Retreatment Procedures Research Articles

Comparative Retreatment Efficacy of Two Multi-File Systems with Different Access Cavity Designs: A Micro-Computed Tomography Study

Background and Objectives: The access cavity design and instrumentation system could affect the remaining root canal obturation materials in root canal retreatment. This study aimed to evaluate the efficiency of two different multi-file systems in removing obturation materials with two different access cavities utilizing micro-CT scanning. Materials and Methods: Conservative access cavity (CAC) preparation was performed for 80 mandibular premolars. Then, root canal preparation was employed followed by obturation. The retreatment process began by dividing the samples into two separate groups: conservative (CAC) and traditional (TAC) access cavities. Subsequently, these groups were assigned to eight distinct subgroups (n = 10): Group 1; TAC and ProTaper retreatment system (PTR) with ProTaper Next (PTN); Group 2, TAC and PTR + ProTaper Ultimate (PTUL); Group 3, TAC and PTN; Group 4, TAC and PTUL; Group 5, CAC and PTR + PTN; Group 6, CAC and PTR + PTUL; Group 7, CAC and PTN; and Group 8, CAC and PTUL. The samples underwent micro-CT scans before and after the retreatment process, and the volume and percentages of remaining root canal filling material were calculated. Statistical analysis of the data was performed, and significance was determined at the 5% level. Results: The influence of the access cavity design (p = 0.500), the ProTaper system (p = 0.138), and the interaction of these variables (p = 0.513) was insignificant. However, group 3 (TAC and PTN) showed the highest percentage of remaining obturation materials at 29.53%, contrasting with group 6 (CAC and PTR + PTUL). Conclusions: Neither retreatment procedure succeeded in completely removing filling materials. Nevertheless, the impact of access cavity design, different multi-file systems, and their interaction on the remaining root canal obturation materials was deemed insignificant.

Quantitative Assessment of Apically Extruded Debris During Retreatment Procedures Using Three Nickel-Titanium Rotary Systems: An In Vitro Comparative Study

Objectives: Apical extrusion of debris can affect the success of endodontic treatments, and the specific performance of certain retreatment systems has not been studied yet. Therefore, the aim of this in vitro study was to quantitatively assess the amount of apically extruded debris produced during retreatment procedures using three rotary NiTi retreatment systems in mature non-resorbed straight roots. Methods: Thirty extracted permanent human teeth with single straight roots were selected. The root canals were prepared with the ProTaper Next system up to size 30 and obturated with gutta-percha and AH Plus sealer using the continuous wave of condensation technique. The samples were stored for 30 days and randomized by computer sequence into three retreatment groups (n = 10): (1) ProTaper Universal Retreatment; (2) HyFlex Remover; and (3) VDW.Rotate Retreatment. Apically extruded debris was collected in Eppendorf tubes and weighed with a microbalance (10−5 g) before and after retreatment procedure. As the data were not normally distributed, the Kruskal–Wallis test was applied for comparing data among groups, with an alpha level set at α = 0.05. Dunn’s test was considered for post-hoc analyses, if appropriate. Results: Hyflex Remover was associated with the highest amount of extruded debris (0.85 ± 0.82 mg), followed by VDW.Rotate Retreatment (0.78 ± 0.41 mg) and ProTaper Universal Retreatment (0.62 ± 0.28 mg). However, the differences were not statistically significant (p > 0.05). Conclusions: All the retreatment systems tested were associated with apical extrusion of debris in vitro, with no significant quantitative differences between them, suggesting that clinicians can choose a retreatment system with features appropriate to the specific clinical situation without risk of increasing the amount of apically extruded debris.

Scanning Electron Microscopic Evaluation of Surface Defects of Remover Retreatment File After Single and Multiple Uses.

This study aimed to evaluate surface defects of Remover rotary Nickel-Titanium (NiTi) files after single and multiple uses in conventional endodontic retreatment procedures using scanning electron microscopy (SEM). Eighty acrylic blocks, simulating root canals with a 1.5 mm internal diameter, a 5 mm radius of curvature, and a 55° curvature, were utilized. After chemomechanical preparation and obturation, 24 new Remover files (N30, 7%, L23) were randomly assigned to three groups: single use, triple use, and six uses. The files were operated at 600 rpm with a torque of 2.5 Ncm, cleaned, and sterilized after each use. SEM analysis at magnifications of 100x, 250x, and 500x revealed surface defects, including tip deformation, microcracks, fracture, unwinding, surface pitting, and blade disruption. Deformation was observed in 75% of the files after a single use and in 100% of the files after three and six uses. Microcracks were absent after single use but appeared in 25% and 87.5% of files after three and six uses, respectively, showing a statistically significant increase (p < 0.001). Surface pitting also significantly increased among groups (p = 0.004). No fractures were observed in any group. The most common defects were tip deformation (91.7%) and surface pitting (70.8%). The findings suggest that repeated use of NiTi files significantly increases surface defects, elevating the risk of fatigue fractures. Thus, the results recommend limiting the reuse of Remover files to a maximum of 3x. Further research is needed to correlate defect types with anatomical factors and to assess file effectiveness in retreatment scenarios.

Effectiveness of Chloroform and Orange Oil as Gutta-percha Solvents used in Endodontic Retreatment: An In Vitro Study

The aim of this study was to assess and compare the effectiveness of chloroform and orange oil to dissolve obturated materials during endodontic retreatment. Thirty extracted human permanent maxillary anterior teeth (10 central incisor, 10 lateral incisor and 10 canine) which fulfilled specific inclusion criteria were de-coronated and after biomechanical preparation using step-back technique obturated with gutta-percha and AH plus sealer and stored in 370C in 100% humidity for 2 weeks. Then the teeth were assigned into 2 groups randomly: Chloroform (n= 15) and Orange oil (n= 15). Solvents were applied to reservoir created on the coronal root third for 2 minutes. Then instrumentation was initiated to remove obturated materials using Hedstrom file until the master apical file size 40 for central incisor and canine and 35 for lateral incisor reach the working length. The time to reach the working length and the time to obtain the last debris were recorded. Data were collected and analyzed by using SPSS version 22. The results showed no statistically significant difference (P&gt;0.05) between two gutta-percha solvent groups in relation to time required to reach the working length by master apical file and time required to remove total obturated material from root canal. In conclusion, there was no statistically significant difference in effectiveness between chloroform and orange oil as gutta-percha solvent during retreatment procedure. So, orange oil can be used in retreatment procedure with the same efficacy of chloroform to dissolve obturated material in the root canal.

Impact of different activation procedures on sodium hypochlorite penetration into dentinal tubules after endodontic retreatment via confocal laser scanning microscopy

BackgroundInfected dentinal tubules are a possible source of bacteria that are responsible for the failure of root canal treatment. Therefore, disinfection of dentinal tubules by increasing the penetration of the irrigation solution is important for success in retreatment cases. This study utilized confocal laser scanning microscopy (CLSM) to assess and compare the impact of XPR, ultrasonic irrigation (UI) and sonic activation (SA) on NaOCl penetration into dentinal tubules following endodontic retreatment.MethodsA total of forty mandibular premolars were enrolled in this investigation. Following root canal preparation up to ProTaper X3 file (30/0.07), root canals were obturated with gutta-percha and bioceramic root canal sealer with single cone technique. The root canal filling materials were removed using ProTaper nickel-titanium rotary retreatment files until the working length was reached. The retreatment procedure was finalized using the ProTaper Next X4 (40/0.06). The teeth were divided into four groups based on the irrigation activation technique: control (conventional needle irrigation), SA, UI and XPR. During the final irrigation procedure, Rhodamine B dye was introduced to 5% NaOCl for visualization via CLSM. Subsequent to image acquisition, the maximum penetration, penetration percentage, and penetration area were calculated. Data were statistically analyzed using the Kruskal-Wallis, Friedman, and Bonferroni Dunn multiple comparison tests through R software (p < 0.05).ResultsIn the middle third, UI yielded a significantly higher penetration percentage than the control group (p < 0.05). The UI and XPR groups showed increased penetration percentages in the coronal and middle thirds compared with the apical third (P < 0.05). Maximum penetration was notably reduced in the apical third than in comparison with the coronal and middle thirds in all groups (p < 0.05). In the control, SA and XP groups, the penetration area was ranked in descending order as coronal, middle and apical (p < 0.05). Conversely, in the ultrasonic group, the penetration area was significantly lower in the apical third than in the middle and coronal thirds (p < 0.05).ConclusionsUI enhanced the penetration percentage in the middle third of the root compared with that in the control group. XPR and SA showed no significant effect on NaOCl penetration following retreatment.

Artificial intelligence in dental practice: An integrated approach

Artificial intelligence (AI) has grown tremendously in importance and has presence in many different industries, including dentistry. By mimicking human intelligence, it can make complex forecasts and judgments in the medical field, particularly in endodontics. A variety of artificial intelligence models, such as convolutional neural networks and/or artificial neural networks, have shown promise in endodontics. These models have been used to study the anatomy of the root canal system, predict the viability of dental pulp stem cells, measure working lengths, identify periapical lesions and root fractures, and predict the outcome of retreatment procedures. Artificial intelligence (AI) technology is utilized in dentistry to expedite the comprehension of massive amounts of data and provide clinical decision-making support. This work aims to comprehensively review the areas in which artificial intelligence (AI) is now having a significant impact on clinical dentistry. Artificial intelligence (AI), which is evolving at a rapid pace, has the potential to replace physical expertise in dentistry. To reduce mistakes and oversight, these technologies must also be employed carefully and under human supervision. Early and accurate diagnosis of oral problems leads to better outcomes for patients.

Single-visit versus multi-visit endodontic retreatment: A systematic review of outcomes in patients with secondary endodontic infection

Abstract Introduction: Secondary endodontic infections present intricate challenges in dental practice, necessitating effective retreatment strategies. The current systematic review aimed to critically evaluate the outcomes of single-visit versus multi-visit endodontic retreatment in patients with secondary endodontic infections. Materials and Methods: The current systematic review was registered in the Open Science Framework database and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Searches were conducted in PubMed/Medline, Scopus, and Web of Science databases for articles published until April 2023. The inclusion criteria for the current systematic review were clinical trials reporting the comparison of nonsurgical single-visit versus multiple-visit endodontic retreatments with predictive outcome. The Cochrane scale was used to assess the risk of bias. Results: Six studies were included in the systematic review. Four studies reported the incidence of postoperative pain, and two studies reported the periapical lesion healing after single- and multiple-visit endodontic retreatments with an 18- and 24-month follow-up. Three studies showed a low risk of bias, one study showed unclear risk of bias, and two studies showed a high risk of bias. Conclusion: Comparative analyses indicated that single-visit endodontic retreatment yielded comparable postoperative pain levels and healing outcomes as retreatment conducted over multiple visits. Notably, the utilization of intracanal medicaments such as calcium hydroxide and triple antibiotic paste demonstrates promise in mitigating postoperative pain subsequent to retreatment procedures.

Implementing microfluidic flow device model in utilizing dural substitutes as pulp capping materials for vital pulp therapy

Vital pulp therapy (VPT) has gained prominence with the increasing trends towards conservative dental treatment with specific indications for preserving tooth vitality by selectively removing the inflamed tissue instead of the entire dental pulp. Although VPT has shown high success rates in long-term follow-up, adverse effects have been reported due to the calcification of tooth canals by mineral trioxide aggregates, which are commonly used in VPT. Canal calcification poses challenges for accessing instruments during retreatment procedures. To address this issue, this study evaluated the mechanical properties of dural substitute intended to alleviate intra-pulp pressure caused by inflammation, along with assessing the biological responses of human dental pulp stem cells (hDPSC) and human umbilical vein endothelial cells (HUVEC), both of which play crucial roles in dental pulp. The study examined the application of dural substitutes as pulp capping materials, replacing mineral trioxide aggregate (MTA). This assessment was conducted using a microfluidic flow device model that replicated the blood flow environment within the dental pulp. Computational fluid dynamics simulations were employed to ensure that the fluid flow velocity within the microfluidic flow device matched the actual blood flow velocity within the dental pulp. Furthermore, the dural substitutes (Biodesign; BD and Neuro-Patch; NP) exhibited resistance to penetration by 2-hydroxypropyl methacrylate (HEMA) released from the upper restorative materials and bonding agents. Finally, while MTA increased the expression of angiogenesis-related and hard tissue-related genes in HUVEC and hDPSCS, respectively, BD and NP did not alter gene expression and preserved the original characteristics of both cell types. Hence, dural substitutes have emerged as promising alternatives for VPT owing to their resistance to HEMA penetration and the maintenance of stemness. Moreover, the microfluidic flow device model closely replicated the cellular responses observed in live pulp chambers, thereby indicating its potential use as an in vivo testing platform.

(220) LESSONS LEARNED FROM REZUM IN PATIENTS WITH SIGNIFICANT MEDIAN LOBE

Abstract Introduction Convective water vapor thermal therapy (Rezum) can have varied outcomes based on prostate architecture. Objective We sought to compare the efficacy of traditional Rezum therapy with steam treatment of the median lobe to transurethral resection for the median lobe, and Rezum treatment for the lateral lobes of the prostate (Rezurp). Methods A single-surgeon series between 2019 and 2024 analyzed standard BPH outcomes. The rate of retreatment, complications, and a global assessment: “Knowing what you know now, would you like to repeat the procedure?” were utilized. Significant median lobe was defined as ≥1 cm of intravesical protrusion for Rezurp patients and ≥ 2 median lobe treatments required for standard Rezum. Results Follow-up assessments were performed for 89/105 patients in the Rezurp group and 107/138 patients in the Rezum group. There was no significant difference in baseline characteristics between the two groups, as shown in Table 1. In the Rezum group, the median IPSS before surgery was 25 (20–28), while the median score after surgery was 9 (5–15), and in the Rezurp group, the median IPSS before surgery was 22.5 (19–28), and the median score after surgery was 5 (3–9.7). The changes were statistically significant for both groups (P &amp;lt; 0.001). For the IPSS quality-of-life (QoL) scores, the median in both groups was 4 (mostly not satisfied) before surgery and 2 (mostly satisfied) after surgery. The changes in QoL scores were significant in both (P &amp;lt; 0.001). In the Rezum group, the median Q-max was 7.9 and 13.1 before and after surgery, while in the Rezurp group, it was 8.0 and 17.1, respectively, and the changes were significant for both (P = 0.001). In addition, changes in post-voiding residue were significant in both groups (P = 0.001) (Table 2). In the Rezum group, 62% (67 patients) were on alpha-blockers before surgery, whereas only 15.8% (17 patients) continued after surgery. For the Rezurp group, 71.9% (64 patients) were on alpha-blockers before surgery, compared to 10.1% (9 patients) afterward. The discontinuation of alpha-blockers was significant for both groups (P = 0.001). Furthermore, changes in stopping the use of 5-alpha reductase inhibitors were significant for both groups (P = 0.001). The changes in stopping PDI-5 were not significant in both groups (P = 0.38). Regarding retreatment, 5.6% (5 out of 89) of patients in the Rezurp group required a retreatment procedure, compared to 14.9% (16 out of 107) in the Rezum group. The retreatment rate was significantly higher in the Rezum group (P = 0.03). When asked if they would repeat the procedure, 91% (81 out of 89) in the Rezurp group expressed interest, compared to 72% (77 out of 107) in the Rezum group. The interest in repeating the procedure was significantly higher in the Rezurp group (P = 0.001). Conclusions Although both Rezum therapy and Rezurp resulted in significant improvements in Q-max, PVR, IPSS, and QoL, the Rezurp group had a significantly lower rate of retreatment. Disclosure No.

Mechanical and Physicochemical Characteristics of a Novel Premixed Calcium Silicate Sealer.

The aim of the present in vitro study was to evaluate specific mechanical and physicochemical properties of three calcium silicate-based sealers, BioRoot™ Flow (BRF), CeraSeal (CRS) and TotalFill® (TF). Samples were prepared to evaluate different physicochemical and mechanical properties of the tested sealers. These evaluations were accomplished by investigating the pH changes over time, porosity, roughness, flow properties, compressive strength and wettability. The results were statistically evaluated using one-way analysis of variance. All three sealers demonstrated an alkaline pH from 1 h of immersion in water to 168 h. A higher porosity and hydrophily were detected in BRF samples compared to CRS and TF. No significant difference was found between the tested materials in the flow properties. Lower compressive strength values were observed for BRF compared to TF and CRS. Differently shaped structures were detected on the three materials after 7 days of immersion in PBS. The three materials demonstrated a higher solubility than 3% after 24 h of immersion in water (CRS < BRF < TF). The novel premixed calcium silicate sealer (BRF) had comparable physicochemical properties to the existing sealers. The lower compressive strength values could facilitate the removal of these materials during retreatment procedures. Further studies should investigate the biological effects of the novel sealer.

A Comparative Evaluation of the Dissolving Abilities of Eucalyptus, Orange, and Castor Oils in Endodontic Retreatment Using Conventional and Rotary Techniques.

Endodontic retreatment is essential for periapical healing, involving the removal of inadequate fillings, thorough cleaning, and new filling application to prevent leakage. This study compares the dissolving abilities of Eucalyptus, Orange, and Castor oils in the re-treatment of resin-based endodontic fillings using conventional and rotary techniques. Thirty single-rooted human teeth were prepared and filled with gutta-percha and AH Plus sealer. They were divided into three groups (n=10) based on the solvent used (Eucalyptus, Orange, or Castor oil) and further subdivided based on the techniques used (conventional and rotary). Standardised re-treatment procedures were performed, and the amount of residual material was measured. A significant difference (p<0.001) was found among the groups, indicating that both the type of solvent and the technique significantly affected the amount of residual material. The rotary technique generally left less residual material compared to the conventional technique for all solvents. Eucalyptus oil with the rotary technique showed the least residual material (mean = 5.8), while Castor oil with the conventional technique showed the most (mean = 10.2). Eucalyptus oil, especially when used with rotary techniques, is highly effective in removing resin-based endodontic fillings, providing a viable and safer alternative to traditional solvents. The study underscores the importance of selecting appropriate solvents and techniques for successful endodontic re-treatment.

Comparison of the Amount of Debris Extruded From the Apex During Retreatment Procedures Using Several File Systems and to Gauge the Effect of Same and Different Taper on the Debris Extrusion: An In Vitro Study.

To determine the amount of apical extrusion between various file systems during the retreatment procedure and to determine the effect of taper on the same. Seventy mandibular extracted premolars were taken, and preparation was performed using a Woodpecker file (Woodpecker Medical Instrument Co., Ltd., Guilin, China) (25/0.06). The gutta-percha (GP) was removed from each specimen with H file (#40/0.02) to simulate retreatment in seven groups (n = 10) using ProTaper Next (PTN;Dentsply, Maillefer, Ballaigues, Switzerland) (PTN) (30/0.07), Reciproc (25/0.08), Hyflex CM (30/0.06), Mtwo (30/0.05), Neoendo flex (30/0.04), Neoendo hybrid (30/0.04), and Flexicon file (30/0.06). The specimens were held with the help of a rubber stopper and put in the Eppendorf tube of volume 4 mL (pre-weighed before retreatment). The debris that was on the root surface of the specimen was washed with distilled water with 1 mL volume, kept in the oven, and then again weighed after 7 days. Apical extrusion was found in the following order: HYFLEX CM (LEAST) < FLEXICON < PROTAPER NEXT < RECIPROC < NEOENDO FLEX < NEOENDO HYBRID < MTWO (HIGHEST). W Hyflex CM and Flexicon files showed lesser extrusion of debris than others.

Postoperative Pain of Endodontic Re-treatment in Single and Multiple Visits: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Abstract Aim: This systematic review aimed to evaluate the influence of single-visit and multi-visit non-surgical endodontic re-treatments on the incidence, intensity, and duration of postoperative pain and adverse effects. Materials and Methods: A search of the literature was conducted after registration of the study protocols in PROSPERO to find randomized clinical studies assessing postoperative pain in non-surgical endodontic re-treatment conducted during one or more visits in PubMed, Cochrane library, and Scopus databases and EBSCO using a definitive search strategy based on inclusion and exclusion criteria. Using the Cochrane risk of bias method, two independent reviewers determined the studies that were eligible for inclusion, extracted data, and evaluated the quality. Meta-analysis was carried out at wherever appropriate. Results: A total of 827 citations were found by the database search and 16 citations from other sources. Eleven full-text articles were obtained after duplicates were eliminated. Three clinical trials were deemed eligible for inclusion; on qualitative evaluation, two studies showed an unclear risk and one was graded as having a significant high risk of bias. The sample size was significant in only one study, and the other two studies had a smaller sample size. Meta-analysis was performed at 24 h, 48 h, and 7 days. The random-effects model at 24 and 48 h and fixed-effects model after 7 days indicated that there is no significant difference in pain intensity between single-visit and multi-visit re-treatments. Conclusion: The significance of the number of visits on the subsequent pain following the re-treatment procedure was underlined by this current systematic review and meta-analysis. The single visit re-treatment caused less postoperative pain and can be considered based on the clinical scenario.

Assessment of Factors Affecting the Success of Endodontic Retreatment Procedures

ABSTRACT Background: Endodontic retreatment is crucial for preserving dental health but is influenced by various factors. Objective: This research aimed to assess factors affecting the success of endodontic retreatment procedures. Methods: A retrospective analysis was conducted on 250 cases of endodontic retreatment. Demographic and clinical data were collected, and treatment success was defined based on predetermined criteria. Statistical analysis was performed to evaluate associations between treatment factors and retreatment outcomes. Results: The overall success rate was 75%. Rotary instrumentation, gutta-percha obturation, and use of intracanal medication were significantly associated with higher retreatment success rates (P &lt; 0.05). Conclusion: Factors such as instrumentation type, obturation material, and intracanal medication significantly influence endodontic retreatment success. Understanding and optimizing these factors are crucial for improving treatment outcomes and patient satisfaction.

Comparative Evaluation of the Removal of Gutta Percha From the Root Canal Using Various Retreatment File Systems With and Without Magnification: An In Vitro Study.

The main goal was to compare the efficacy of gutta percha (GP)removal from the root canal using the Neo Endo Retreatment file system, Solite RS3, and ProTaper Universal Retreatment (PTUR) files with and without magnification under a direct operative microscope using stereomicroscopic evaluation. Sixty single-rooted teeth were randomly assigned to one of three groups after obturation till F2 mastercone with resin sealer: Group 1 (n=20): Neo Endo Retreatment Files, Group 2 (n=20): Solite RS3, Group 3 (n=20): PTUR files. Each group was further separated into two subgroups: Subgroup 1: without magnification (no direct operative microscope) and Subgroup 2: with magnification under a direct operative microscope at 12× magnification. After retreatment, the roots were grooved buccolingually and split into two halves using a diamond disc with the help of a chisel. The samples were examined under a stereomicroscope. Images were captured in a digital camera and analyzed using image analyzing software Image Pro v10 (Media Cybernetics). The Neo Endo retreatment file system had a significantly greater percentage of remaining obturating material than the Solite RS3 Retreatment and PTUR file systems (p<0.05) in both groups with and without magnification. In the group without magnification, Solite RS3 showed a significant difference compared to ProTaper (p<0.05). In the group with magnification, there was no significant difference between the ProTaper Universal retreatment file system and Solite RS3 (p=0.589). Retreatment performed without magnification had more remnant GP when compared to the retreatment procedure performed under magnification of the direct operative microscope. Under stereomicroscopic evaluation, the remnant GP was higher in the Neo Endo File System both with and without magnification than in the Solite Retreatment and PTUR file systems. ProTaper showed moderate significance in removing the obturation than Solite RS3 in the magnification group. The Solite RS3 file system performed as efficiently as the PTUR file system.

The incidence and intensity of postoperative pain and Flare-up following the use of three different intracanal medicaments in teeth with posttreatment apical periodontitis: a randomized clinical trial

ObjectivesThis randomized clinical trial aimed to compare the effect of intracanal medicaments on the incidence of postoperative pain and flare-up with posttreatment apical periodontitis (PTAP) of retreatment cases.Materials and methodsOne hundred twenty patients diagnosed with PTAP with single-rooted teeth with single-canal without spontaneous pain or swellings were included and randomly divided into three groups according to the intracanal medicament used. Intracanal medicaments were placed into the root canals following the removal of previous root canal fillings and re-instrumentation. Calcium hydroxide (Ca (OH)2), chlorhexidine gel (CHX), calcium hydroxide and chlorhexidine gel combinations were used as intracanal medicaments. Postoperative pain scores were recorded at 6 and 12 h and 1, 2, 3, 4, 5, 6, and 7 days using a visual analog scale (VAS). Sensitivity on percussion, spontaneous pain, swelling, antibiotic and analgesic requirements of the patients were evaluated during clinical examinations performed postoperatively after 2 and 7 days.ResultsThere were no statistically significant differences between groups in terms of VAS scores following the intracanal medicament application (p > 0.05). However, compared to the patients of 20–34 and 50–65 age groups, greater VAS scores were observed in patients of 35–49 age groups at 12 h, and 3, 4, 7 days (p < 0.05). Flare-up was observed in only one patient in the CHX gel group, and no flare-up was observed in other groups.ConclusionsSimilar postoperative pain incidence in all experimental groups indicates that all three medicaments are clinically acceptable in inter-appointment management of retreatment cases in terms of post-endodontic pain and flare-up.Clinical relevanceIn this randomized clinical trial, three different intracanal medicaments were utilized in nonsurgical endodontic retreatment and their effect on postoperative pain and flare-up incidence was examined. Thus, this study will be a significant contribution in the decision-making during clinical practice; since there are a limited number of prospective clinical trials in the literature about the severity of pain following retreatment procedures including intracanal medicament use.

Evaluation of the Efficacy of Neo-endo, Hyflex Re-treatment File Systems and H-Files for Removing Gutta-Percha From Root Canal Treated Tooth by Using Stereomicroscope—An In Vitro Study

ABSTRACT Aim: To evaluate the efficacy of Neo-endo, Hyflextm retreatment file systems, and H-files for removing gutta-percha from root canal treated tooth. Materials and Methods: Thirty extracted single-rooted human teeth with a single canal were opted. The shaping of the root canals was done with pro-taper universal files and later obturated. The samples were grouped based on the file system chosen for removing the obturating material: Group I-H-files; Group II-Neo-endo retreatment files; Group III-Hyflex™ retreatment files. The quantity of remaining gutta-percha still present after the retreatment procedure was assessed under a stereomicroscope. One-way Analysis of Variance (ANOVA) was used to statistically analyze the data. Results: Hyflex™ files left less remaining filling material than with Neo-endo and H-files. Conclusion: The Hyflex™ retreatment files were most efficient in removing the gutta-percha from the root canal.

Evaluation of Obturating Material Removal from Root Canal by Hedstrom and Rotary Retreatment File

An in vitro investigation was conducted to assess the efficacy of Hedstrom and Rotary Retreatment File using Cone Beam Computed Tomography (CBCT) in removing obturating material from moderately to severely curved root canals. Thirty-six removed human molar teeth were split into two groups based on the canal curvature using the Schafer and Schneider method. Each group consisted of 18 teeth. Teeth in Group A had roots that were moderately curved (angles between 10 and 20 degrees), whereas teeth in Group B had roots that were severely curved (angles more than 20 degrees). Following decoronation, each root was ready for obturation using the appropriate rotary files, following the manufacturer’s recommendations. Using the CBCT image, the total surface area of the root canals in the axial cross-section and the volume analysis of the obturated area were calculated. H files were used to retreat half of each group, while Rotary (ProTaper) retreatment files were used for the other half, in accordance with their retreatment protocol. It was noted how long it took to reach the working length and remove all obturating items. Cone beam computed tomography and Auto CAD software are used to analyze the surface area and volume of any residual obturating material in the canal after it has been completely removed. An analysis of the data using the ANOVA test was conducted between four groups. When p &lt; 0.05 was reached, it was deemed statistically significant. Rotary retreatment files were discovered to be the most efficient method for removing obturating material and to take the least amount of time to achieve working length. Compared to the Rotary retreatment file, the H file left greater residue in the root canal. Compared to moderately curved root canal groups, severely curved root canal groups have noticeably more residues. In all four groups, the apical part had more residues than the middle and coronal portions. The obturating substance in the root canal could not be entirely removed using any of the retreatment procedures. Furthermore, there was no advantage in terms of root-filling removal’s effectiveness.

The Impact of Citric Acid Solution on Hydraulic Calcium Silicate-Based Sealers and Root Dentin: A Preliminary Assessment.

Hydraulic calcium silicate-based (HCS) sealers have recently gained tremendous popularity due to their unique properties. However, their removal during endodontic retreatment is challenging. The solvent, which could chemically deteriorate the material, would be highly desirable for endodontic retreatment procedures. This preliminary study assessed the interplay and dissolving capability of 10% and 20% citric acid, compared to 17% EDTA, on commonly used HCS sealers (AH Plus Bioceramic Sealer, Bio-C Sealer, BioRoot RCS, TotalFill BC Sealer), and evaluated the potential impact of these solutions on root dentin structure. The interaction between tested sealers and irrigating solutions was photographed, and solubility-related mass changes were determined. The surface morphology of treated filling materials and dentin was evaluated using a scanning electron microscope (SEM). One-way analysis of variance (ANOVA) along with Tukey's test were used to detect the statistically significant differences among groups at the confidence level of 0.95. Intense gas release was observed during the interaction of HCS materials and citric acid, with no evidently visible "bubbling" after the immersion in EDTA. The mass loss of HCS sealers equally confirmed the significantly higher dissolving characteristics of 10% and 20% citric acid solutions compared to EDTA. The surface structural changes, associated with pore and crack formation, were mainly seen for HCS sealers exposed to citric acid. Meanwhile, no severe erosion was detected for dentin after root canal preparation with 10% and 20% citric acid solutions. These findings demonstrate that citric acid has the potential to dissolve HCS sealers with minimal or no negative impact on root dentin, suggesting citric acid as a solvent for HCS sealers in endodontic retreatment procedures.

Bioceramic and Resin-Based Sealers Removal Using XP-Endo Finisher: A Scanning Electron Microscopy Study

Abstract Objectives The aim of this study was to evaluate remaining filling materials of a bioceramic sealer (TotalFill BC sealer) and an epoxy resin sealer (AH Plus) after retreatment using a supplementary instrumentation (XP-endo Finisher). Materials and Methods Forty single-rooted teeth were selected for the study. The teeth were instrumented using ProTaper system and randomly divided into two groups (n = 20). Then they were obturated with either TotalFill BC/gutta-percha or AH Plus/gutta-percha using lateral compaction technique. Canals were retreated using ProTaper retreatment files and a solvent. The groups were subdivided (n = 10) according to the application or not of the XP-endo Finisher as a final step of retreatment. All roots were cleaved longitudinally and examined under scanning electron microscope to evaluate root canal filling remnants. A scoring system was utilized to quantify the amount of residual filling material at the three predetermined portions of each root canal.Statistical analysis was performed using IBM SPSS.25 with a significant value p &lt; 0.05. Data were compared using the Mann–Whitney test and Kruskal–Wallis test. Results There was no statistically significant difference in the remaining filling materials for each third of the root canal after initial retreatment procedure between the TotalFill group and AH Plus group. Similar results were observed among the TotalFill groups with or without the application of XP-endo Finisher supplementary step. However, the remaining filling materials of AH Plus in the middle third of root canal were significantly less after the XP-endo Finisher application (p = 0.015). Conclusion No retreatment protocol tested in this study allowed the total elimination of root canal filling materials. The residual root canal filling materials is similar for the bioceramic and resinous sealers. The XP-endo Finisher is not effective in improving the removal of bioceramic root canal filling material while it is able to improve the removal of resinous cement.