Ultrasonic Tip Research Articles

In vitro effect of different implant decontamination methods in three intraosseous defect configurations.

This in vitro investigation was aimed to evaluate the cleaning ability of four mechanical devices designed for decontaminating implant surfaces. Ninety-six implants were coated with permanent ink and inserted into 3D-printed resin blocks simulating three different intraosseous defect configurations (types Ib, Ic, and Ie). The four tested mechanical decontamination devices (air-polishing with glycine powder, rotating titanium brush, polyetheretherketone [PEEK]-coated ultrasonic tip, and stainless steel ultrasonic tip) were randomly applied onto the 5 mm exposed implant surface. Standardized photographs were taken from a frontal perspective and with a 30° angle coronally and apically to the implant axis. The area with remnant ink on the implant surface was calculated. Although none of the groups achieved complete ink removal, air-polishing with glycine and titanium brushes demonstrated a higher cleaning ability when compared with ultrasonic devices either with standard or PEEK tips for all three defect configurations. For the three tested models, the best cleaning ability in all groups was shown on implant surfaces without facing an intraosseous wall. Titanium brush was the most effective when the intraosseous walls existed. Cleaning effectiveness diminished in the threads located in the apical third, especially when using air-polishing and ultrasonic devices. Titanium brushes and air-polishing devices were more effective in removing artificial biofilm using this in vitro model, although their effectiveness was influenced by the presence of the intrabony component.

Endodontic reintervention of a mandibular second premolar with four root canals: a case report

Complex anatomical variations on root canals morphology are one of the most arduous challenges in the endodontic practice. The objective of this case report is to discuss the clinical management of a mandibular left second premolar with four root canals and four distinct apical foramina. This case report has been written according to Preferred Reporting Items for Case reports in Endodontics (PRICE) 2020 guidelines. A 74-year-old patient was referred to retreat a left mandibular second premolar. The patient complained of discomfort when chewing hard food. After obtaining consent from the patient to investigate the symptoms, a thorough clinical and radiographic examination was performed. The main clinical findings observed were a moderate sensitivity to vertical percussion and mild discomfort at palpation. The periapical radiograph showed a fusion-like root with multiple canals and unsatisfactory root canal fillings associated with apical radiolucency. Based on this investigation, a diagnostic of persistent apical periodontitis was made to the tooth, and nonsurgical root canal re-treatment was proposed to the patient. After written informed consent was obtained, the procedure was performed under magnification provided by a dental operating microscope with the aid of ultrasonic tips. During the access opening and fillings removal, four root canal orifices were observed. Therefore, state-of-the-art technology such as the dental operating microscope, ultrasonics, and cone-bean computed tomography image are strong allies to manage anatomical variations.

Research on optimization of cutting force in AISI D2 hardened steel ultrasonic vibration-assisted turning

This study utilized the self-developed ultrasonic vibration-assisted turning system to conduct turning experiments on AISI D2 hardened steel. The investigation is carried out by the Robust Design method via controlling different ultrasonic vibration-assisted turning factors and levels, including feed rate, spindle speed, depth of cut, and the magnitude of amplitude of the ultrasonic vibration tool tip. This study is carried out with optimal cutting force by the Robust Design goals. The optimal combination is A1 (0.5 mm depth of cut) B1 (0.08 mm/rev feed rate) C3 (20 μm amplitude) D2 (885 rpm spindle speed). The cutting force is 119.85 N which hugely decreased 28.6% by comparing with the lowest group. Through analysis of variance, the depth of cut and feed rate play a dominant role in cutting force. These two factors are used for obtaining the difference of cutting force and tool wear by comparing the two factors at different levels. The experimental results show that the optimal depth of cut and feed rate can be reduced by 15.8% and 28.4% in cutting force, and 72% and 81% in tool wear compared with other levels. When turning AISI D2 hardened steel, ultrasonic vibration-assisted turning systems can greatly improve the turning efficiency.

The Efficiency of the BTR-Pen System in Removing Different Types of Broken Instruments from Root Canals and Its Effect on the Fracture Resistance of Roots.

The study aimed to evaluate the efficiency of the BTR-Pen system in removing different types of instrument fragments from root canals and to assess its effect on fracture resistance of the roots after the removal of the instruments. One hundred thirty human teeth were divided into 10 groups (2 control groups and 8 study groups) according to the localization and type of the fractured fragment as well as the retrieval techniques. Broken instruments were extracted either with BTR-Pen system loops or removed using solely ultrasonic tips. The success rate of instrument removal and consumed time were recorded. All the teeth were subjected to a load at a 1 mm/min rate in a universal testing machine for mechanical testing. The success of removing broken instruments using the BTR-Pen and ultrasonic was 86.7% and 83.3%, respectively (p > 0.05). When the time is compared, the BTR-Pen system (23.97 ± 8.35 min) showed similar results to that of the ultrasonic technique (24.1 ± 8.28 min) (p > 0.05). The BTR-Pen group required less force to fracture than the ultrasonic group (p = 0.024). In conclusion, the BTR-Pen and ultrasonic groups showed no significant difference in terms of the success rate and removal time. The roots that underwent instrument removal using the BTR-Pen system had less fracture resistance.

In Vitro Evaluation of Root Surface Roughness in The Use of an Ultrasonic Device with Different Tips Having Different Mechanism of Action: A Profilometric Study

Objective: The aim of this study was the profilometric evaluation of the changes in root surface roughness created by different types of ultrasonic tips and mechanism of action.
 Methods: Thirty root dentine samples obtained from 15 maxillary premolars, extracted for orthodontic reasons, were included in the study. The sample surfaces were embedded into acrylic blocks, polished, and divided into 3 study groups as linear oscillating device (LOD) with straight tip (ST); LOD with perio-curette tip (PCT); conventional ultrasonic scaler tip (CUST). A calibrated clinician instrumented all surfaces in each group. The root surfaces were evaluated before and after instrumentations with a profilometer device.
 Results: There were no statistical differences between the initial roughness values of the groups (p

Endodontic Challenges in the Management of Multiple Pulp Stones and Root Canal Calcification - A Case Report

Root canal calcification is currently a challenging and interesting case for endodontists. Removing microorganisms and their by-products from the root canal system is the goal of root canal treatment. Worse outcomes from root canal procedures can occur due to root canal calcification, as it can block access to the root canal and hinder cleaning and shaping. Iatrogenic errors may occur in the treatment of such cases which will lead to failure of endodontic treatment. This case report describes a 20-year-old woman with multiple pulp stones in the pulp chamber of the mandibular left first molar. In addition, there were also calcified root canals in the mesiolingual and mesiobuccal canals. The patient had asymptomatic irreversible pulpitis and had to undergo endodontic treatment. Several challenges were faced in this case. The initial challenge was to determine the location of the pulp stone in the pulp chamber. Radiographs taken from multiple angles, as well as a direct assessment of the cavity during access preparation, addressed this initial challenge. Retrieval of the pulp stone which in this case is the embedded type that was carried out by grinding it with the help of an ultrasonic tip. Other difficult challenges were avoiding perforation of the pulp chamber floor during treatment, especially when removing the pulp stone, and identifying the location of the orifice. With clinical knowledge, magnification aids and ultrasonic tips, successful treatment in this challenging case was achieved.
 Calcific metamorphosis, sometimes known as pulp canal obliteration (PCO), is the extensive formation of tertiary dentin in the pulp chamber leading to circumferential narrowing of the pulp chamber and root canal.[1] According to the AAE (American Academy of Endodontics), PCO is radiographic evidence of increased dentin production mainly in response to trauma. The result is a calcified canal and does not necessarily indicate pulp disease.[2] Pulp calcification is a common occurrence. The incidence varies, but overall it can be estimated that 50 % of teeth have one or more calcifications.[3]
 There is no evidence to explain whether pulp calcification is a pathological process associated with various forms of injury or natural phenomena.[3] In general, the pulp chamber becomes progressively smaller and often very small, a phenomenon known as calcified metamorphosis or obliteration of the pulp canal. Dentin can be accelerated by caries, trauma, abrasion, restoration, and periodontal disease and is not uniform.[1]
 Calcifications are divided into denticle (pulp stones) and diffuse (linear) calcifications. Pulp stones are divided into free, attached, and embedded types. Pulp stones tend to be found in the coronal pulp, and diffuse calcifications are found in the radicular pulp. It has been speculated that the nidi of calcification arise from degenerating nerves or blood vessels, but this has not been proven.[1

Impact of the removal of filling material from the post space with ultrasonic insert and magnification with a surgical microscope on the bond strength and adhesive interface of multifilament fiberglass posts onto flat-oval root canals

• Higher BS was found for MFPs compared to conventional fiberglass posts. • Ultrasonic tip filling removal results in higher BS and better adaptation of MFPs. • Highest BS was found for the use of ultrasonic tip with surgical microscopy.

The Properties of Cement Paste Incorporating Multi Wall Carbon Nanotube Solution Prepared through Bead Mill and High-Pressure Homogenizer Process with Polycarboxylate Ester

Carbon nanotube (CNT) has been successfully used for production of cementitious composites due to its excellent mechanical properties. In most of the existing literatures, the dispersion of CNT was mostly achieved using either ultrasonic water bath or tip sonicator that is known to provide relatively small amount of energy. In this work, the high energy dispersion processes, bead mill and high-pressure homogenizer, which have been applied for other industrial purposes, were applied to prepare multi wall carbon nanotube (MWCNT) solution with polycarboxylate ester (PCE) as a dispersing agent. The MWCNT solution was used for preparation of cement paste specimens. Ultrasonic tip sonication, a conventional lab-scale dispersion process, was also used for comparison purposes. According to the experimental results, PCE in MWCNT solution behaved as an air-entraining high-range water reducer for cement paste, causing increase in porosity, retardation in hydration, and reduction in undisturbed yield stress. Such effect was more significantly observed from the cases with bead mill and high-pressure homogenizer than ultrasonic tip sonication. The 28-day compressive strength increased by the addition of MWCNT, showing the maximum efficiency at 0.05% MWCNT content. The viscosity of cement paste increased as the amount of MWCNT increased, but flexural strength generally decreased as MWCNT was incorporated.

Root canal treatment of a maxillary second molar with four mesiobuccal root canals – a case report

Among the roots of maxillary molars, the mesiobuccal often presents with a root canal system that may be complex and variable, leading to a greater challenge when trying to achieve a proper chemo-mechanical preparation. The present report intends to show a successful root canal treatment of a maxillary second molar with six root canals, of which four were present in the mesiobuccal root. After being diagnosed with pulp necrosis and symptomatic apical periodontitis, a molar was endodontically treated. It also had an uncommon paracone cusp. A careful inspection of the pulp chamber floor revealed a mesiopalatal sulcus, which, after exploration with ultrasonic tips under an operating microscope magnification, showed three additional mesiobuccal root canals. After proper mechanical debridement, disinfection with sodium hypochlorite, and warm gutta-percha obturation, a favorable outcome was observed at the 12-month follow-up.

Integrated effects of ultrasonic scaling and subgingival irrigation with 0.12% chlorhexidine by a newly designed ultrasonic scaler tip in chronic periodontitis.

To evaluate the integrated efficacy of completely simultaneous ultrasonic scaling and subgingival irrigation with chlorhexidine in chronic periodontitis. This was a split-mouth randomized controlled trial including 19 patients with moderate to severe chronic periodontitis. After calculus removal, the test side received simultaneous ultrasonic scaling and subgingival irrigation with 0.12% chlorhexidine, and the control side received simultaneous ultrasonic scaling and subgingival irrigation with distilled water. A newly designed ultrasonic scaler tip with a liquid outlet on the terminal was used. Clinical parameters were assessed, and gingival crevicular fluid was collected before treatment at baseline and 1.5, 3, and 6 months after baseline. On follow-up, both sides showed significant reductions in clinical parameters and concentration of inflammatory mediators in gingival crevicular fluid. Adjunct application of CHX resulted in an additional periodontal pocket reduction (0.27 to 0.29 mm, P < .05) compared to the control side, in sites with initial probing depth of 4 to 5 mm. Within the initial probing depth ≥ 6 mm, the additional probing depth reduction was 0.44 to 0.60 mm (P < .05), with clinical attachment loss, concentration of interleukin-6, and concentration of matrix metalloproteinase-8 being 0.32 to 0.38 mm, 2.64 to 3.40 µg/L, and 19.78 to 22.39 ng/L, respectively (all P < .05). In this study, treatment outcomes of chronic periodontitis could be improved by treating the root surface with simultaneous ultrasonic scaling and chlorhexidine irrigation. The adjunctive use of 0.12% chlorhexidine with a newly designed ultrasonic scaler tip in the treatment of moderate to severe chronic periodontitis demonstrated significant clinical benefits and decrease in inflammatory mediator when compared with scaling and root planing plus placebo.

In Vitro Qualitative Evaluation of Root-End Preparation Performed by Piezoelectric Instruments.

Although the application of ultrasounds in endodontic surgery allows for effective debridement of the root canal, incorrect device setting or inefficient tips seem to generate cracks during root-end retropreparation. The primary aim of this in vitro study was to establish the presence, or absence, of a correlation between ultrasonic root-end preparation and the formation of cracks. The present study was conducted on human teeth, extracted for periodontal reasons. After root canal treatment, roots were resected 3 mm from the anatomical apex by using a high-speed handpiece and carbide burs. The resected teeth were retroprepared by using an ultrasonic tip (R1D, Piezomed, W&H, Bürmoos, Austria), setting the piezoelectric device at maximum power available for the tip. Time required for the retropreparation was recorded. Before and after retropreparation, all roots were photographed under a stereomicroscope and analyzed by two different operators to evaluate: (a) the presence and extension of dentinal cracks and (b) the morphology of root-end preparation. Finally, piezoelectric tips were analyzed by scanning electron microscopy (SEM) to evaluate morphologic changes after use. A total of 43 single roots (33 with one root canal, 10 with two root canals) were treated. Average preparation time was 1 minute and 54 seconds. None of the roots without initial cracks developed new cracks after retropreparation. Quality of the preparation margins was fairly equal among the prepared specimens. None of the piezoelectric tips broke during instrumentation, and SEM analysis showed minimal surface wear of the tips after performing 11 retropreparations. Within the limits of the present study, the tested piezoelectric system does not seem to represent a major cause for root crack formation. Pre-existing cracks may expand after ultrasound root-end preparation.

Irrigant flow characteristics in the root canal with internal root resorption: a computational fluid dynamics evaluation.

Irrigation dynamics of syringe irrigation with different needle designs (side-vented, double side-vented, notched) and ultrasonic irrigation in the root canal with internal root resorption were evaluated using a computational fluid dynamics model. A micro-CT scanned mandibular premolar was used for modeling internal root resorption. The needles and the ultrasonic tip were positioned at 2, 4, and 5mm from the working length. The insertion depth and the irrigation model were found influential on the shear stress and the irrigant extension. The extension of the irrigant increased toward 2-5mm from the working length. Ultrasonic irrigation revealed the highest shear stress values regardless of the insertion depth. The shear stress distribution on the resorption cavity walls gradually increased when the needles were positioned coronally. The residence time of the irrigant in the canal was affected by the needle position relative to the internal root resorption cavity and the needle type.

Processing‐structure‐property relationship of multilayer graphene sheet thermosetting nanocomposites manufactured by calendering

AbstractThe dispersion state of multilayer graphene sheets in polymers has a strong impact on the properties of the nanocomposite, and is driven by the processing parameters of the dispersion method. Herein, multilayer graphene sheet/vinyl ester nanocomposites were manufactured using a three‐roll mill. The roller gaps and number of processing cycles were varied to study their effect on the dispersion state and their relationship with the effective electromechanical properties of the nanocomposites. It was found that reducing the roller gaps and increasing the number of processing cycles yields smaller (up to 7.4 μm in diameter) and more densely packed (up to ~1500 agglomerates/mm2) agglomerates. Nanocomposites manufactured with the three‐roll mill contain agglomerates up to 75% smaller and more densely packed than those manufactured with an ultrasonic tip. Electrical conductivity was higher for moderately‐sized, homogeneously distributed agglomerates (23 μm in diameter) with a high areal density (~920 agglomerates/mm2), while smaller agglomerates reduced electrical conductivity. Smaller agglomerates increased the mechanical properties but decreased the piezoresistive sensitivity. The agglomerate density proved to be a key factor governing the piezoresistive sensitivity, with a lower number of agglomerates per unit area promoting higher gauge factors.

Enzyme-free saccharification of cellulose to glucose using ultrasonic welding

• Ultrasonic welding can decompose cellulose in a short time. • No enzymes or catalysts are required for cellulose degradation. • The present method can be applied to the process of producing bioethanol from nonedible biomass. Ultrasonic welding is a processing technology that can instantly fuse and join thermoplastic resins by applying minute amounts of ultrasonic vibration and pressure. The present study demonstrates that the frictional force or pressure caused by ultrasonic welding can cause cellulose decomposition without a saccharifying enzyme or catalysts. Ultrasonic waves of 19.5 kHz were irradiated downward on samples using a horn-type transducer. The cellulose specimens were composed of 15 – 105 stacked sheets of filter paper with high cellulose content, a sheet of cotton, and a sheet of hemp. The high frictional forces resulting from direct contact of cellulose with the ultrasonic horn tips decomposed the saccharides within a short time to produce glucose. Cellulose is decomposed into glucose through hydrolysis in an enzyme-free environment by ultrasonic irradiation, but then it is further decomposed into 5-hydroxymethylfurfural, furfural, and other compounds via a dehydration reaction caused by an increase in temperature of the reaction field from continuous ultrasonic irradiation. Glucose could be obtained from the cellulose without using an enzyme through ultrasonic welding. The result of decomposing cellulose, cotton, and hemp by this method revealed that a yield of 1.2% glucose could be obtained by decomposing filter paper.

The Efficacy of Two Novel Retreatment Systems in the Removal of Root Canal Obturating Materials (An In vitro Study)

BACKGROUND: The complete removal of root filling material is one of the main goals of non-surgical endodontic retreatment. Thus, the development of new techniques and instruments aiming to promote this task presents clinical significance. AIM: The purpose of the study was to assess the amount of residual root canal filling materials (gutta-percha/sealer) after using two different endodontic retreatment systems and ultrasonic tip. METHODS: Forty-five mandibular premolar teeth were mechanically instrumented and obturated. Retreatment was performed using two different Endostar RE (Group 2), Rogin retreatment system (Group 3), and ultrasonic tip (Group 1). Roots were separated buccolingually into two halves. A digital camera connected to the stereomicroscope captured images to each half. Image-J software was used to evaluate and measure the areas with remaining filling material in each third (cervical, middle, and apical). RESULTS: Data analysis revealed significant differences between the groups in the coronal, middle, and apical thirds (p &lt; 0.05). The ultrasonic retreatment tips (G1) were significantly more efficient in removing the gutta-percha and sealers compared to the Rogin (G3) and Endostar (G2) retreatment endodontic kits. CONCLUSIONS: All the file systems left some filling material in the canals. Ultrasonic retreatment tip had maximum efficacy for the removal of filling materials in comparison with the retreatment file systems under investigation.

Comparative Analysis of Ease of Removal of Fractured NiTi Endodontic Rotary Files from the Root Canal System-An In Vitro Study.

This study aimed at analyzing and comparing the ease of removal of fractured nickel–titanium (NiTi) endodontic rotary files from the root canal system between the ultrasonic tips and the Endo Rescue appliance removal systems, as well as comparing the volume of dentin removed between ultrasonic tips and the Endo Rescue appliance using a micro-computed tomography (micro-CT) scan. Material and Methods: Forty NiTi endodontic rotary files were intentionally fractured in 40 root canal systems of 20 lower first molar teeth and distributed into the following study groups: A: Ultrasonic tips (n = 20) (US) and B: Endo Rescue device (n = 20) (ER). Preoperative and postoperative micro-CT scans were uploaded into image processing software to analyze the volumetric variations of dentin using an algorithm that enables progressive differentiation between neighboring pixels after defining and segmenting the fractured NiTi endodontic rotary files and the root canal systems in both micro-CT scans. A non-parametric Mann–Whitney–Wilcoxon test or t-test for independent samples was used to analyze the results. Results: The US and ES study groups saw 8 (1 mesiobuccal and 7 distal root canal system) and 3 (distal root canal system) fractured NiTi endodontic rotary files removed, respectively. No statistically significant differences were found in the amount of dentin removed between the US and ER study groups at the mesiobuccal (p = 0.9109) and distal root canal system (p = 0.8669). Conclusions: Ultrasonic tips enable greater ease of removal of NiTi endodontic rotary files from the root canal system, with similar amounts of dentin removal between the two methods.

Validity of the dental operating microscope and selective dentin removal with ultrasonic tips for locating the second mesiobuccal canal (MB2) in maxillary first molars: An in vivo study.

BackgroundSeveral investigations have determined whether the use of a dental operating microscope (DOM) in combination with selective dentine removal with ultrasonic tips increases the percentage of location of the Mesiobuccal 2 (MB2) root canal in maxillary first molars (MFM). However, these studies did not report the performance of in vivo measurements with the comparison with a gold standard. The aim of this study was to determine the validity of the DOM and selective dentin removal with ultrasonic tips to locate the MB2 root canal in MFM using Cone Beam Computed Tomography (CBCT) as the gold standard. Material and MethodsThe initial sample size was 91 patients, but 7 were excluded, so the sample size was 84 patients who signed the informed consent. Inclusion criteria: MFM indicated for root canal treatment. An expert blinded observer identified the MB2 in the CBCT. Two standardized examiners (Kappa=91%) performed the clinical assessment in three stages: Stage 1, canal location with an endodontic explorer and a mirror; Stage 2, use of DOM and Stage 3, use of DOM plus selective dentine removal with ultrasonic tips. The validity of each stage was calculated. ResultsThe prevalence of MB2 using CBCT was 79%, by clinical location was 68%. Sensitivity was 79%, 82%, 86% for stage 1, 2 and 3, respectively. Specificity and Positive Predictive Values were 100% for all methods. Negative Predictive Value was 56%, 60%, 67%, respectively. Positive Likelihood Ratio tends to infinity for all methods, Negative Likelihood Ratio= 0.21, 0.18 and 0.14 and Accuracy= 83%, 86% and 89%, respectively. ConclusionsThe use of DOM with selective dentine removal with ultrasonic tips is the most valid method for locating MB2 canal in MFM. There was an increase in the location of the MB2 root canal with the DOM and ultrasonic tips, which definitely help the clinician. Key words:Cone beam computed tomography, microscopy, second mesiobuccal canal, sensitivity and specificity, validity.

Sealing ability of mineral trioxide aggregate, Biodentine, and EndoSequence RRM putty used as retrograde restorative material: An in vitro bacterial leakage model study

Sealing ability of mineral trioxide aggregate, Biodentine, and EndoSequence RRM putty used as retrograde restorative material: An in vitro bacterial leakage model study

Research on clinical characteristics and clinical healing assessment after endodontic surgery using ultrasonic tip and root -end filling material by MTA

Background: Endodontic surgery is one of the tooth-conserving interventions indicated when conventional endodontic treatment fails for teeth with periapical lesions with the conventional classical method using handpiece with drill for osteotomy, apectomy, sinus creation and retrograde filling with Amalgam. Today, many studies have shown that when applying improvements in surgery such as the use of ultrasonic instruments for osteotomy, apectomy, sinus creation and retrograde filling with biomaterial Mineral Trioxide Aggregate (MTA) helps to reduce pain and swelling, to increases the clinical healing rate after surgery, thereby contributing to increase the success after intervention. Objectives: To investigate the clinical outcomes and evaluate clinical healing after endodontic surgery using ultrasound instruments and retrograde fillings with MTA materials. Materials and methods: This quasi experimental study carried out on 24 pernament teeth, one maxillary root in 16 patients (8 males and 8 females), whose periapical lesions of teeth with indication for endodontic surgery, who came for examinaton and treatment at Department of Dentistry, 175 Military Hospital from 10 /2021 to 10 /2022. Before surgery, patients were recorded with clinically relevant features. Endodontic surgery was performed according to the standard procedure of the Department of Oral Surgery, Faculty of Odonto-Stomatology, University of Medicine and Pharmacy, Ho Chi Minh City, using ultrasonic instruments and root -end filling with MTA material. Pain and swelling at 1, 3, 7 days after surgery were assessed according to the variable VAS scale of Pasqualini et al (2005). Clinical healing assessment according to the criteria of Gutmann (1994). Results: Before surgery, most of the damaged teeth were not endodontic treatment (66,7%), pain (70,8%), swelling (87,5%), no pus fistula in the gums (70,8%), no fixed prosthesis (33,3%), discolored (58,3%), . At 1, 3, 7 days after surgery, most of the studied cases had mild pain, mild swelling; this level of pain, swelling gradually decreases over time; the difference in the rate of pain and swelling rates was evident at the 1st and 7th day after surgery and was statistically significant (with p &lt; 0,001). The average pain score was 0,792 ± 0,588; 0,458 ± 0,509 and 0,083 ± 0,282 with the difference in mean pain score at 1, 3, 7 days after surgery was statistically significant ( p &lt; 0,001). The mean swelling score was 1,375 ± 0,647; 0,833 ± 0,637 and 0,125 ± 0,338 with the difference in mean swelling score at 1, 3, 7 days after surgery was statistically significant (p &lt; 0,001). At 3, 6 month after surgery, most of the teeth had a high clinical healing rate (including complete healing and incomplete healing) with the rate of 87,5% (3 months) and 91,7% (6 months), respectively. There was no difference in clinical healing rates between 3 and 6 months postoperatively. Conclusion: Endodontic surgery using ultrasonic instruments and retrograde filling with MTA has mild postoperative pain and swelling; achieve a high clinical healing rate. This technique contributes significantly to the success of surgery, helps improve treatment efficiency, and improves oral health for patients.

Comparative evaluation of the apical leakage of different bioceramic retrofilling materials with and without smear layer: A stereomicroscopic study.

Present in-vitro study aimed to evaluate the apical leakage of different bioceramic retrofilling materials with and without smear layer. : Sixty human single-rooted teeth were decoronated at a standardized root length of 13 mm, chemo-mechanically prepared and obturated. After obturation, root-end resection was done and root-end cavities were prepared using ultrasonic tips. The specimens with prepared retro cavities were randomly assigned into 2 groups (n = 30) based on the smear layer removal protocol used. Each group was further subdivided into 3 subgroups (n = 10) based on the bioceramic retrofilling material MTA (Mineral Trioxide Aggregate; Proroot Dentsply/Tulsa), CEM (Calcium-Enriched Mixture; Bionique Dent, Tehran) and ERRM (EndoSequence® Root Repair Material; Brasseler USA, Savannah, GA). The extension of dye (2% Rhodamine B) penetration was measured in millimetre using a stereomicroscope at 10× zoom. Results were statistically analysed using one-way ANOVA (analysis of variance) test and unpaired Student's t test. In the presence of smear layer, MTA demonstrated maximum mean apical leakage value (1.70 ± 0.30), followed by CEM (1.40 ± 0.37) and ERRM (1.40 ± 0.23), which was statistically not significant. Without the smear layer, ERRM demonstrated the least mean apical leakage value, which was statistically significant as compared with CEM (P <.05) and MTA (P <.01). : All bioceramic retrofilling materials demonstrated apical leakage irrespective of the presence or absence of the smear layer. The presence of a smear layer is beneficial for the sealing ability of MTA and CEM, whereas, the absence of the smear layer is advocated while using ERRM.