotic teeth and chronic apical pathosis. They were randomised into groups A and B. On the initial visit, after access opening and chemomechanical preparation, calcium hydroxide paste was placed as an intracanal medication in both groups. the patients were recalled after two weeks. In Group A, calcium hydroxide was removed from the canals using a rotary master apical file, while in Group B, an endoactivator was used to sonically agitate the endodontic irrigant. Verification of placement was done by using a periapical radiograph. Data was analysed using SPSS 26. Of the 98 individuals assessed initially, 60(61.22%) were included; 34(57%) females and 26(43%) males with age ranging from 19 to 57 years. There were 27(45%) incisors, 22(36.7%) premolars and 11(18.3%) canines. There were 30(50%) patients in each of the 2 groups. The intergroup difference was not statistically significant (p=0.43). Tooth arch did not significantly correlate with the removal method (p=0.79). Both methods were found to be equally effective in removing water-based calcium hydroxide medication from the endodontic system. NCT05744661.

Experiences of Elderly Mental Health Patients and Their Care Partners Using a Proxy Account to Access Open Notes: Qualitative Study (Preprint)

Experiences of Elderly Mental Health Patients and Their Care Partners Using a Proxy Account to Access Open Notes: Qualitative Study (Preprint)

Anaesthetic Efficacy of Adjunct Therapy with Inferior Alveolar Nerve Block in Symptomatic Irreversible Pulpitis: A Randomised Controlled Study

Abstract Objective: The aim of this prospective, randomised controlled study was to evaluate the efficacy of pulpal anaesthesia in the management of pain in mandibular first molars with symptomatic irreversible pulpitis (SIP) in relation to alternative adjunct therapies with a conventional inferior alveolar nerve block (IANB) versus the conventional IANB technique. Methods: In accordance with the CONSORT statement, a prospective, randomised controlled parallel-design clinical trial was created. Group 1: Conventional IANB (Control group); Group 2: IANB plus local infiltration; Group 3: IANB plus long buccal nerve block; Group 4: IANB plus premedication with paracetamol; and Group 5: IANB plus cryotherapy was the five groups comprised 50 participants who met the inclusion and exclusion criteria. People were asked to use the Heft-Parker Visual Analogue Scale (HP-VAS) to score their level of discomfort at three separate intervals during the treatment process: before treatment, during access opening, and during pulp extirpation. Results: During access opening, Tukey’s post hoc multiple comparison tests showed statistically highly significant differences (P < 0.001) between Group 1 and Group 4 and a statistically significant difference (P < 0.05) between Group 1 and Group 3. During pulp extirpation statistically significant difference (P < 0.05) between Group 1 and Group 4 were reported. While the other group shows a statistically insignificant difference. Conclusion: IANB alone does not provide painless endodontic treatment in SIP patients. Hence, adjunct therapy of premedication with paracetamol or a supplementarily anaesthetising long buccal nerve block can significantly increase anaesthetic efficacy of IANB.

Comparative evaluation of clinical efficacy and volumetric changes in pulpectomized primary molars using hand K-file, ProTaper rotary file, and Kedo-SG blue file: an in-vitro cone beam computed tomography analysis.

The accomplishment of a successful pulpectomy depends on multiple factors that involve targeted removal of the causative irritants and soft and hard tissue debris by mechanical and chemical means. Compare and evaluate the efficacy of canal preparation and volumetric filling using conventional files and two rotary file systems using cone beam computed tomography (CBCT). Thirty freshly extracted human primary second molars were randomly divided into three groups of 10 teeth each. After access opening and working length determination, pre-operative volume analysis was done using CBCT. The canals were then instrumented by either hand K-files, ProTaper rotary files or Kedo-SG Blue rotary files. Post-operative volume analysis was performed using CBCT. All the canals were obturated using Metapex and scanned again using CBCT. Mean values of the pre- and post-operative canal volumes were analyzed using one-way Analysis of Variance (ANOVA). Inter- and intra-group volumetric changes were analyzed statistically using a post hoc test. The mean difference in volume after canal preparation and obturation was the highest in the Kedo-SG Blue group, followed by the ProTaper group and the least in the hand K group (p = 0.001). Inter-group comparison showed statistically significant differences between the hand K group and ProTaper group (p = 0.001), the ProTaper group and Kedo-SG Blue group (p = 0.001), and the hand-K group and Kedo-SG Blue group (p = 0.02). The volume of preparation and obturation was the highest using Kedo-SG Blue, followed by the ProTaper file systems.

Evaluating The Effectiveness of Nurse-Led Education on The Anxiety Level of Preoperative Candidates for Opening Vascular Access in Shariati Hospital

Background: Every year, many patients with Chronic Kidney Disease (CKD) undergo surgeries to provide suitable vessel access for hemodialysis. These surgeries cause significant anxiety in these patients. Therefore, this study was conducted to examine the effectiveness of nurse-led training on reducing the level of anxiety experienced by these patients. Methods: 38 patients were randomly selected from the candidates for vascular access opening at Shariati Hospital, Tehran, Iran. They were divided equally into two groups: cases and controls. The anxiety level was measured in both groups using the Spielberger State-Trait Anxiety Inventory at baseline. After 30 minutes of personalized training, the anxiety level was reevaluated in the cases and statistically compared with the anxiety level before the intervention using a paired t-test. Results: The mean baseline anxiety level was 40.94 in the cases and 40.42 in the controls. These numbers changed to 34.78 in the cases and 40.05 in the controls after the training intervention. Statistical comparison revealed a significant decrease in the case group (p = 0.048), while the observed difference was statistically insignificant in the controls (p = 0.788). Conclusions: Providing an appropriate personalized nurse-led educational package can significantly reduce the anxiety level in preoperative candidates for vascular access opening in kidney failure cases. Further studies are required to better develop the content of this training and also to determine whether a gap between the training and surgery is required to increase effectiveness.

Digital precision meets dentin preservation: PriciGuide™ system for guided access opening

Traumatic injuries to maxillary central incisors often necessitate root canal treatment (RCT). However, traditional access cavity preparation can remove significant dentin, compromising tooth strength and long-term prognosis. This article explores the use of the PriciGuide™ system for minimally invasive access cavity preparation in such cases. PriciGuide™ system is a novel, patented system that utilizes a sleeveless guide technique to enhance accuracy and control during access procedures. This article presents a clinical case demonstrating the application of PriciGuide™ system for access cavity preparation in traumatized necrotic maxillary central incisors. The focus is on preserving dentin while achieving optimal access for successful RCT. By showcasing the effectiveness of PriciGuide™ system in this case, this article contributes to the growing body of evidence supporting its role in minimally invasive endodontics. The approach presented has the potential to improve long-term outcomes for patients with not only traumatized necrotic maxillary central incisors but also in teeth having prosthesis that requires RCT and in teeth with calcifications.

Apexification treatment on tooth with a history of trauma: A case report

Background: Traumatic dental injuries to the teeth may result in pulpal and periapical disease. Most dental traumas occur in the 7 -10-year-old age group with incomplete apical root development. Apexification is the procedure to close the apex using bioactive material to create an apical plug. MTA can be used as a material of choice to treat open apex. Purpose: To perform an apexification of open apex with MTA apical plug. Case: A 30-year-old female patient with a chief complaint to fix her missing anterior filling and blackened tooth. The tooth had a history of trauma when the patient was 7 years old. One year ago, the tooth had intermittent pain so the tooth was treated and filled by another dentist. Case Management: Access opening is performed and apical gauging is determined. Then, working length was established. Debridement was done with H-file #80. Irrigation sequence with NaOCl 1,5% - Aquadest – EDTA 17% -aquadest. Ca(OH)2 dressing was given and temporary restoration was placed. On the second visit, temporary restoration was removed, followed by a root canal filled with MTA 3 mm from the apex using MAP carrier then confirmed with a radiograph. Conclusion: Trauma that occurs during tooth formation may cause an open apex that is treatable using an MTA plug.

Evaluation of lavender and rose aromatherapies on the success of inferior alveolar nerve block in symptomatic irreversible pulpitis: A randomized clinical trial

Trial designThis is a prospective, block-randomized, blinded, multiple arm and parallel-group superiority clinical trial. MethodsSeventy-eight patients satisfying the recruitment standards, were randomly allocated into three groups as follows: Group I (n = 26) – Inferior alveolar nerve block (IANB) devoid of aromatherapy (AT); Group II (n = 26) - IANB with lavender AT and Group III - IANB with rose AT (n = 26) with the help of the ultrasonic aroma diffuser (with respective oils)for 20 min/2 h in operatories 1,2 and 3 respectively. For AT, 3–4 drops of lavender and rose-conditioned oils were added from a 100 ml solution containing 100 mg of these medicinal plants. The pre-operative (PRO) and access opening (AO) pain as well as the anxiety of patients were recorded using the Visual Analog Scale (VAS) and Modified Dental Anxiety Scale (MDAS) respectively. Data thus obtained was entered into the Excel sheet and subjected to statistical tests (analysis of variance and paired t-test). The p-value less than 0.05 was considered statistically significant. ResultsGroup I showed non-significant disparity between PRO and AO for both VAS as well as MDAS (p = 0.62, p = 0.71). However, group II (p = 0.04, p = 0.02) and group III (p = 0.03, p = 0.01) revealed significant differences between PO - AO VAS and MDAS. MDAS and VAS intergroup comparison revealed a significant difference among groups I and II (p = 0.03, p = 0.04), and groups I and III (p = 0.02, p = 0.03). However non-significant disparity was observed among groups II and III (p = 0.85, 0.34). Moreover, there was a statistically significant reduction in anxiety levels in females compared to males after rose AT (p = 0.02). Nevertheless, groups I and II did not show any gender predilection for anxiety as well as pain. ConclusionAlleviation of dental anxiety as well as reduction in pain during AO of teeth with SIP can be achieved using Lavender and rose AT. In female patients, rose AT can be preferred over lavender AT.

Comparative evaluation of antimicrobial efficacy of various intracanal medicament in young permanent teeth: An in vivo study.

Bacteria and their byproducts are key contributors to the onset and perpetuation of pulpoperiapical pathosis. Intracanal medication is vital in achieving successful endodontic outcomes as it targets and eradicates remaining microorganisms following biomechanical preparation. The aim of the study was to compare and evaluate the antimicrobial efficacy of calcium hydroxide (CH) paste, triple antibiotic paste (TAP), and probiotics (PBs) as intracanal medicament in 12-17-year-old children undergoing root canal treatment for the management of infected pulpal tissues in young permanent teeth. A total of 30 patients aged 12-17 years indicated for endodontic therapy in maxillary incisors and with no systemic complications were selected. They were randomly divided into three groups, i.e., Group I - CH group, Group II - TAP, and Group III - PB allocating 10 teeth in each group. After access opening, the first sample (S1) was collected by inserting a paper point into the root canal, the second sample (S2) was collected immediately after biomechanical preparation, and the third sample (S3) was collected after 7 days, i.e., postintracanal medication. Samples were sent for microbiological analysis to assess the microbial count, and statistical analysis was done for the obtained data. The three intracanal medicaments were successful in reducing the microbial counts of Enterococcus faecalis in the infected root canals. However, according to the results of the study, the PB group demonstrated greater effectiveness against E. faecalis compared to the CH group and displayed similar antimicrobial efficacy as the TAP group. PB exhibited antimicrobial efficacy comparable to TAP but greater than Ca (OH) 2 paste. Hence, PB can be utilized as an intracanal medicament in young permanent teeth.

Finnish open university education and students’ transitions into and within higher education

There is a growing number of higher education (HE) students who do not follow the conventional sequential progression from the beginning to the end of their studies. Instead, they may use alternative admission routes, take gap years, delay their studies and transfer from one discipline or institution to another. In particular, students from under-represented social groups tend to follow less linear trajectories. In this article, we are interested in the institutional policies and practices that enable multiple ways for students to navigate into and within HE. As a theoretical lens, we apply Gale and Parker’s typology of student transition and the conceptualisation of transition as ‘becoming,’ which entails rejecting the notion of linearity and normativity. Our empirical case is Finnish open university education (OUE). Using student interviews (N=16) and reflexive thematic analysis, we identified three institutional characteristics: openness of access, flexible mode of studies, and alternative access route to degree studies. These characterisics enabled highly individualised learning trajectories and opportunity to enter, withdraw and return to OUE throughout life. However, the OUE gateway was selective, which limited its potential to reduce social inequality in student transitions. The study advances the policy discussion and development of inclusive universities.

Effect of Apical Preparation on Different Needle Depth Penetration.

Introduction: Irrigation is a fundamental part of endodontic debridement as because it allows for cleaning beyond what might be accomplished by root canal instrumentation. The flushing action produced by the irrigant and the penetration of the irrigant is not dependent only on the anatomy of the root canal system, but also on the depth of placement, system of delivery, the volume and fluid properties of the irrigant. Aim: The aim of the study was to evaluate the effect of apical preparation on the penetration depth of different types of needles. Methods: Thirty single-rooted lower premolar teeth were involved in this study. The access opening was performed by using a round diamond bur turbine (diameter 12) and Kfiles (diameter 15) were used for initial penetration in the canal. Stereo- microscope under 20 magnifications was used to determine the working length of the canal. Then the canals were prepared using protaper next in continuos rotation according to manufacture instructions with sequence files reached the WL (X1, X2, X3, X4). 4 mL of 5.25% NaOCI was used between each instrument. Three different types of endodontic needles were used. Needles size 27, 30-gauge stainless steel and IRRIFLEX endodontic irrigation needle. Each needle was inserted in the canal and its length of penetration was measured before canal preparation and after finishing files then the depth of penetration was measured. Results: ANOVA test showed that there are significant differences among all groups also results show a significant difference when comparing 27 with 30 needle gauge irriflex but there was no significant difference between the needle gauge 30 and irriflex. Conclusion: This study shows that the penetration depth of needles influences on apical preparation it appears that 27 -gauge needles show less depth penetration when compared to irriflex and 30- gauge needles. Keywords: apical, needle, penetration depth, endodontics.

Comparative evaluation of increase in temperature on the external root surface of teeth during retrieval of broken NiTi instrument using two ultrasonic tips and two power settings: An in vitro study.

An unfavorable event that can hinder endodontic treatment and affect the outcome of root canal treatment is the separation of endodontic instruments. Endodontic instrument separation can occur due to clinical or metallurgical factors. Friction between the ultrasonic tip and the remaining dentin generates heat, which is subsequently transferred to the external root surface. Elevated temperatures exceeding 10°C above body temperature for more than a minute may result in injury to periodontal or bone tissue. The aim of this study was to evaluate and compare temperature rise on the external root surface of teeth during retrieval of broken NiTi instrument using two different ultrasonic tips and two power settings. In each group, a sample size of 8 was sufficient to attain a statistical power exceeding 90%, enabling the detection of a minimum mean difference of 0.9204 (delta) through a one-way ANOVA test at a 95% confidence level (alpha 0.05). After access opening and working length determination, samples were randomly distributed into two groups - Group 1 (A and B) - ProUltra tip at high and low power settings and Group 2 (A and B) - Cric Dental IR3 at high and low power settings. The temperature rise was measured using K-type thermocouple thermometer. The comparisons were analyzed using the Kruskal-Wallis test with pairwise comparisons using the Dunn's test. Group 1A and Group 1B resulted in lower heat generation compared to Group 2A and 2B and its difference was statistically significant (P < 0.05). Minimum temperature rise is seen in the ProUltra group at lower power settings (Group 1A) at the apical level and maximum temperature rise is seen in the Cric Dental IR3 group at higher power settings (Group 2B) at the middle third level. It was found that there is a significant temperature rise seen when ultrasonic tips are used for the retrieval of separated files, especially at higher power settings. The ProUltra tip demonstrated the lowest temperature rise at lower power settings, particularly at the apical level, whereas the IR3 Cric Dental tip exhibited the highest temperature rise, notably at higher power settings and the middle third level.

Effect of apical foraminal enlargement on postoperative pain and inflammatory markers in asymtomatic single-rooted mandibular teeth with apical periodontitis - An in vivo randomized controlled trial.

This study aims to assess the effect of apical foraminal enlargement on inflammatory markers and pain in patients with asymptomatic single-rooted mandibular teeth with apical periodontitis. The study included 60 patients based on inclusion and exclusion criteria. Before beginning root canal treatment (RCT), a blood sample was obtained from the antecubital fossa to evaluate the inflammatory markers, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Access opening was done and initial irrigation was done. Working length (WL) was determined with an electronic apex locator and verified with a radiograph. In the control group, the determined WL was maintained, while in the experimental group, the WL was set till the apical foramen. Biomechanical preparation was done in both groups till F2 or F3 based on the initial apical file, followed by final irrigation and obturation based on the master apical file size. Patients were given a Visual Analog Scale to record pain sensations at 24, 48, and 72 h postoperative. After 72 h, patients were recalled for follow-up appointments, and blood was taken from the antecubital fossa again to evaluate inflammatory markers. The resultant findings for the reduction in inflammatory markers before and after RCT with or without foraminal enlargement were statistically analyzed using the Student's t-test. The pain was statistically examined with one-way "analysis of variance" and Tukey's post hoc test for inter-group comparison of pain. The level of significance was set at P < 0.05. The statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) Version 23 for Windows (SPSS Inc., Chicago, IL, USA). As pain in the control groups is zero before and after RCT, statistical analysis is not required as the overall pain score is zero. The P values of the CRP and ESR of the control group were 0.02 and 0.03, respectively, which indicates it is significant whereas the P values of the ESR and CRP of the experimental group were 0.0002 and 0.0008 which indicates it is highly significant. Results indicate that the experimental group is more effective compared to the control group in reducing inflammatory markers. Pain in the control group after RCT was zero at the end of 24, 48, and 72 h. In the experimental group, where RCT was done with apical foraminal enlargement, mild pain was present at the end of 24 h which gradually decreased at the end of 48 h and no pain was reported at the end of 72 h. Reduction in inflammatory markers was more effective in RCT with apical enlargement than without apical enlargement. RCT with apical enlargement caused mild pain in the patients immediately after treatment which gradually decreased over time.

In Vitro Efficacy of Apical Negative Pressure Irrigation in Primary Teeth: A Smear Layer Analysis.

This study aimed to assess the efficacy of root canal debris removal in primary teeth through irrigation using the Endo-Irrigator Plus (CWAIS). A total of 25 primary mandibular first molars were divided into five groups, with five teeth in each group. After determining the working length and performing biomechanical preparation, groups I and II were subjected to hand and rotary instrumentation (ProTaper, Dentsply, United States of America) with conventional syringe irrigation with positive pressure, while groups III and IV were instrumented using hand and rotary instrumentation with positive and negative pressure irrigation employing the Endo-Irrigator Plus (CWAIS) system. Sodium hypochlorite (5.25%) and ethylenediaminetetraacetic acid (EDTA) (17%) were used as irrigants. Group V served as the control group, undergoing only root canal access opening. The removal of the smear layer was analyzed at the cervical, middle, and apical thirds of the canal using environmental scanning electron microscopy (SEM). Statistical significance was set at p < 0.05. Statistically significant differences were observed among all groups at the cervical, middle, and apical levels (p < 0.05). Groups III and IV exhibited significantly lower smear scores at all levels, particularly in the apical third, as observed through SEM examination. The use of the Endo-Irrigator Plus (CWAIS) system demonstrated superior debridement of intracanal debris in primary teeth compared to the positive pressure irrigation method. Badnaware SD, Kakade A, Takate V, et al. In Vitro Efficacy of Apical Negative Pressure Irrigation in Primary Teeth: A Smear Layer Analysis. Int J Clin Pediatr Dent 2024;17(6):653-657.