Successful Endodontic Therapy Research Articles

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.

Postoperative pain evaluation in patients undergoing endodontic treatment subsequent to working length determination with and without integrated apex locator endomotor: Randomized control trial.

Precise working length control during chemomechanical preparation is one of the primary factors for successful endodontic therapy. The study aims to evaluate the postoperative pain after determining working length with an integrated apex locator-endomotor and a separate apex locator-endomotor. One hundred and twenty subjects with a diagnosis of symptomatic irreversible pulpitis and preoperative pain score Visual Analog Scale (VAS) >50 were allocated into Group I with nonintegrated apex locator and endomotor and Group II with integrated apex locator endomotor, further treated by single endodontist. Postoperative pain was assessed with a VAS chart on days 1, 3, and 7. The necessity of analgesic intake if required was considered as the highest VAS score. Pre- and post-operative VAS scores between the groups were compared using the Mann-Whitney and one-way ANCOVA tests. On days 1 and 3, Group II showed significantly lower values of postoperative pain and lesser frequency of rescue medication when compared with Group I (P < 0.05). On day 7, none of the patients reported postoperative pain. Simultaneous working length determination during instrumentation leads to significantly lesser postoperative pain.

Resolving The Hidden And Intricate Canals- A Case Series

Successful endodontic therapy relies on the objectives of accurate diagnosis, complete debridement and three dimensional obturation of root canal system. However complexities such as extra canals and root roots as well as canal intricacies determines the prognosis of root filled teeth. This case series presents four individual case reports depicting the variability of canal space

An in vitro comparative evaluation of cyclic fatigue resistance of two rotary and two reciprocating file systems.

Root canal instrumentation is one of the important procedures for successful endodontic therapy. Unexpected fracture of files occurs during root canal instrumentation without any visible signs of deformation compromising the success of root canal treatment. The aim of the study was to evaluate and compare cyclic fatigue resistance (CFR) of rotary and reciprocating files in simulated canals with 45°, 60°, and 90° angle of curvature. The study design was an In vitro study. Sixty nickel-titanium files, 30 each of rotary and reciprocating files were selected and divided into four groups (n = 15) of Neoendo Flex, ProTaper Next, WaveOne Gold (WOG), and Reciproc Blue (RPB) files. Each group was further subdivided into three subgroups containing five samples each based on their use in simulated canals with 45°, 60°, and 90° angle of curvature. To simulate root canals with 45°, 60°, and 90° angle of curvature, three artificial canals were designed in a stainless steel metal block. Each file was autoclaved, immersed in 3% sodium hypochlorite (NaOCl), and coated with 17% ethylenediaminetetraacetic acid (EDTA). Each file was tested for CFR using a torque-controlled reduction handpiece by instrumenting in a simulated canal for 10 s until fracture. The cycle of autoclaving, exposure to NaOCl, EDTA, and testing of CFR for 10 s per canal as per groups and subgroups was repeated again and again until the respective file fracture. The time taken to file fracture was recorded using a digital chronometer. The time taken for each file fracture (in minutes) was multiplied by the number of rotations per minute to attain the number of cycles to failure (NCF). The obtained results were subjected to statistical analysis using one-way analysis of variance and independent t-test. One-way ANOVA test showed a statistically significant difference between the four groups, P < 0.001. Independent "t"-test between individual subgroups showed a statistically significant difference, as P < 0.05. WOG and RPB reciprocating file systems showed superior CFR, more especially in canals with abrupt 90° angle of curvature compared to both rotary file systems tested. Among rotary file systems tested, Neoendo Flex showed greater CFR than ProTaper Next.

Endodontic therapy in teeth with calcified canals

Treatment of obliterated canals as a result of calcifications is a challenge even for experienced endodontists. For that reason, the aim of this study was to present some cases from practice where, even in spite of almost complete canals obliteration, success in endodontic therapy has been achieved. In the cases presented, endodontic therapy was indicated due to symptoms, periapical lesions, or the need for prosthetic treatment with post placement. By working carefully and using EDTA, we achieve successful endodontic treatment and preserve tooth functionality.

Effect of Different Electroconductive Root Canal Irrigations on the Accuracy of Different Apex Locators: An In Vitro Comparative Study.

An accurate working length (WL) estimation is fundamental to a successful endodontic therapy. The objective of this comparative in vitro research was to investigate the performance of iPex II and the Root ZX Mini electronic apex locators (EALs) in measuring root canal WL with different irrigant solutions and their relation to the electrical conductivity of irrigation solutions. Seventy sound permanent lower premolar teeth, each with a single root and developed apices, were used. Under an X15 stereomicroscope, the real working length was determined with the aid of a #10 file. After that, teeth were placed into an alginate model, and the iPex II and Root ZX Mini were used for the detection of electronic working length with various irrigants. Seventy teeth were randomly distributed into seven groups, 10 per each group (group I: dry canal; group II: distilled water; group III: ozonated water; group IV: 5% sodium hypochlorite (NaOCl); group V: 2% chlorhexidine, group VI: 17% ethylenediaminetetraacetic acid (EDTA) solution, and group VII: 17% EDTA gel). The difference in WL was calculated by deducting real working length from its electronic working length. The study also evaluates the electrical conductivity of the seven endodontic irrigant solutions. The two-way analysis of variance (ANOVA) test was used for statistical analysis. Statistically, neither both types of EALs (P = 0.088) nor various irrigating solutions with varying electrical conductivities (P = 0.099) significantly affect the accuracy of EL estimation. There were no significant differences between the accuracy of the Root ZX Mini and the iPex II. The accuracy of both apex locators is unaffected in the presence of various irrigation solutions with varying electrical conductivities in this research.

Assessment of Long-Term Success and Survival Rates of Different Types of Intracanal Medicaments.

Antimicrobial endodontic intracanal medicaments play a vital role along with biomechanical preparation in the elimination of bacteria present in the pulp area to achieve success in endodontic therapy. The present research was conducted with the objective of evaluating and comparing intracanal medicaments regarding antibacterial properties against Enterococcus faecalis. One hundred and twenty healthy human premolars of the mandible were used. All premolar crowns were removed, keeping the standardized length of the root as 15 mm. Category 1 received triple antibiotic paste (TAP) (n = 30), Category 2 received double antibiotic paste (DAP) (n = 30), Category 3 received augmentin (n = 30), and Category 4 received calcium hydroxide (n = 30). Hygienic paper points were placed in each root canal, then they were moved to a tube containing 1 mL of brain-heart infusion medium and left there for bacteriological testing. Colony-forming units (CFUs) of E. faecalis were then observed and counted after the plates had been incubated overnight at a temperature of 37°C. During intracategory comparisons, there was a significant reduction in colonies of E. feacilis in each category (P ≤ 0.001). When there were intercategory comparisons, there was a maximum reduction in CFU in specimens of Category 1 (TAP) followed by Category 3 (Augmentin) and Category 2 (DAP). Intracanal medicaments like TAP, DAP, and augmentin are effective against root canal E. faecalis.

An Experimental Anatomic CBCT Study on the Correlations Between MB1 and MB2 of the Mesio-Vestibular Root of the Upper First Molars.

This experimental anatomic study aimed to investigate the correlations between the mesio-vestibular canal (MB1) and the second mesio-vestibular canal (MB2) of the mesio-vestibular root of the upper sexts using cone-beam computed tomography (CBCT) imaging. A total of 24 extracted maxillary first molars were collected and subjected to CBCT imaging. The presence, location, and morphology of MB1 and MB2 canals were evaluated using axial, coronal, and sagittal CBCT sections. The interrelation between MB1 and MB2 canals was assessed, including their separate canals, merging, and division points. Among the 24 maxillary first molars examined, 86.5% demonstrated the presence of an MB2 canal in addition to MB1. The MB2 and MB1 were confluent in 80% of the cases with a confluent height of 4,16mm. The mean distance between MB1 and MB2 canals was 1.85mm. This study provides detailed information on the anatomic correlations between MB1 and MB2 canals of the mesio-vestibular root in the upper sexts using CBCT imaging. The high prevalence of MB2 canals suggests their significance in endodontic procedures and emphasizes the importance of thorough exploration and identification during root canal treatment. The knowledge of the location and morphology of these canals can aid in successful endodontic therapy and enhance treatment outcomes.

Influence of Cavity Designs on Fracture Resistance: Analysis of the Role of Different Access Techniques to the Endodontic Cavity in the Onset of Fractures: Narrative Review.

In recent years, new endodontic access techniques have been proposed with the aim of preserving as much dental tissue as possible for subsequent prosthetic rehabilitation. It has indeed been demonstrated that the success of this therapy is essential and dependent on the proper execution of endodontic cavity access. The main objective is to provide a comprehensive and up-to-date overview of the new access techniques in endodontics in order to guide clinical practice toward a more precise and qualitative approach. As of today, there is still no universally standardized and recognized taxonomy for the different access cavity designs described in the literature. It has been observed that there are various nomenclatures in the literature. The cavity access designs described mainly in the literature can be categorized into six groups: Traditional Access Cavity (TradAC), Conservative Access Cavity (ConsAC), Ultra-Conservative Access Cavity (UltraAC), Truss Access Cavity (TrussAC), Caries-Guided Access Cavity (CariesAC), and Restoration-Guided Access Cavity (RestoAC). The drafting of this narrative review followed the indications of the SANRA (Scale for the Assessment of Narrative Review Articles). A search for scientific articles was conducted on the PubMed and SCOPUS databases, using the following search query: ((truss) OR (conservative) OR (ninja) OR (traditional)) AND access AND endodontic. The initial search yielded a total of 941 articles. After removing duplicates using EndNote X8 software, the number of articles decreased to 785. By applying the inclusion and exclusion criteria, a total of 64 articles were obtained. Among these, 20 articles were finally selected for the purposes of this review, 11 literature reviews and 9 ex-vivo studies. Studies on fracture resistance have yielded heterogeneous results. For anterior teeth, studies do not find a significant relationship between different endodontic access cavities and fracture resistance. However, in the posterior sector, there is more discrepancy and many positive results for minimally invasive access cavities seem to relate to molars. Therefore, it can be concluded that the evidence supporting the influence of endodontic preparations on dental fracture resistance is still limited. Research on new endodontic access techniques holds significant clinical relevance in contemporary endodontics. The evolution of dental technologies, including cone beam computed tomography (CBCT) and computer-guided cavity preparation, has ushered in the era of minimally invasive endodontics. This shift aims to enhance the precision and quality of endodontic treatments while preserving maximum healthy dental tissue for subsequent prosthetic rehabilitation. The success of endodontic therapy is closely tied to the proper execution of access to the endodontium, influencing all phases of endodontic treatment and playing a role in determining fracture resistance for subsequent rehabilitation phases. The dichotomy between traditional and minimally invasive approaches has spurred clinical investigations. Specifically, within the scientific community, doubts have been raised about the potential limitations of minimally invasive access cavities. Concerns include their impact on canal orifice localization and raise questions about their influence on the overall success of endodontic treatment. This review holds clinical significance as it sheds light on the evolving landscape of endodontic access techniques, analyzing the anatomical trajectory, carefully examines the transition to minimally invasive approaches, and critically assesses existing scientific evidence and concerns surrounding these developments, contributing to an informed decision-making process in clinical practice.

CBCT Comparison of the Remaining Dentin Thickness Following Biomechanical Teeth Preparation using Edge Endo X7, Hero Gold, and Neo Endo Flex Rotary File Systems: An In-vitro Study

Introduction: Success in endodontics depends on canal preparation, disinfection, and obturation. Cleaning and shaping play a pivotal role in successful endodontic therapy. An important factor in preventing procedural mishaps and further complications is the quantity of dentine removed during instrumentation because the fracture resistance of the root is directly influenced by the amount of dentine that remains after instrumentation. Aim: To evaluate and compare the remaining dentine thickness of the root canal after instrumentation with three different rotary file systems using Cone Beam Computed Tomography (CBCT) imaging. Materials and Methods: Thirty permanent extracted, singlerooted teeth were collected. The samples were decoronated at the level of the Cementoenamel Junction (CEJ). A preinstrumentation CBCT scan was taken. Access opening and working length were determined. The samples were randomly assigned to three groups: Group I - Edge Endo X7, Group II- Hero Gold, Group III - Neo-endo flex files. Biomechanical preparation was carried out using the respective files. To evaluate the remaining dentine thickness, a comparison was made with the pre-instrumentation CBCT scan. Statistical analysis was performed using One-way ANOVA. Results: Upon inter-group comparison of the pre-instrumentation group, no significant difference (p≥0.05) was observed. Postinstrumentation, it was noted that the remaining dentine thickness in Group I (p≤0.05) at the apical third was significantly less than in Group II (p=0.007) and Group III (p=0.042). Maximum preservation of dentine was seen with Hero gold files, whereas the minimum preservation of dentine was seen with Edge Endo X7. Conclusion: Hero gold files exhibited less removal of dentine apically, whereas Edge Endo X7 showed more removal of dentine apically

Debridement ability of the WaveOne Gold and TruNatomy systems in the apical third of root canals: ex vivo assessment.

Cleaning and shaping the root canal system are essential steps for performing successful endodontic therapy, and are challenging procedures in the apical region. This study aimed to conduct an ex vivo assessment of the debridement ability of the WaveOne Gold (Medium 35/.06) and TruNatomy (Medium 36/.03) systems in the apical third of round root canals of mandibular premolars. Forty-eight teeth, extracted for orthodontic or periodontal reasons, were divided into three groups (n=16), as follows: Group C, control (without instrumentation or irrigation); Group WOG, instrumentation with WaveOne Gold; Group TN, instrumentation with TruNatomy. A total of 40 mL of 2.5% sodium hypochlorite and 5 mL of 17% ethylenediamine tetraacetic acid were used per root canal in all the groups. Ten 0.5-μm serial cross-sections per specimen were obtained every 0.2 mm from a 2-mm segment of the apical region, extending from 1 to 3 mm short of the root apex. The sections were stained with hematoxylin-eosin and analyzed under a digital microscope (100x). The percentages of unprepared walls and remaining debris were quantified using ImageJ software. Generalized linear models were used to analyze the results (α=5%). Groups WOG and TN had significantly lower percentages of unprepared walls and remaining debris than Group C (p<0.05). There was no significant difference between groups WOG and TN for either of the variables studied (p>0.05). Instrumentation with the WaveOne Gold Medium and TruNatomy Medium instruments was associated with equivalent percentages of unprepared walls and remaining debris in the apical third of round canals of mandibular premolars.

Evaluation of the stress generated during biomechanical preparation with nickel–titanium rotary endodontic file using finite element analysis

Introduction: Adequate biomechanical preparation of root canals is the essence of successful endodontic therapy. Roots with curved canal framework led to endodontic complexity. The hassles in the preparation of such complex canals have prompted the inauguration of nickel–titanium (Ni-Ti) instruments with properties of shape memory and superelasticity. They benefit root canal preparation with causing less aberration, yet intracanal separation due to fatigue remains a concern. The study was intended to evaluate and compare the stresses developed during biomechanical preparation with Ni-Ti rotary file in straight, moderate, and severely curved root canals using finite element analysis (FEA). Materials and Methods: Six real sizes, three-dimensional root models were designed in SolidWorks software with varying angles of curvature (2°–45°), and using the same software, ProTaper Gold F2 rotary file was developed. All the designed root models with the rotary file inserted into each model were subjected to FEA. ANSYS Software (version 17.2 Company, Commonwealth of Pennsylvania, USA) 2015 was used to simulating root canal shaping, and the stresses generated in all the root canal models were observed. Results: Highest mean stress was observed with 45° models which was 235.95 MPa, followed by a 30° simulated model showed 220.36 MPa and least stress of 125.22 MPa was observed with 2° models (P &gt; 0.05). Conclusions: Increased canal curvature has definitely resulted in generation of more amount of stress.

Irriguesit endodontikë

Irrigation in endodontics is one of the key factors in the success of endodontic therapy. There are many irrigants that are used in endodontics with wide spectrum of anti- microbial effect, biocompatibile, help lubricate the root ca- nal, remove debris, but we still do not have an ideal irrigant that can fulfill all the necessary conditions for successful endodontic treatment. Therefore, this review will describe the proper characteristics and methods of irrigation in end- odontics.

The impact of pulpotomy on the long-term prognosis and survival of young permanent teeth

This review explores the impact of pulpotomies on the long-term prognosis and survival of primary and young permanent teeth. Pulpotomy is a vital pulp therapy procedure aiming to preserve pulp health and functions. The review covers various vital pulp therapy techniques, including indirect pulp treatment, direct pulp treatment, partial pulpotomy, and full pulpotomy. Apexogenesis, a procedure promoting root end formation, is also discussed. Long-term success in endodontic therapy requires an effective coronal seal to prevent microleakage and bacterial ingress into root canals. The study's methodology involved a comprehensive literature search to gather information on pulpotomy's effects on tooth prognosis and survival. Factors influencing the success of vital pulp therapy, such as the size of the exposure, the state of the pulp, and the choice of capping material, are analyzed. Bacterial contamination is identified as a crucial factor affecting the therapy's prognosis. Strategies to improve pulp healing and treatment outcomes are explored, offering insights into clinical decision-making for pulpotomy procedures.

Morfologjia e rrënjëve dhe kanaleve të molarëve të tretë të poshtëm në popullatën e Mitrovicës – studim in vitro

For successful endodontic therapy, full knowledge of the morphology of the root canal is required, especially for complex cases such as lower third molars. The aim of this study was to investigate the root and canal morphology of mandibular third molars in Mitrovica. From our dental office in Mitrovica, 175 extracted mandibular third mo- lars were randomly selected. Each tooth was meticulously cleaned before the root canal anatomy and morphology were carefully examined. Under dental loupe at a 2.5x magnification, mandibular third molars were examined for root number and morphology, number of canals per root, root canal configuration according to the Vertucci classification, incidence of dilacerated roots, and C-shaped canals. 16.43% of the 175 mandibular third molars exam- ined had a root. Sixty-eight percent of the teeth had two roots. Three roots were present in 11% of the teeth. In this study, 4% of the teeth had four roots, while in 4% of cases the C-shaped canals were reported. Also, 6.5% of cases had a dilacerated root. Despite the fact that the anatomy and morphology of the root canal of the mandibular third mo- lar is quite different, these teeth generally have two roots in most cases.

Assessment of debris extrusion on using step-wise irrigant activation versus conventional activation in different access designs: An ex-vivo study

Introduction: A successful endodontic therapy mainly depends on the effective chemomechanical debridement. The present study assessed the effect of different activation modes on debris extrusion in different access cavity designs. Materials and Methods: Freshly extracted 168 maxillary premolars were collected. They were allocated into two groups (n = 84) (Group I: Traditional Endodontic Access (TEA) and Group II: Contracted Endodontic Access (CEA)). These groups were further subgrouped (n = 28) based on the activation protocol used (Subgroup A, D: Manual irrigation with no activation, Subgroup B, E: Conventional activation (CA), and Subgroup C, F: Step-wise irrigant activation). Each tooth specimen was inserted into Eppendorf for debris collection. The canals were instrumented using HyFlex CM rotary files to 0.04 taper. The irrigation was specific to the experimental subgroups, which was done by a single operator. Following the experimental irrigation, the collected debris was weighted using an analytical balance. The collected data were statistically analyzed. Results: Statistical significant debris extrusion was seen with TEA (P &lt; 0.05). Among the subgroups, step-wise irrigant activation technique showed significant (P &lt; 0.05) debris extrusion. Conclusion: CEA showed less debris extrusion when the CA technique was used for irrigation.

Comparative Assessment of Novel Collagen Cross-linking Agents on Push-out Bond Strength of Two Different Sealers: An In Vitro Study.

To assess the push-out bond strength and tubular penetration of resin-based and bioceramic sealers after employing two collagen cross-linking agents, namely, cashew nut shell liquid (CNSL) and epigallocatechin-3-gallate (EGCG) on sodium hypochlorite treated root canal dentin. Fifty human permanent mandibular premolars selected were decoronated at CEJ, this was followed by cleaning and shaping protocols, root canals were enlarged up to 20 sizes with 6% taper and were randomly divided into the following 5 groups with 10 samples each based on the cross-linking agent and the sealer: • Group I: Irrigation with saline (control). • Group II: Irrigation with cashew nut shell liquid followed by bioceramic sealer obturation. • Group III: Irrigation with cashew nut shell liquid followed by resin-based sealer obturation. • Group IV: Irrigation with EGCG followed by bioceramic sealer obturation. • Group V: Irrigation with EGCG followed by resin-based sealer obturation. Five specimens in each group were evaluated for push-out bond strength with the universal testing machine while the remaining five specimens in each group were evaluated for depth of sealer penetration by a scanning electron microscope (SEM). The data was recorded, tabulated, and statistically analyzed. The push-out bond strength was found to be maximum in the apical region in all the five groups followed by the middle third and coronal region. The maximum push-out bond strength was seen in group II followed by groups III and IV, and least in group V. The mean depth of tubular penetration of sealers was found to be effective in the coronal portion followed by the middle third while the apical third region showed the least depth penetration of sealers into the tubules. The maximum penetration of sealers was revealed in group V followed by groups III and IV, and least in group II. Within the limitations of this study, it can be concluded that push-out bond strength was found to the maximum in specimens irrigated with cashew nut shell liquid and obturated with bioceramic sealer. The maximum push-out bond strength was seen in the apical third of all root canals followed by the middle and coronal region. The scanning microscopic analysis revealed maximum mean tubular penetration in the coronal portion followed by the middle third and apical third. A greater penetration was seen in specimens irrigated with EGCG and obturated with hybrid sealer. Selection of sealers plays a pivotal role in the success of endodontic therapy. Leakage-related issues can compromise the bond strength enhancing the bond strength can be achieved through the addition of cross-linking agents.

Evaluation of antibacterial effects of different intracanal medicaments on Enterococcus faecalis in primary teeth: An in vitro study.

Successful endodontic therapy is based on the reduction of infecting bacteria by cleaning, shaping, and disinfecting of the root canal system, thus the use of intracanal dressing is necessary for optimal success of root canal treatment. This study was designed to evaluate the effect of chitosan and propolis as intracanal medicaments against Enterococcus faecalis compared to calcium hydroxide in primary root canals. Ninety-six extracted primary second molars were collected. Teeth preparation was completed to size 30 K-file. They were randomly divided into four groups; (A): chitosan, (B): propolis, (C): calcium hydroxide, and (D): control group (saline). The tooth specimens were inoculated with E. faecalis. Then, tested materials were applied for all groups in accordance to the groups each tooth belonged to. Following this, the bacterial colonies were counted after 24 h, 72 h, and 1 week of applying dressing materials and incubation. Finally, one-way analysis of variance and Fisher's least significant difference tests were used for statistical comparisons between the groups at a significance level of .05. No statistically significant difference was found between groups A, B, and C for both 24 h and a week (p ≥ .05). Yet, a statistical difference between groups A, B, C, and D after 72 h and 1 week were seen (p ≤ .05). Chitosan and propolis medicaments were as effective as calcium hydroxide against E. faecalis in primary root canal treatment and might be considered as an alternative dressing material between treatment sessions.

Pathway of Infections and Virulence Factors in Endodontics

Endodontic treatment has increasingly become a preferred method for tooth preservation, largely due to its consistently high success rates. The success of endodontic therapy, aimed at tooth preservation, has improved due to a deeper understanding of endodontic pathology and advancements in treatment methods. Infections within the root canal, leading to apical periodontitis, are typically polymicrobial with a significant role played by obligate anaerobic bacteria. The study highlights the importance of understanding the intricate pathways of infection, such as through dentinal tubules, open cavities, the periodontal membrane, and the bloodstream, as well as the impact of faulty dental restorations. Key to managing these infections is an in-depth knowledge of the endodontic microbiota and its interplay with various disease states. The review also underscores the role of virulence factors in the pathogenesis of endodontic infections. These factors contribute to bacterial behavior, including adherence, invasion, evasion of host defenses, and induction of proinflammatory cytokines. Understanding these complex interactions is essential for developing effective treatment strategies and enhancing the field of endodontics, with a focus on maintaining long-term oral and overall health.

Comparative Evaluation of Apical Debris Extrusion from the Root Canal using Hand Files, Continuous Rotary Files and Reciprocating File System: An In-vitro Study

Introduction: Root canal preparation is an important step of endodontic therapy. For successful endodontic therapy apical extrusion of debris through the apical foramen into the periradicular region should be minimal to avoid postoperative complication such as flare-ups. Aim: To evaluate in-vitro, extrusion of apical debris from the root canal using continuous rotary files (using multiple files system and single rotary file system), reciprocating file system and hand files. Materials and Methods: This in-vitro research was carried out in the Department of Conservative Dentistry and Endodontics, MM college of Dental Sciences and Research, Mullana, Ambala, Haryana, India, from November 2017 to January 2018. A total of 120 human mandibular premolar teeth that were caries free and single-rooted were split into four groups (each group with n=30) Group I: Hand ProTaper, Group II: Protaper Universal, Group III: F360 and Group IV: WaveOne Gold file system. The root canal was instrumented according to manufacturer’s Instructions; and standardised irrigation with distilled water was performed. The Myers and Montgomery’s Model was employed to gather irrigant and debris that had been apically ejected. The analysis of data obtained was done using Post-hoc Bonferroni test, Oneway Analysis of Variance (ANOVA) and paired t-test. Results: The findings indicate that all instrumentation techniques produced significant amount of extruded debris and irrigant. The mean apical debris extrusion using the One-way ANOVA test showed significant difference (p-value&lt;0.001). WaveOne Gold file group showed least (0.0005±0.0001 mg) and Hand ProTaper file showed maximum (0.0017±0.0002) apical debris and irrigant extrusion. Conclusion: Less apical extrusion of irrigant and debris was observed in the engine-driven nickel-titanium systems than manual technique. Reciprocating file system when compared with hand and continuous rotary file system showed less debris extrusion.