Endodontic Procedures Research Articles

Effects of aqueous and ethanolic extracts of Chinese propolis on dental pulp stem cell viability, migration and cytokine expression

Background Propolis is a natural substance produced by honeybees that has various biological properties including, anti-inflammatory, antioxidant and antimicrobial properties. Although previous studies have evaluated the antimicrobial effects of propolis in dentistry, its effects on dental pulp stem cell (DPSC) viability, migration, and differentiation are yet not well understood. The objective of this study was to investigate the effects of Chinese propolis on viability/proliferation, migration, differentiation and cytokine expression in DPSCs. Methods Commercially available DPSCs (Lonza) were treated with aqueous extract of propolis (AEP) or ethanolic extract of propolis (EEP), and viability/proliferation was evaluated using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assays and quantification of nuclear staining. DPSC differentiation into mineralizing cells was evaluated with Alizarin red staining and cell migration was assessed using Boyden Chamber Transwell inserts. Cytokine expression was measured by RT-qPCR. AEP and EEP at 0.03 and 0.1 mg/mL did not affect DPSC viability/proliferation for up to 7-days treatment. Results Higher doses (0.33–33 mg/mL) induced a dose dependent decrease in DPSC viability/proliferation with a more prominent effect with EEP at 7 days. Neither AEP nor EEP induced DPSC differentiation into mineralizing cells, but both AEP and EEP (0.03–0.1 mg/ml) induced a dose dependent increase in DPSC migration. In addition, EEP prevents the upregulation of IL1b and IL6 but not IL8 and CCL2 in response to lipopolysaccharide stimulation. AEP has less potent anti-inflammatory effects and prevents only IL1b upregulation. Conclusion This study provides new information about the biologic properties of ethanolic and aqueous extracts of propolis and shows that propolis, at doses that do not affect cell viability, induces DPSC migration and has anti-inflammatory properties. These data highlight the potential use of propolis as an alternative intra-canal medicament for regenerative endodontic procedures.

Dehydrated Human Amnion–Chorion Membrane as a Bioactive Scaffold for Dental Pulp Tissue Regeneration

The dehydrated human amnion–chorion membranes (dHACMs) derived from the human placenta have emerged as a promising biomaterial for dental pulp regeneration owing to their unique biological and structural properties. The purpose of this review is to explore the potentials of dHACMs in dental pulp tissue engineering, focusing on their ability to promote cellular proliferation, differentiation, angiogenesis, and neurogenesis. dHACMs are rich in extracellular matrix proteins and growth factors such as TGF-β1, FGF2, and VEGF. They also exhibit significant anti-inflammatory and antimicrobial properties, creating an optimal environment for dental pulp regeneration. The applications of dHACMs in regenerative endodontic procedures are discussed, highlighting their ability to support the formation of dentin and well-vascularized pulp-like tissue. This review demonstrates that dHACMs hold significant potential for enhancing the success of pulp regeneration and offer a biologically based approach to preserve tooth vitality and improve tooth survival. Future research is expected to focus on conducting long-term clinical studies to establish their efficacy and safety.

Pulp regeneration using a peptide nanofiber artificial scaffold on animal models: A preliminary study.

In regenerative endodontic procedures (REPs), it is crucial to find effective materials. This study introduces glycosaminoglycan (GAG) mimetic peptide amphiphile (PA, GAG-PA) and K-PA nanofibers, synthesized to emulate sulfated GAGs, aiming to enhance tissue repair within damaged pulp - an area where standardized protocols are currently lacking. The objective of this study was to investigate the regenerative potential of GAG-PA nanofibers in REP. Heparan sulfate mimicking PAs was designed to develop a bioactive nanofibrous supramolecular system. The cavities on the mesial surfaces of the first upper molars of 8 rats (4 rats in the study group and 4 in the control group) were prepared, and the pulps were perforated. Then, the material was applied onto the dental pulp, and the cavities were closed with a self-curing glass ionomer cement filling material. Physiological saline was used in the control group. Thirty days after application, the teeth were extracted, and the formation of regenerative tissue sections in the pulp was evaluated using hematoxylin and eosin (H&E) staining and Masson's trichrome staining. After 30 days, H&E staining demonstrated robust tissue regeneration in the implanted region, with minimal neutrophil infiltration. Masson's trichrome staining confirmed reparative dentin formation. Quantitative analysis revealed a regeneration percentage of 85% in the study group, compared to 80% in the control group. Statistical analysis showed no significant difference in regeneration between the groups (p > 0.05). Our comprehensive study, utilizing GAG-PA and K-PA nanofibers, demonstrated successful synthesis, characterization and formation of nanofiber networks. The in vivo experiment with rats exhibited substantial tissue regeneration with quantifiable results supporting the efficacy of the nanofiber approach. Statistical analysis confirmed the consistency between the study and control groups, emphasizing the potential of these nanofibers in endodontic tissue regeneration applications.

Assessment of Dentists Attitudes, Knowledge, Practices, and Challenges in Utilizing Rubber Dams for Restorative and Endodontic Procedures: An Online Questionnaire Survey

Rubber dams are essential for dental procedures, ensuring isolation, patient safety, and better work efficiency for dentists. However, their use is often limited by challenges such as difficulty in application, time constraints, and inadequate training. This study aimed to assess the attitudes, knowledge, practices, and challenges to rubber dam use during among dentists in Tripoli, Libya. A cross-sectional online survey involving 165 dentists was conducted using a validated 26-item questionnaire. Data were analyzed using chi-square tests, with significance set at p <0.05. Results showed that 67.9% of dentists had access to rubber dams, but only 64.8% used them. Lack of training during undergraduate studies was reported by 61.2%, and 42.4% identified inadequate training as the main barrier. Significant association were found between rubber dam use and gender, place of work, prior training, and years of practice. Although dentists expressed positive attitudes toward rubber dam use, barriers such as insufficient training, radiographic procedures, and time constraints hindered regular application. Enhanced training programs could improve acceptance rates.

Multilayer Ultratranslucent Monolithic Zirconia Crowns Treated With Multimode Universal Adhesive System Containing Zirconia Primer: A Clinical Report

ABSTRACTIntroductionUltratranslucent zirconia combines high mechanical strength and esthetics, making it ideal for monolithic restorations. This case report describes a total rehabilitation of the upper dental arch with single‐unit crowns made of multilayer ultratranslucent zirconia (Prettau 4 Anterior, Zirkonzahn), as well as the use of a simplified adhesive cementation protocol for this type of ceramic.Materials and MethodsA 64‐year‐old female patient sought rehabilitative treatment, after planning in a semi‐adjustable articulator, interim prostheses, from tooth 2 to 15, were installed to restore occlusal vertical dimension and esthetics. After all surgical, periodontal, and endodontic procedures, impressions of the upper and lower arches were taken. In the maxilla, 14 zirconia crowns with a color gradient were fabricated and cemented, with their internal surface treated with a multimode adhesive system containing zirconia primer (Single Bond Universal, 3M ESPE). The same adhesive system was applied to the preparations, and the crowns were cemented with dual resin cement (RelyX Ultimate, 3M ESPE).ResultsAfter the crowns exhibited excellent esthetic results, with only a minor fracture observed on the palatal cusps of the right first upper premolars.ConclusionsThus, ultratranslucent zirconia appears to be a viable option for oral rehabilitation with single‐unit crowns due to its excellent clinical performance.Clinical SignificanceMonolithic ultratranslucent zirconia crowns are able to reproduce the natural characteristics of dental elements. Additionally, the application of 10‐methacryloyloxydecyl dihydrogen phosphate‐based primer has proven to be an efficient surface treatment for adhesive cementation of UT zirconia.

Exploring the Impact of Access Cavity Designs on Canal Orifice Localization and Debris Presence: A Scoping Review.

One of the primary objectives in endodontics is to achieve thorough cleaning and disinfection of the root canal system during an endodontic procedure. This aims to reduce microbial contamination and prevent the development of endodontic lesions. To attain this goal, it is imperative to establish access to the endodontic space that allows for the complete removal of pulp tissue and the accurate identification of canal orifices while preserving the anatomical integrity of the root floor and pulp chamber as much as possible. In this scoping review, we aim to explore aspects related to the identification of canal orifices and the presence of pulp debris and residues during endodontic treatment. Specifically, we aim to assess whether and to what extent the design of the access cavity impacts these factors. The scoping review was conducted and prepared following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PRISMA Extension for Scoping Reviews [PRISMA-ScR]). The search yielded a total of 3697 bibliographic sources. After eliminating duplicates and applying eligibility criteria, only 10 studies were included. In conclusion, our review, conducted following PRISMA guidelines, includes 10 studies and suggests a potential trend: conservative techniques may generate more debris, whereas guided techniques exhibit superior precision in locating canal openings.

Peripherally induced movement disorders in the stomatognathic system after oral surgical or dental procedures.

Peripherally induced movement disorders (PIMD) are hyperkinetic movement disorders that can occur after injury to a part of the body. This study aimed to identify PIMD in the stomatognathic system following dental or oral surgical procedures. A total of 229 patients with PIMD (144 women and 85 men; mean age: 53.4 years) triggered by oral surgical or dental interventions were evaluated retrospectively. The average latency between the procedures and onset of PIMD was 14.3 days. Oral surgery (40.2%), including tooth extraction, trauma treatment, and other surgical procedures, was the most frequent trigger of PIMD. This was followed by general dental treatment, including periodontal, endodontic, and restorative procedures (36.7%), prosthetic treatment (19.7%), and orthodontic treatment (3.5%). PIMD consisted of oromandibular dystonia (73.8%), functional (psychogenic) movement disorders (11.4%), orolingual dyskinesia (7.9%), and hemimasticatory spasms (5.7%). These results suggest that even minor alterations in normal anatomy or physiology after dental procedures may result in PIMD in predisposing patients. Dental professionals should be aware that although infrequently, PIMD can develop after various dental treatments. If such symptoms precipitate, the attending physician should properly explain them to the patient and provide appropriate treatment or consultation with a movement disorder specialist.

Umbilical cord mesenchymal stem cells improve bone regeneration in diabetes mellitus animal model with apical periodontitis

BackgroundPrevious studies revealed diabetes mellitus subjects tend to have persistent apical periodontitis. Regenerative stem cells therapy through endodontic procedure is hoped to be a solution. This study assessed bone regeneration in diabetic rats with apical periodontitis through histopathological analysis of osteoblasts and immunohistochemical analysis of runt-related transcription factor 2 (Runx2) and Osterix. MethodsDiabetes mellitus and apical periodontitis was induced on 20 rats. Apical periodontitis was induced on mandibular right first molars under anesthesia. The teeth were left open for 7 days following access cavity and pulp extirpation, then the rats’ teeth were endodontically treated and randomly allocated into 4 groups (5 rats per group). The first and second groups was ended at 30 days (C30) and 60 days (C60) and labelled as control. The third and fourth groups was given umbilical cord mesenchymal stem cells and ended at 30 days (T30) and 60 days (T60). The osteoblasts, Runx2 and Osterix were analyzed. ANOVA and Tukey HSD tests were used for analysis. Differences with p values < 0.05 were considered significant. ResultsThe number of osteoblasts in the apical area in control groups (C30 and C60) and treatment groups (T30 and T60) showed a significant increase (p < 0.05). The expressions of Runx2 and Osterix in osteoblasts showed a significant increase among the control (C30 and C60) and treatment groups (T30 and T60) (p < 0.05). ConclusionUmbilical cord mesenchymal stem cells improve bone regeneration in diabetic animal model with apical periodontitis, in terms of osteoblasts, Runx2 and Osterix.

Perception of Dental Interns About Intracanal Fracture of Endodontic Instruments in the Central Region of Saudi Arabia: A Cross-Sectional Study

ABSTRACT Objective: This study assessed the perceptions among dental interns regarding intracanal fracture of endodontic instruments. Methodology: This cross-sectional observational study was performed among 206 dental interns working in Saudi Arabia. A validated questionnaire encompassing 15 close-ended questions was used. The questionnaire consisted of two components: the first component (Section I) gathered demographic details, and the second part (Section II) examined the causes of EFS during root canal treatment. A Pearson’s Chi-square test was applied to determine the association of perceptions of EFS during endodontic procedures between male and female interns. Results: The study findings showed that out of 206 dental interns, 107 (51.9%) were males and 99 (48.1%) were females. The perceptions regarding intracanal instrument fracture revealed that hand files (71 (34.5%)) were less likely to break than rotary files (132 (64.1%)). Around 152 (73.8%) respondents said that stainless steel was the most frequently broken alloy. Moreover, there was a significant relationship between gender and the belief that operator expertise plays a role in preventing instrument fracture. Conclusion: This study concluded that dental interns were aware of factors contributing to file separation during endodontic treatment. They believed fractures were more common in the apical third of posterior teeth, preferred Nickel Titanium for instruments, and thought hand files were less prone to fracture than rotary files.

To Evaluate and Compare the Microleakage of Chitosan Nano Hydrogel-Incorporated MTA and Glass Ionomer Cements When used as a Retrograde Filling Material

ABSTRACT Background: An inadequate apical seal stands out as a primary cause of disappointment in surgical endodontic procedures. Therefore, the choice of root-end filling material should aim to prevent the leakage of potential contaminants into the periapical tissue. Aim: To evaluate and compare microleakage of chitosan nano hydrogel-incorporated mineral trioxide aggregate (MTA) and glass ionomer cement (GIC) when used as a retrograde filling material. Materials and Methods: Sixty single-rooted premolars were decoronated at cemento enamel junction (CEJ), and root canals were prepared and obturated, with the coronal part sealed with a composite. The dye absorption was measured by an automatic spectrophotometer. Results: The results showed that the MTA + chitosan group had less microleakage values compared to the MTA group but was not statistically significant and GIC + chitosan had less microleakage values compared to the GIC group and was statistically significant. Conclusion: Chitosan-incorporated MTA and chitosan-incorporated GIC can be considered as retrograde filling material; however, further in vitro and in vivo research and long-term clinical studies are required.

Patient-related perceptions and experience measures of non-surgical endodontic treatment – A cross-sectional study

Objectives: This study assessed the outpatients’ perceptions of non-surgical root canal treatment (RCT) and compared them with their post-treatment experiences. Material and Methods: Eighty participants were selected for this cross-sectional study based on inclusion and exclusion criteria. Two surveys were conducted from October 01, 2023, to November 30, 2023 (Pretreatment survey) – one conducted before the RCT includes a survey about the patient’s past RCT experiences and demographics such as age, sex, and level of educational status. Multiple-choice questions were employed to determine patient concerns related to RCT, while modified visual analog scales (0–100) were used to assess pain and anxiety (Post-treatment survey) – done after the endodontic procedure with a root canal filling material. It outlines the patient’s experience, any discomfort experienced during treatment, the significance of tooth retention, and Re-RCT. Results: No difference was found in the demographic analysis. Out of the 80 participants, 33 participants (41.25%) presented with pretreatment anxiety, and 12 participants (15%) reported post-treatment. In the pretreatment survey, the primary concerns were pain and cost, which were reported at 27.55% and 10%, respectively. The post-treatment survey detailed that the time and the need for Re-RCT were the concerns, with reported rates of 11.25% and 10%, respectively. An absolute difference was found between anticipated and pre-operative pain and between experienced and pre-operative pain. However, no difference was found between anticipated and experienced pain 89% of the patients were willing to go for RCT again if needed. Conclusion: Treatment success is the goal for any dental procedure performed, which might be perceived differently by the patient and dentist. Consideration of patient perceptions and experiences, along with the dentist’s opinions, will help enhance endodontic treatment success.

Evaluating the effectiveness of a novel training model in dental preclinical regenerative endodontic education.

Regenerative endodontic procedures (REPs) are tissue engineering-based treatments aimed at regenerating the pulp-dentin complex. However, these procedures are not widely practiced or well-known among dentists due to a lack of training. This study aims to develop a practical hands-on training model for REPs to enhance students' theoretical knowledge and practical skills. A cost-effective, easy-to-operate, and reusable training model for preclinical training of REPs was developed. A total of 125 undergraduates were divided into an experimental group (REPs model) and a control group (traditional teaching). The students' theoretical knowledge and operational skills were assessed through examinations and practical assessments. Student perceptions were assessed by questionnaires. The experimental group achieved higher scores in theoretical knowledge and operational skills compared to the control group (p < .001). The process evaluation of the experimental group demonstrated a high level of proficiency in executing root canal disinfection steps, with pass rates ranging from 93.5% to 95.2%. Students in both groups perceived the model as valuable for improving critical thinking, stimulating interest, and enhancing their confidence and proficiency. The developed REPs training model is a practical and effective tool for teaching and training regenerative endodontics. It bridges the gap between preclinical and clinical education, enhancing students' confidence and clinical competence.

Effect of Autoclave on Surface Topography of Various Rotary Files

ABSTRACT Background: Rotary files are essential tools in endodontic procedures, designed to efficiently shape and clean the root canals. However, repeated sterilization, particularly via autoclaving, may affect their surface integrity, potentially compromising their performance and longevity. This study aims to evaluate the changes in surface topography of various rotary files after multiple autoclave cycles using Scanning Electron Microscopy (SEM). Materials and Methods: In this study, three types of rotary files—NiTi, stainless steel, and gold-treated files—were selected for analysis. Each type comprised 20 samples, totaling 60 files. The files underwent 10 cycles of autoclave sterilization at 121°C for 15 minutes. SEM analysis was conducted before and after sterilization to assess changes in surface characteristics. Parameters such as surface roughness, presence of micro-cracks, and debris retention were meticulously evaluated. Results: Post-autoclave SEM analysis revealed significant alterations in surface topography across all file types. NiTi files showed an increase in surface roughness by 35%, with evident micro-cracks in 40% of samples. Stainless steel files exhibited a 25% increase in surface roughness, while 30% showed minor deformities. Gold-treated files displayed the least surface alteration, with a 15% increase in roughness and micro-cracks observed in only 10% of samples. Debris retention was notably higher in NiTi files post-sterilization. Conclusion: Autoclave sterilization significantly impacts the surface topography of rotary files, with NiTi files showing the most pronounced changes. Gold-treated files exhibited greater resistance to topographical alterations, suggesting superior durability under repeated autoclave conditions. These findings underscore the importance of selecting appropriate file types based on sterilization frequency to ensure optimal endodontic performance and tool longevity.

Comparative Efficacy of Intracanal Medicaments in Healing Apical Periodontitis: Insights from a Comprehensive Clinical Study

ABSTRACT Background: Apical periodontitis is a prevalent condition that necessitates effective intracanal medicaments for successful endodontic therapy. Materials and Methods: A randomized controlled clinical trial was conducted on 120 patients diagnosed with apical periodontitis. The patients were randomly assigned to three groups, Group A (calcium hydroxide), Group B (triple antibiotic paste), and Group C (chlorhexidine gel), with 40 patients in each group. Each medicament was placed in the root canal after standard endodontic procedures, and the patients were evaluated at 1, 3, and 6 months using radiographic assessment and clinical examination. The primary outcome measure was the reduction in lesion size, and secondary outcomes included pain relief and healing time. Results: After 6 months, Group B (triple antibiotic paste) showed the highest reduction in lesion size, with an average decrease of 75%, followed by Group C (chlorhexidine gel), with a 60% reduction, and Group A (calcium hydroxide), with a 50% reduction. Pain relief was observed in 85% of patients in Group B, 75% in Group C, and 65% in Group A. The average healing time was the shortest in Group B (4 months), compared to Group C (5 months) and Group A (6 months). Conclusion: Triple antibiotic paste demonstrated superior efficacy in healing apical periodontitis compared to calcium hydroxide and chlorhexidine gel.

The Effect of Different Obturation Techniques on the Sealing Ability of Root Canal Filling Materials

ABSTRACT Background: The performance of root canal filling materials in sealing is crucial for the effectiveness of endodontic procedures as it prevents the escape of microorganisms and guarantees the durability of the treatment. Materials and Methods: The present in vitro investigation included the preparation of 90 human single-rooted teeth using a standardized process. These teeth were then randomly separated into three groups (n = 30) according to the obturation technique: Group A (Lateral Compaction), Group B (Thermafil), and Group C (Continuous Wave of Condensation). Furthermore, each group was separated into two subgroups based on the specific kind of root canal filling material employed: Subgroup 1 (Gutta-Percha) and Subgroup 2 (Resilon). The sealing capacity was evaluated using a dye penetration technique, with measurements conducted at three specific time intervals: 24 hours, 1 week, and 4 weeks after the obturation process. Statistical analysis of the data was conducted using analysis of variance and post hoc tests to identify significant differences across groups. Results: The findings showed that the Continuous Wave of Condensation method (Group C) had the lowest dye penetration, with an average depth of penetration of 1.2 mm. The Thermafil technique (Group B) followed closely with a penetration depth of 1.8 mm, while the Lateral Compaction technique (Group A) achieved a penetration depth of 2.5 mm. In terms of sealing ability, Gutta-Percha demonstrated superior performance compared to Resilon, achieving average penetration depths of 1.5 mm and 2.0 mm, respectively. Statistical analysis showed statistically significant differences between the groups (P &lt; 0.05), with the Continuous Wave of Condensation approach utilizing Gutta-Percha showing the highest level of sealing effectiveness. Conclusion: In conclusion, the Continuous Wave of Condensation approach showed a substantial improvement in the sealing efficacy of root canal fillings when compared to the Lateral Compaction and Thermafil procedures.

Prevalence of Three-Rooted Mandibular First Molars Among Jordanian Royal Medical Services Patients Using Cone-Beam Computed Tomography.

Background Anatomical variations in the mandibular first molars can significantly impact endodontic outcomes. The presence of additional roots, such as the distolingual radix entomolaris (RE) and the mesiobuccal radix paramolaris (RP), complicates endodontic procedures. Traditional radiographs often fail to detect these variations due to their inherent limitations. This study aims to determine the incidence of RE and RP in mandibular first molars using cone-beam computed tomography (CBCT) in a Jordanian population. Methodology A retrospective study was conducted at the Queen Alia Military Hospital, Jordan, involving 1,278 patients who underwent CBCT imaging from January 2019 to January 2023. We included patients aged 18-70 years with bilateral mandibular first molars. A total of 500 CBCT scans were evaluated by two experienced endodontists to assess the presence of a supernumerary third root. Demographic data, including age, sex, and the presence of right-sided, left-sided, or bilateral third roots, were collected and statistically analyzed using the chi-square and Fisher's exact tests. Results The prevalence of a third root was 7.4% on the right side, 3.2% on the left side, and 2.6% bilaterally. A significant association was found between gender and the presence of a right-sided third root (p = 0.027), with a higher prevalence in females (9.9%) compared to males (4.7%). Conclusions The prevalence of this racial anatomical variant was higher in females in the Jordanian population. Clinicians must be aware of this variant. A thorough radiographic examination must be conducted before initiating endodontic procedures to avoid any potential complications.

An Investigation Into Contaminated Waste Composition in a University Dental Clinic: Opportunities for Sustainability in Dentistry.

Many international dental organizations have been advocating for sustainable practices in dentistry, whereby significant reductions in environmental impacts are needed. The aim of this study was to analyze dental clinical waste in a university clinic setting to explore opportunities for sustainable practices. Fifty dental units (chairs) that are routinely used in delivery of dental treatment and involved supervising clinicians, dental students, and patients were randomly selected, and the clinical waste generated was collected, segregated, and weighed. Statistical analysis was performed to analyze differences in waste production based on treatment performed. The mean waste production generated by each chair was 81.4 g of aprons, 56.2 g of gloves, 17.2 g of masks, 24.0 g of sterile wrappings, 48.8 g of other plastics, 100.8 g of cellulose-based items, and 25.8 g of miscellaneous items. Higher waste was generated from the chairs performing endodontic procedures when compared with examinations. A potential annual greenhouse gas saving of approximately 10 kg CO2e per year (when one patient is treated daily) can be achieved if sterile wrapping plastics were to be recycled. Simple yet achievable opportunities for efficient clinical waste management at university clinics exist, which in turn will increase environmental sustainability in the post-COVID-19 era. Increased awareness and incentives for sustainable measures could potentially enhance the possibility of wider adoption of ecofriendly approaches.

Comparative Evaluation of the Effectiveness of Rotary and Reciprocating Single File Systems on Postoperative Pain After Biomechanical Preparation in Patients With Chronic Apical Periodontitis: A Randomized Clinical Trial.

Background and objective Postoperative pain after biomechanical preparation of root canals can be equally distressing to the patient as well as the dentist and can mold the patient's attitude and trust for future dental procedures. This randomized clinical trial aimed to evaluatethe effectiveness of rotary and reciprocating single-file systems on postoperative pain after biomechanical preparation in patients with chronic apical periodontitis. Materials and methods In this randomized clinical trial (CTRI Reg No-CTRI/2021/04/032841), 94 patients with chronic apical periodontitis in single straight-rooted teeth were divided equally into two groups, according to a standardized protocol. Biomechanical preparation of the root canal was done by a single operator using the Hyflex Electrical Discharge Machining (EDM) rotary file system (Coltene, Altstätten, Switzerland) in group 1 and Reciproc Blue (VDW Dental, Munich, Germany) file system in group 2, respectively. Standardized instrumentation and irrigation techniques were followed in both groups. Participants (blinded to the instrumentation technique) rated their pain intensity at 24 hours, 48 hours, and 72 hours following the root canal instrumentation appointment using the Visual Analog Scale (VAS) and Numerical Pain Rating Scale (NPRS). Statistical analysis The number and time of analgesic intake were also recorded. The data was analyzed using repeated ANOVA, post hoc test, Student T-test, and independent T-test at a 5% level of significance with 80% power of the study. Results and discussion Both the file systems showed low mean postoperative pain intensity at all three time-points assessed. The mean pain value was found to be greater in the Hyflex EDM group at 24 hours, but less at 48 hours and 72 hours when compared to the Reciproc Blue group. However, this difference in pain values was not statistically significant at any of the assessed time points(p>0.05). No significant difference in pain was found based on gender and analgesic intakebetween the two groups(p>0.05). A low incidence of postoperative pain detected in this study can be attributed to the advanced endodontic devices and methodsused during routine endodontic procedures, which provide more appropriate chemo-mechanical disinfection. Conclusion There was no statistically significant difference in postoperative pain between the rotary single file system and reciprocating single file systems at all the assessed time intervals. Hence, this study concluded that the instrumentation kinematics (single-file reciprocating or single-file rotary) had no impact on the intensity of postoperative pain after biomechanical preparation, and no file system is superior to the other in terms of postoperative pain, and hence, both file systems can be used clinically with equal efficiency when considering postoperative patient discomfort.

Patient’s Perceptions and Experiences about the Root Canal Treatment: A Survey among Patients Visiting Nobel Medical College

Introduction: One major drawback of root canal therapy (RCT) is that most people don't know enough about it. To effectively address the issue, it is imperative to comprehend and identify the elements that impede or discourage patients from undergoing Root Canal Treatment. A survey of the literature reveals a dearth of information regarding patients' understanding and acceptability of root canal treatment (RCT) in the Nepali community. Objective: The objective of the study was to determine how well-informed patients were about root canal treatment at Nobel Medical College and Teaching Hospital in Biratnagar. A wide-ranging patient viewpoint on the matter was sought by means of a patient survey. Methods: This survey was conducted with the help of prestructured questionnaire consisting of 15 questions, distributed to random 250 patients coming to the outpatient department of Conservative dentistry and Endodontics at Nobel Medical College and Teaching Hospital. The completed questionnaires were then analyzed to assess patients’ experiences, concerns, and perceptions about RCT. Results: There is a lack of awareness among patients regarding RCT. Conclusion: The people need to be made more aware of the importance of maintaining a healthy dentition and the consequences that follow if this isn't done. If patients were fully informed about endodontic procedures, more might consider having them.

The impact of root end filling material type and the application of bone graft on healing of periapical tissues after endodontic microsurgery (a clinical randomized controlled trial)

To evaluate the effect of combining different bioactive root-end filling materials with composite bone graft (xenogeneic mixed with autogenous bone fragments) on the healing process of periapical tissues after endodontic micro-surgery procedure. In this triple-blinded clinical trial, 56 patients were divided into 2 main groups (28 each) according to the root-end filling material and 2 subgroups according to the presence or absence of the composite bone graft material. Group I: MTA root-end filling (n = 28) in which there are Sub-group A: without bone graft (n = 14) and Sub-group B: with composite bone graft (n = 14). Group II: TotalFill root-end filling (n = 28) in which there are Sub-group A: without bone graft (n = 14) and Sub-group B: with composite bone graft (n = 14). Healthy patients whose ages range from 20 to 50 years with small-to-medium size radiolucency in CBCT related to single-rooted maxillary teeth were included in this study. Patients were assigned a number starting from 1 to 56 and were randomly allocated to four test groups (2 main groups and 2 sub-groups) following simple randomization procedure guidelines described by IBM SPSS V23 (IBM USA) statistical analysis software. This trial was triple-blind where the patient, the outcome assessors, and the main operator were blinded to the applied intervention. Every patient was evaluated clinically and by CBCT at two main observation periods: presurgical and 12-month post-operative. They were also examined and evaluated clinically and radiographically through periapical x-rays after one week, three, and six months. Statistical analysis was performed with IBM SPSS Statistics for Windows Version 23.0. Armonk, NY: IBM Corp. Of the 56 patients enrolled in the study, 49 patients were available for the final analysis. All groups showed no statistically significant differences with regard to healing or success rates at the 12-month follow-up mark. No adverse effects were encountered. Results showed that high success rates were achieved using MTA and TotalFill in the healing of periapical lesions after endodontic surgery. The addition of bone graft in small-to-medium size lesions did not affect the success rate of endodontic surgeries.