Root Canal Research Articles

Effect of ultrasonically-activated irrigation protocols used for regenerative endodontics on removal of dual species biofilm in a three-dimensionally printed tooth model: in vitro study

IntroductionEradication of residual biofilm from root canal dentine is critical for the success of regenerative endodontic procedures (REPs).The aim of the studyTo evaluate the influence of ultrasonically activated irrigants in concentrations used for REPs for removal of dual-species biofilm from three-dimensionally printed tooth models with attached dentine samples.MethodologySeventy-two three-dimensionally printed teeth models were fabricated with a standardized slot in the apical third of the root to ensure a precise fit with a human root dentine specimen. Dual-species biofilms (comprising Enterococcus faecalis and Streptococcus mutans) were cultivated in the root canal for a period of three weeks. Models with dentine specimens were randomly assigned into 5 groups according to the irrigation protocol; G1(dis H2O): infected root canals irrigated with distilled water to serve as controls; G2(1.5% NaOCl): 1.5% NaOCl for five minutes; G3(1.5% NaOCl + PUI): 1.5% NaOCl + passive ultrasonic irrigation (PUI) for 30 s; G4(3% NaOCl): 3% NaOCl for five minutes; G5(3% NaOCl + PUI): 3% NaOCl + PUI for 30 s. Bacterial reduction was determined by colony-forming unit (CFU) counting (n = 12/G), whilst biofilms were analyzed using field emission scanning electron microscopy in additional samples.ResultsThe four experimental groups showed a significant reduction in CFU counts compared to the control group (p < 0.05). When compared with (dis H2O), the highest reduction in bacterial count was obtained in G5 (3% NaOCl + PUI) followed by G4 (3% NaOCl), then G3 (1.5% NaOCl + PUI), and finally G2 (1.5% NaOCl).ConclusionResults of the current study propose that a 3D-printed mature tooth model can be effectively used to analyze the antimicrobial effects of different irrigation protocols on dual-species biofilm. The use of NaOCl in concentrations used for regenerative endodontics can effectively remove bacterial biofilms. Furthermore, the use of PUI did not significantly enhance antibacterial effects of NaOCl.

Evaluation of bacterial biofilm, smear layer, and debris removal efficacy of a hydro-dynamic cavitation system with physiological saline using a new ex vivo model: a CLSM and SEM study

IntroductionTo evaluate the bacterial biofilm, smear layer and debris removal efficacy of a hydro-dynamic cavitation system with physiological saline using a new ex vivo model.MethodsSeventy-five dentin discs were prepared from fifty-four extracted teeth. Seventy-five artificial root sockets were prepared. Sixty dentin discs were used to grow 3-week-old bacterial biofilms, while smear layer and debris were produced on fifteen dentin discs. These dentin discs were adhered to the middle third of the artificial root canals. The sixty ex vivo models with biofilm-covered dentin discs were divided into six groups: control, needle with physiological saline, ultrasonic with physiological saline, Odne™ Clean with physiological saline, needle with 3% NaOCl, and ultrasonic with 3% NaOCl. Biofilm removal efficacy was evaluated using confocal laser scanning microscopy. The fifteen ex vivo models with smear layer and debris-covered dentin discs were divided into three groups: control, Odne™ Clean with physiological saline, and 5% NaOCl followed by 17% EDTA. Smear layer and debris removal efficacy was evaluated using scanning electron microscopy. Statistical analysis was performed using one-way analysis of variance for comparisons involving more than two groups. Post-hoc pairwise comparisons were conducted using the Tukey test.ResultsOdneTMClean with physiological saline (98%) performed significantly better than needle irrigation (47%) or ultrasonic activation (54%) with physiological saline (P < 0.05). OdneTMClean with physiological saline removed biofilms as effectively as needle irrigation (97%) or ultrasonic activation (98%) with 3% NaOCl (P > 0.05). Additionally, 5% NaOCl followed by 17% EDTA (score: 1.33) removed the smear layer significantly better than OdneTMClean with physiological saline (score: 4.47) (P < 0.05). However, OdneTMClean with physiological saline (score: 1.27) removed debris as effectively as 5% NaOCl followed by 17% EDTA (score: 1.13) (P > 0.05).ConclusionsOdneTMClean with physiological saline can effectively remove bacterial biofilm and debris from the dentin surface but cannot effectively remove the smear layer. Utilizing OdneTMClean during the final irrigation may enhance root canal cleaning efficacy.

Metabolic syndrome and its effect on immune cells in apical periodontitis- a narrative review.

Apical periodontitis (AP) is an inflammatory immune response in periapical tissues caused by microbial infections. Failure of root canal treatment or delayed healing is often due to intracanal or extra-radicular bacteria. However, beyond microbial factors, the patient's systemic health can significantly influence the progression and healing of AP. Metabolic syndrome is a risk factor and it is characterized by a cluster of interconnected metabolic risk factors, including abdominal obesity, hyperlipidemia, hypertension, and hyperglycemia. A comprehensive literature review was conducted on apical periodontitis and metabolic syndrome, and their impact on the roles of different immune cell populations. Both AP and metabolic syndrome are inflammatory diseases that involve complex and interwoven immune responses. The affected immune cells are categorized into the innate (neutrophils, macrophages, and dendritic cells) and adaptive immune systems (T cells and B cells). Metabolic diseases and AP are closely correlated, possibly intertwined in a two-way relationship driven by a shared dysregulated immune response. Understanding the pathophysiology and immune mechanisms underlying the two-way relationship between metabolic syndrome and AP can help improve treatment outcomes and enhance the overall well-being of patients with endodontic disease complicated by metabolic syndrome.

Finite element analysis of stress in mandibular molars repaired after fractured instrument removal

BackgroundThis study assessed stress distributions in simulated mandibular molars filled with various materials after the removal of fractured instruments from the apical thirds of the root canals.MethodsFinite element models of the mesial and distal root canals were created, where fractured instruments were assumed to be removed using a staging platform established with a modified Gates-Glidden bur (Woodpecker, Guangxi, P.R. China). Each canal was treated with different materials: Biodentine (Septodont, Saint Maur-des-Fosses, France), mineral trioxide aggregate (MTA), and gutta-percha. In addition to these, four control models were also created. In total, 14 models were generated and subjected to a 300 N force applied at a 45° angle to simulate the stress.ResultsModel 1 (Biodentine) and 2 (Gutta-percha + Biodentine) showed the lowest stresses among mesial root canal models, whereas Model 5 (Gutta-percha) showed the highest. Among distal root canal models, Model 6 (Biodentine) and 7 (Gutta-percha + Biodentine) showed the lowest stresses, while Model 10 (Gutta-percha) showed the highest. In addition, Biodentine (Septodont) and Gutta-percha + Biodentine (Septodont) produced similar stress levels in both mesial and distal roots, while MTA and Gutta-percha + MTA led to increased stresses, especially in the distal root. Among the control models, the highest maximum von Mises stress values were in Model 13 and Model 14, which had a staging platform and were not filled with any root canal filling material, after the broken instrument was removed.ConclusionsBiodentine (Septodont) may be preferable to MTA for filling staging platform cavities post-fractured instrument removal due to lower stress levels. Furthermore, calcium silicate-based materials alone or in combination with Gutta-percha showed similar stress levels, suggesting their potential use for root canal filling. All models demonstrated structural integrity within safe limits.

Assessment of the Quality of Root Canal Fillings-An Ex-Vivo Comparison of CBCT Scans, Conventional Intraoral Sensors, and a Novel Photon-Counting Sensor.

To compare a novel photon-counting sensor, two CBCT protocols and two CMOS sensors on the detection of gaps between a gutta-percha cone and root canal walls. Twenty-five mandibular incisors were prepared to 45/.04 (size/taper) at working length. Teeth were placed in a partially dentate mandible and single gutta-percha cones of seven sizes were placed at length, one at a time, for image acquisition with a photon-counting sensor, two CBCT protocols (90µm3, 120µm3) and two CMOS sensors. Three calibrated observers assessed images for gap presence. Sensitivity, specificity, accuracy, AUC, and agreement with gold standard were determined using ANOVA and Tukey test (p ≤ 0.05). Photon-counting sensor showed superior sensitivity and accuracy (88.47%, 81.57%), significantly higher than the CBCT protocols (50.70-56.33%, 45.87-53.17%). Contrarily, the photon-counting sensor showed the lowest specificity (40.27%), significantly lower than the CBCT protocols (90.27%, 97.23%). CMOS sensors showed sensitivity, specificity, and accuracy between 72.23-74.53%, not differing from other modalities. All intraoral sensors showed AUC around 82.87-84.03%, significantly higher than CBCT protocol 120µm3 (74.07%). The file size was inversely related to gap size and percentual agreement with gold standard. CMOS sensors showed consistent results, while the photon-counting sensor had the highest sensitivity but lacked specificity. CBCT protocols excelled in specificity but had lower sensitivity. Novel photon-counting sensors and CBCT imaging provided no significant advantage over conventional sensors in assessing gaps as an indicator of quality of root canal filling. Furthermore, smaller gaps were more difficult to detect, regardless of the imaging technique used.

Three-year follow-up case report: root canal treatment combined with intentional replantation for treating type III palatogingival groove in a maxillary lateral incisor

Three-year follow-up case report: root canal treatment combined with intentional replantation for treating type III palatogingival groove in a maxillary lateral incisor

Evaluation of the effect of different irrigation solutions used in regenerative endodontic treatment of necrotic molar teeth with open apex on postoperative pain- randomized clinical trial

ObjectivesThis study evaluates the effect of different irrigation solutions for postoperative pain in the regenerative endodontic treatments (RET) of necrotic teeth with open apex.Materials and methodsThis study included necrotic, deeply carious lower molars of 42 patients. Access cavities of the teeth were opened and working lengths were measured at the first visit. In Group 1, the root canals were irrigated with 1.5% sodium hypochlorite (NaOCl) and 17% Ethylenediaminetetraacetic-acid (EDTA), in Group 2, with 1.5% NaOCl and 10% citric acid, and in the Group 3, with 1.5% NaOCl and 9% Etidronic acid (HEDP) mixture solution. Final irrigation was performed with distilled water. The canals were dried, filled with calcium hydroxide paste, and sealed with Cavit. Postoperative pain was assessed using a numerical rating scale, and Paracetamol was prescribed. At the second visit, calcium hydroxide was removed with 1.5% NaOCl, irrigated with chelators, and sealed with Sure-Seal PT 3 mm below the cementoenamel junction before composite resin filling.ResultsPostoperative pain was higher in Group 3 (p < 0.05), but analgesic consumption did not show a significant difference (p > 0.05).ConclusionsHEDP caused significantly more postoperative pain than EDTA and citric acid (p < 0.05). While the study provided information regarding the effects of irrigation solutions on postoperative pain, further research is needed as it did not include detailed assessments of long-term periapical healing and apex closure.Clinical relevanceWhen HEDP is used as a chelation agent in RETs, it shows a higher degree of postoperative pain than EDTA and citric acid solutions.Clinical trial registrationThe study protocol was registered at www.clinicaltrials.gov (ID: NCT 06386991).

In vitro comparison of the marginal adaptation of cold ceramic sealer with the single-cone obturation technique versus AH-26 sealer with the lateral compaction technique in single-canal teeth

ObjectivesThis study aimed to compare the marginal adaptation of a cold ceramic (CC) sealer with the single-cone obturation technique with that of an AH-26 sealer with the lateral compaction technique in single-canal teeth.Materials and methodsIn this in vitro experimental study, the root canals of 24 extracted single-rooted single-canal teeth were instrumented to F3 files by the crown-down technique and randomly assigned to 2 groups (n = 12). The root canals were obturated with a CC sealer and single-cone obturation technique with 4% gutta-percha in group 1 and with an AH-26 sealer and lateral compaction technique with 2% gutta-percha in group 2. After 4 weeks of storage at room temperature and 100% humidity, the root ends were sectioned horizontally 3 mm from the apex, and the mean linear distance between the root filling material and the root dentinal wall was measured under a scanning electron microscope (SEM). Comparisons were made by the Mann‒Whitney test (alpha = 0.05).ResultsThe mean linear distance (gap) was significantly smaller in the CC sealer/single-cone group than the AH-26/lateral compaction group (6.72 ± 2.57 vs. 12.94 ± 4.82 μm, P = 0.001).ConclusionMarginal adaptation was significantly higher with the CC sealer and single-cone obturation technique than with the AH-26/lateral compaction technique, suggesting the suitability of the CC sealer and single-cone obturation technique for a hermetic seal in single-canal teeth.

УДАЛЕНИЕ СЛОМАННЫХ ИНСТРУМЕНТОВ ИЗ КОРНЕВЫХ КАНАЛОВ: АНАЛИЗ УЛЬТРАЗВУКОВОГО МЕТОДА И ЕЕ ЭФФЕКТИВНОСТЬ

The goal is to evaluate the effectiveness of methods for extracting broken files from root canals and their impact on tooth strength. Materials and methods. The study used 25 chlorhexidine-treated double-rooted maxillary premolars. Samples were divided into experimental and control groups. The experimental group underwent complex procedures for extracting damaged instruments with various localizations, the results of which were analyzed using statistical methods. Results. In the experimental group, 80% of broken instruments were successfully extracted, especially effectively in the middle part of the root. Although the control group required slightly more effort to break down the root, no significant differences in strength were noted between the groups. Conclusions. The ultrasonic extraction method is effective for removing broken instruments, minimally affecting tooth strength. Careful planning of procedures, taking into account the configuration of the channels, significantly increases the chances of successful deletion.

Development of photodynamic therapy in treating oral diseases

The morbidity of oral disorders, including gingivitis, caries, endodontic-periodontal diseases, and oral cancer, is relatively high globally. Pathogenic cells are the root cause of many oral disorders, and oral therapies depend on eradicating them. Photodynamic therapy (PDT) has been established as a potential and non-invasive local adjuvant treatment for oral disorders. PDT consists of three essential components: photosensitizer (PS), a light source with a certain wavelength, and oxygen dissolved in the cells. These three components can interact to cause damage to proteins, lipids, nucleic acids, and other biological components within diseased tissues. Herein, we aimed to provide a detailed understanding of PDT and how it can treat oral diseases. Concerns about PDT and potential remedies are also a factor. PDT has been shown in numerous clinical studies to be an efficient supplementary therapy that can reduce pathogenic cells. The PDT has great potential for dental applications, including treating bacterial and fungal infections during root canal therapy and preventing oral cancer, potentially malignant disorders, periodontitis, dental caries, and peri-implant disorders. Although PDT has been promoted as having significant potential and utility in dentistry, more clinical research must be conducted before being used broadly.

Influence of Calcium Silicate-Based vs. Resin-Based Sealers on Pull-Out Bond Strength of Two Universal Adhesive/Resin Cement Combinations for Fiber Posts Cementation

This in vitro study investigated the influence of root canal sealer type (calcium silicate-based vs. resin-based) on the pull-out bond strength of two universal adhesive/resin cement combinations. Forty-eight human premolars were prepared, obturated with either Ceraseal™ (calcium-silicate based) (C) or AH Plus™ (resin-based) (A), and stored at 37°C, 100% humidity for 24 hours. Two adhesive/resin cement combinations were used for fiber post cementation: Single Bond Universal/RelyX™ Ultimate (UT) and ScotchbondTM Universal Plus/RelyX™ Universal (UN). Pull-out bond strength values (Newton) were measured after seven days using a universal testing machine. Then all fiber posts were observed for mode of failure using a stereomicroscope. AH PlusTM and ScotchbondTM Universal Plus/RelyXTM Universal (AUN) had the highest bond strength (263.50 ± 46.47 N), while CeraSealTM and Single Bond Universal Adhesive/RelyXTM Ultimate (CUT) had the lowest (202.88± 38.21 N). The results of the two-way ANOVA indicated a significant main effect for root canal sealer types (P = 0.025); a significant main effect for resin cement types (P = 0.015); and no significant interaction effect between root canal sealer types and resin cement types (P = 0.068). Post hoc Tukey HSD testing revealed significant differences between CUT and CUN (p = 0.008), CUT and AUN (P = 0.003), and CUT and AUT (P = 0.024). The most common failure mode was the mixed type. The type of root canal sealer and the combination of adhesive/resin cements influence pull-out bond strength values. Using the calcium-silicated base sealer may decrease the pull-out bond strength values in certain adhesive/resin cement combinations.

The employment of recommended root canal treatment procedures by dentists in Croatia and the Czech Republic.

This study aimed to evaluate the compliance of dentists in Croatia and the Czech Republic with endodontic recommendations and identify the subjective and objective factors influencing their adherence to them. A total of 1386 dentists from Croatia and the Czech Republic participated in an online survey through a self-administered, author-designed questionnaire. After excluding those who did not perform root canal treatments (RCT), 1376 responses (394 from Croatia and 982 from the Czech Republic) were statistically analysed. The median age of respondents was 40 years, with a higher proportion of females in both countries. Croatian dentists treated fewer patients weekly but performed more RCTs and placed more composite fillings than their Czech counterparts. Czech dentists more frequently employed magnification devices, rubber dam (RD), pre-endodontic build-ups, nickel-titanium (NiTi) instruments, irrigant activation, bioceramic sealers, indirect post-endodontic restoration of lateral teeth, and single-visit treatments. These practices were also more common among endodontists than general dental practitioners and other specialists in both countries. Croatian dentists adhered more consistently to the recommended irrigation protocol. In the Czech group, adherence to recommended procedures, such as magnification, RD usage, and irrigation protocol correlated with younger age, smaller weekly number of patients, and preference for treating patients in the supine position. No such correlations were observed among the Croatian dentists. Despite notable improvements in recent years, dentists still do not fully comply with the recommended RCT working procedures in Croatia and the Czech Republic.

ENDODONTIC TREATMENT OF DECIDUOUS LOWER MOLAR DUE TO AGENESIS OF THE PERMANENT TOOTH GERM

The objective of this study was to describe the preparation of root canals with a rotary system in a lower molar (85). A 23-year-old female patient was referred to the office of an endodontic specialist for endodontic therapy of her primary lower molar (85). During the clinical examination, he reported pain on vertical percussion and occluso-distal composite resin restoration. Radiographic examination revealed deep restoration close to the distal pulp horn and agenesis of tooth 46. The probable diagnosis was acute apical periodontitis. Exploration of the root canals is carried out with a #10 C-pilot file, based on the apparent length of the tooth. Electronic odontometry was performed with the apex locator (Iroot Apex). The preparation of the root canals was carried out with a Prodesign Logic #30.05 file in the three root canals. During the preparation of each canal, 2% Chlorhexidine gel was used to facilitate the action of the nickel-titanium instruments. The filling of the root canals, carried out in the same session with the calibrated MX single cone technique (Tanari) associated with Bio-C Sealer cement (bioceramic cement). Clinical and radiographic follow-up, carried out two years after filling the canals, determined the success of endodontic therapy. It is concluded that the endodontic treatment of deciduous teeth must be carried out in accordance with the technical standards of endodontics, aiming at sanitization, modeling and hermetic filling, determining reabsorption of the bioceramic cement extravasated at the time of filling, which has been proven during 2 years of maintenance. completion of endodontic therapy.

Proprietary surgical approach to the treatment of large radicular cyst with retrograde filling of resected root canals: a clinical case report

Relevance. Radicular cysts account for 86% of all odontogenic cysts. Recurrence rates following cystotomy and cystectomy range from 18% to 36%, and in some cases, up to 55%. The primary causes include incomplete removal of pathological tissues, damage to adjacent anatomical structures, insufficient pathogen eradication, and inadequate bone tissue regeneration.Clinical case description. This paper presents a clinical case of a large radicular cyst affecting teeth 3.1, 4.1, 4.2, and 4.3 of the mandible. The treatment process was carried out in two stages. In the first stage, endodontic treatment was performed on the affected teeth. Seven days after the exudation subsided, the second stage involved filling the canals with a fast-setting material (FSM) Rootdent SM DMT as a sealer, followed by the placement of silver pins. Three hours after completing the endodontic treatment, a cystectomy was performed using a proprietary method that combined guided tissue regeneration, apical resection of the affected teeth, and retrograde filling of their root canals with FSM. A one-year follow-up showed full recovery, including complete bone regeneration and no gingival scarring.Conclusion. The proposed treatment strategy for large radicular cysts has the potential to greatly minimize the need for extracting the affected teeth.

Restoring Original Canal Trajectory Post complete Obstruction: Guided Endodontics case report

Guided Endodontics uses imaging technologies and computer-aided design to plan and perform procedures in challenging cases such as root canal calcification. This study describes the case of a 75-year-old female patient with pain in tooth 22. Radiographic analysis revealed calcification of the root canal. The procedure involves Cone Beam Computed Tomography and intraoral scanning for virtual planning of the endodontic guide, which was 3D printed and fixed in the patient's maxilla to access the canal using a specific drill. After instrumentation of the canal and removal of the smear layer, the canal was obturated with bioceramic cement. The patient returned three years after obturation of the root canal system, observing the success of endodontic therapy, concluding the effectiveness of Guided Endodontics in the treatment of root canal calcification, providing satisfactory and predictable clinical results.

Current Trends in Endodontic Clinical Practice in Croatia: A Report From a Croatian National Survey.

To assess the state of endodontic practices and identify factors influencing the use of modern endodontic techniques among dental practitioners in Croatia. A questionnaire was distributed to all dental offices in Croatia, yielding 819 responses (27% response rate). Data were descriptively analyzed and statistically modeled. Nearly 74% of endodontic treatments in Croatia are performed by general practitioners (17 teeth per month per practitioner), while endodontic specialists handle the highest number of treatments per specialist (67 teeth per month, representing 15% of total treatments). 56% of respondents use radiography before the procedure "always" or "almost always" with intra-oral periapical radiography being the most commonly used technique. Rubber dams are used "never" to "rarely" by 74% of respondents. Apex-locators are highly prevalent, used "almost always" to "always" by 83% of practitioners. Magnifiers are rarely used, with 63% of respondents reporting they "never" use them. Lasers are never used by 92% of respondents, whereas 59% frequently use engine-driven instrumentation. 76% of respondents "always" or "almost always" determine the working length of the root canal. Sodium hypochlorite is the most common irrigant (88%), and EDTA for smear layer removal is used by 36% of respondents. The cold lateral condensation is the most popular obturation technique (64%). CBCT is unused by 59% of responders, most probably because it is not accessible. Croatian endodontic practices are comparable to those in countries with similar economic status, but there is substantial potential, particularly among general practitioners, to enhance knowledge and awareness of modern technologies through continuous education. Underused techniques in Croatia include rubber dams, magnifiers, lasers, and CBCT.

Chitosan’s Ability to Remove the Smear Layer—A Systematic Review of Ex Vivo Studies

Background and Objectives: This systematic review aimed to compare the effect of chitosan in smear layer removal with other commonly used chelators during root canal treatment. Materials and Methods: The PRISMA guidelines were followed. Ex vivo studies performed in non-endodontically treated extracted human permanent teeth with a fully formed apex, in which sodium hypochlorite was the main irrigant and chitosan was used as final irrigation to observe its capacity to remove the smear layer using a Scanning Electron Microscope (SEM), were included. In addition, reviews, letters, opinion articles, conference abstracts, book chapters, or articles that did not use a control group were excluded. A literature search was undertaken without limits on time or language, until February 2024, in PubMed—MEDLINE, Scopus, Web of Science, and in the electronic archives of four endodontic journals. The risk of bias was evaluated by adapting the risk of bias assessment used in a previous study. Study selection, data collection, and synthesis were performed and the risk of bias was assessed by two independent reviewers. Results: Six studies fulfilled the eligibility criteria and were included. Four studies found chitosan to be as effective as EDTA and one paper showed it was more effective than EDTA and MTAD; however, one article found it to be comparable to citric acid. The overall risk of bias was medium. Quantitative analysis of the results was not possible due to the heterogeneity found between the study methodologies of the included articles. Conclusions: Within the limitations of this study, 0.2% chitosan may be considered as a promising irrigation solution when employed as a final irrigant in order to remove the smear layer. Nonetheless, a standardized protocol for the use of chelators in root canal treatment should be established in future studies.

Efficacy of non -thermal pressure plasma versus other modalities for disinfection of primary root canals

BackgroundEndodontic treatment aims in the preservation of extremely carious primary teeth. For root canal therapy to be successful, root canals must be properly prepared and effectively irrigated .Therefore, it is necessary to select the proper root canal disinfection method to preserve the primary tooth.ObjectiveThis research was carried out to compare non-thermal pressure plasma (NTPP), diode laser, propolis, and chlorhexidine (CHX) efficacy for disinfection of deciduous anterior root canals contaminated with Enterococcus Faecalis (E. faecalis) after sterilization by gamma radiation.MethodsIn this study, forty extracted single-rooted primary anterior teeth were used. All teeth were cleaned, disinfected, and stored till use. Gaining access was provided till reaching the orifices of canals, all pulp tissue debris was removed, and root canals of all teeth were prepared. Standardized 8 mm root length was obtained through crown decronation below the cemento-enamel junction. Samples were sterilized by gamma radiation then the bacterial suspension was inoculated inside root canals. Specimens divided into four main groups; ten samples each group. Group I: Samples irrigated with chlorhexidine. Group II: Samples treated with diode laser. Group III: Samples irrigated with Ethanolic extract of propolis. Group IV: Samples treated with NTPP.ResultsA significant difference was found between values measured before and after four irrigation types (p < 0.001) for CHX, Diode Laser, NTPP and (P = 0.035) for Propolis. The highest values of colony reduction measured before and after irrigation were for NTPP (4.06 ± 0.88). Maximum reduction in colony-forming units was recorded in the NTPP group (98.79%), while the lowest reduction in colony-forming units was recorded in Propolis group (81.99%).ConclusionAll tested methods (CHX, NTPP, Diode laser and Propolis) decreased colony count, with the highest reduction noted in group treated by NTPP and the least reduction noticed in Propolis treated group.

Potential Antibacterial of Leaf Sirih Merah Against Enterococcus Faecalis ATCC 29212 Bacteria.

Dental root canal failure is a disease caused by gram-positive bacteria, Enterococcus faecalis. The disease is caused by the bacterial cell wall consisting of a peptidoglycan layer that protects the bacteria from internal osmotic pressure. Peptidoglycan biosynthesis includes many enzymes, such as MurA, Penicillin-binding protein (PBP), and SrtA. Herbal plants are a source of bioactive compounds, including antibacterial agents. There is information that red betel leaves, also known as Piper crocatum, contain active substances such as flavonoids, terpenoids, and steroids. However, there is no additional information on the antibacterial properties of P. crocatum and the molecular mechanisms that affect the cell wall of E. faecalis ATCC 29212 bacteria. This study aims to determine the antibacterial activity of the extract in vitro, screen and study the antibacterial compounds of red betel leaves against oral pathogenic bacteria, namely E.faecalis ATCC 29212 through molecular docking. The n-hexan:ea (9:1) fraction of P. crocatum extract was tested for inhibition zones against E. faecalis ATCC 29212 bacteria, fractions that had positive results were then identified using the LC-MS method. The LC-MS resulting compounds were tested using In Silico. Antibacterial in the n-hexane: ethyl acetate (9:1) fraction of Red Betel Leaf has the best concentration of 10% with a moderate inhibition zone category. LC-MS test results identified compounds including Longicamphenylone, m/z 207, Nootkatone m/z 219, and Tridecanal m/z 221. Molecular interactions between these compounds with target proteins, namely MurA, PBP, and SrtA, show lower binding affinity values than natural ligands and positive controls for each protein. Nootkatone compounds demonstrated potential as MurA and PBP inhibitors, while Longicamphenylone compounds showed potential as SrtA inhibitors. Both compounds have the potential to inhibit peptidoglycan biosynthesis and bacterial cell wall formation through docking simulations.

The XP-endo Shaper and Its Impact on Post-treatment Discomfort: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

This systematic review and meta-analysis assess the impact of the XP-endo Shaper (XPS) on postoperative pain following root canal treatment (RCTs) and compare its efficacy with other endodontic systems. A comprehensive literature search was conducted in MEDLINE, Web of Science, Embase, and the Cochrane Library from January 2000 to August 2024. Randomized controlled trials using XPS and reporting postoperative pain were included. Pain levels were measured using the Visual Analog Scale (VAS) at multiple postoperative time points. Data were pooled and analyzed using a random-effects model, revealing significant heterogeneity. Six randomized controlled trials involving 731 patients met the inclusion criteria. The pooled analysis revealed that XPS significantly reduced pain scores at the 6, 12, and 24-hour time points (SMD -1.30, 95% CI [-2.36, -0.24], p = 0.016; SMD -3.00, 95% CI [-3.54, -2.46], p < 0.001; SMD -0.91, 95% CI [-1.53, -0.28], p = 0.005, respectively) compared to other systems, including WaveOne Gold (WOG) and HyFlex EDM (HEDM). Pain scores beyond 48 hours were comparable between XPS and other file systems. XPS shows substantial short-term efficacy in reducing postoperative pain following RCTs, likely due to its flexible design and reduced debris extrusion. The findings suggest that XPS can potentially improve patient comfort, though long-term pain outcomes remain similar to other systems.