XP-endo Finisher Research Articles

Investigating the Antibacterial Ability of Sodium Hypochlorite Solution Activated with PUI and XPF File Against Enterococcus faecalis Using CFU, RT-PCR, and SEM

Eradication of microorganisms present in the root canal system during endodontic therapy is one of the critical factors affecting the final outcome of endodontic treatment. However, even adequate technique of the root canal treatment and use of irrigants according to the established protocol does not lead to the complete elimination of microorganisms during endodontic treatment. The presence of Enterococcus (E.) faecalis inside the root canal system may be an important factor contributing to the failure of the treatment. Introducing agitation techniques in irrigation, such as passive ultrasonic irrigation (PUI) and the use of the activating instrument XP-endo Finisher (XPF), contribute to a better debridement and disinfection of the root canal. This study was conducted on 42 root canals experimentally inoculated with E. faecalis and exposed to three irrigation protocols. These have included a standard irrigation protocol using a syringe and needle, passive ultrasonic irrigation, and activation of the irrigant using an XPF instrument. The reduction in microorganisms was evaluated using the quantitative polymerase chain reaction in real-time (RT-PCR) as well as via the method of determining the number of colony forming units on nutrient medium (CFUs). The results of this study showed that the use of supplementary irrigation protocols, PUI, and XPF led to a significant decrease in the number of microorganisms inside the root canal of experimental teeth. These findings indicate a significant positive impact of these procedures on the disinfection of the root canal system.

Effectiveness of supplementary antimicrobial procedures in disinfecting lateral canals as evaluated by a novel ex vivo analytical approach

This ex vivo study devised an analytical ex vivo method for infection/disinfection of simulated lateral canals located in the middle and apical segments of the root. The antibacterial effects of supplementary approaches were tested in this model. Extracted mandibular premolars had their main root canals enlarged and then two lateral canals (100 μm in diameter) were created in the root, one in the apical and the other in the middle portion. Micro-computed tomography was used for specimen selection and to confirm the quality of the simulated ramifications. The specimens were contaminated with a mixed bacterial culture from subgingival bacterial biofilm added to pure Enterococcus faecalis strain ATCC 29212 grown overnight, using special strategies to facilitate culture medium penetration within the lateral canals. The following procedures were tested for disinfection: NaOCl/passive ultrasonic irrigation (PUI), NaOCl/XP-endo Finisher, ozonated water/continuous ultrasonic irrigation (CUI), and NaOCl/conventional irrigation with 30-G needles (control). Bacteriological samples were taken from the main canal before (S1) and after (S2) each supplementary protocol, and also from each lateral canal after treatment (S3). DNA extracted from the samples was subjected to quantitative real-time polymerase chain reaction. All S1 main canal samples were positive for bacterial presence. Bacterial counts in the main root canal substantially decreased by 99.2% after PUI, 99.1% after ozone/CUI, 99% after XP-endo Finisher, and 96% in the control group (P < 0.01 for all groups). There were no significant differences between groups (P > 0.05). The same was observed when comparing the effects of the supplementary approaches in the apical and middle lateral canals (P > 0.05). Only a few lateral canals showed no detectable bacteria. The method proposed here proved effective for ex vivo infection/disinfection studies. All supplementary approaches induced a substantial bacterial reduction in the main canal, with no significant differences between them. However, in terms of lateral canal disinfection, none of the tested approaches showed significant effects when compared to the control group.

XP-Endo Finisher behaviour and irrigant temperature in intracanal environment: Clinical measurements.

To evaluate the behaviour of the XP-Endo Finisher and the variation in the intracanal temperature of the irrigant at rest and when activated over time. Differential scanning calorimetry (DSC) determined the transformation temperatures of XP-Endo Finisher instruments. A digital thermocouple was used to measure the temperature of the irrigant inside the pulp chamber. Two measurements were performed for each tooth (n = 12): with the irrigant at rest and during XP-Endo agitation for 60 s to observe the temperature evolution. The data were statistically analysed using a t-test with a confidence level of 95%. DSC results suggested that the XP-Endo Finisher had a mixed R-phase and austenitic structure at room temperature. The temperature values at predetermined time points (0, 10, 40, 70, 120 and 240 s) were measured, and no statistical difference was observed between the values of the resting and activated solutions at any of the selected points (p > .05). For the protocol performed with the XP-Endo file, the mean irrigant temperature observed at instrument insertion inside the root canal was 28.65°C. After 60 s of agitation, the temperature was 34.02°C. The solution temperature stabilized inside the canal only after 211 s at 35.5°C. The mean maximum irrigation solution temperature recorded inside the canal was 35.5°C without agitation and after XP-endo agitation (p > .05). Although the XP-Endo Finisher system does not promote heating of the irrigation solution, file expansion responsible for improved instrument cleaning starts at a temperature below the expected value.

The Efficiency of Different Supplementary Irrigation Techniques After Nickel-Titanium Rotary System in Endodontic Retreatment

Objective: To assess the efficiency of XP-Endo Finisher file (XPFF), EDDY, and diode laser as supplementary irrigation activation techniques following nickel-titanium rotary files in the endodontic retreatment. Methods: 48 mandibular premolars were collected. Each root canal was shaped and filled with EndoSequence BC sealer and gutta percha. After 14 days, endodontic retreatment was performed using D-Race instruments. Then, 48 samples were assigned into 4 groups (n=12) as control, diode laser, EDDY, and XPFF according to the supplementary irrigation methods. After the irrigation procedure, all samples were visualized under a stereomicroscope. The remaining root filling material was scored and compared statistically using Kruskal-Wallis and Post-hoc pairwise comparison tests. Results: In all thirds, there was a significant difference between the diode laser and control groups. The amount of remaining filling material in the diode laser group was significantly lower than in the control group. When the other groups were compared, a significant difference was observed only between the diode laser and XPFF groups in the coronal third. Conclusion: No supplemental method could eliminate the root obturation material. The diode laser can be used in addition to nickel-titanium rotary retreatment systems to improve the removal of gutta percha and bioceramic sealer.

Effectiveness of XP-Endo Finisher, Endoactivator, and PUI agitation in the penetration of intracanal medicaments into dentinal tubules: A confocal laser scanning microscope analysis.

This investigation assessed the impact of irrigation activation systems on the depth of penetration of intracanal medicaments into dentinal tubules. Ninety-six mandibular premolar teeth were prepared using ProTaper Next up to size X3. The teeth were randomly divided into four groups based on the final irrigation activation systems (n=24): group 1: EndoActivator, group 2: XP-Endo Finisher, group 3: Passive ultrasonic irrigation (PUI), and group 4: control. After the final irrigation, all the samples were divided into two subgroups (n=12): subgroup A: calcium hydroxide (Ca(OH)2 ) and subgroup B: modified triple antibiotic paste (mTAP). Statistical analysis involved three-way analysis of variance (ANOVA). EndoActivator, XP-Endo Finisher, and PUI activation methods significantly increased the penetration of intracanal medicaments compared to conventional needle irrigation (P<0.05). The XP-Endo Finisher group exhibited the highest penetration percentage and maximum penetration depth, showing a statistically significant difference from the EndoActivator group (P<0.001). No significant difference was observed between XP-Endo Finisher and PUI, nor between PUI and EndoActivator (P>0.05). mTAP showed a higher percentage of dentinal tubule penetration than Ca(OH)2, although no significant difference was found in maximum penetration depth. The coronal region demonstrated the highest penetration percentage and depth, while the apical region showed the lowest. This study showed the effectiveness of XP-Endo Finisher in improving the penetration of intracanal medicaments into dentinal tubules. The findings emphasize the importance of selecting appropriate irrigation activation systems to improve treatment outcomes in endodontics. By demonstrating the effectiveness of advanced systems like XP-Endo Finisher, this research supports their integration into routine clinical practice for better endodontic success.

Efficacy of various techniques in calcium silicate-based intracanal medicament removal: a micro-CT analysis

The purpose of this study was to evaluate the efficacy of different techniques in removing calcium silicate intracanal medicament (Bio-C Temp). Forty human single-canaled premolars were randomly distributed into five groups (n = 8). All root canals were instrumented, then filled with Bio-C Temp. Following 1-week incubation, the intra-canal medicament was removed using one of five techniques according to tooth group: conventional syringe irrigation, Endo Activator, passive ultrasonic irrigation (PUI), ProTaper Universal F3 and XP-endo Finisher (XPF). Micro-CT scanning was performed before and after removal of Bio-C Temp. All techniques significantly reduced the volume of Bio-C Temp (p < 0.001) without reaching complete elimination. The percentage of Bio-C Temp removed was significantly higher in the XPF group (98.2%) compared to conventional syringe irrigation (70.6%), the Endo Activator (75.7%), and the ProTaper Universal (76.6%). There was no significant difference between the XPF and PUI (95.1%) groups. None of the removal techniques were able to completely remove Bio-C Temp from the root canal. However, XPF was the most effective method, but was not statistically significant when compared to PUI. Clinical Relevance: This study demonstrated that both XPF and PUI outperform conventional irrigation in removing Bio-C Temp intracanal medicament.

Evaluation of different irrigation activation techniques for the removal of various medicaments from a simulated internal resorption cavity: an in vitro study.

This study aimed to assess the efficacy of different activation techniques in removing calcium hydroxide (Ultracal XS), Ledermix, and Bio-C Temp from simulated internal root resorption (IRR) cavities. 108 single-rooted maxillary incisors were prepared using Reciproc R50 files. Simulated IRR cavities, 2mm in diameter and located 8mm from the apex, were created. Ultracal XS, Ledermix, and Bio-C Temp were applied to the samples, grouped by irrigation activation techniques: Standard Needle Irrigation (SNI), EDDY, Passive Ultrasonic Irrigation (PUI), and XP-endo Finisher (XPF). Medicament removal efficacy was evaluated using a standardized scoring system. Statistical analysis was performed using the Kruskal-Wallis test. XPF and PUI were more effective than SNI in medicament removal across the groups, with no significant difference. EDDY showed no significant difference than other groups. Ledermix was more effectively removed in all activation groups compared to Bio-C Temp. The XPF was superior in removing Ultracal XS compared to Bio-C Temp. However, none of the groups achieved complete medicament removal. XPF and PUI techniques enhance medicament removal efficacy. Bio-C Temp was more difficult to remove from the IRR cavities than other medicaments. Bio-C Temp could be removed from the canals less effectively compared to calcium hydroxide and Ledermix. Among the tested irrigation activation methods, XPF and PUI were found to be more effective at removing the tested medicaments.

Comparative Evaluation of Different Methods of Activation of Chelating Solution for Smear Layer Removal in the Apical Portion of the Root Canal Using a Scanning Electron Microscopy: An In Vitro Study.

Background The smear layer has an adverse effect on the sealing of root canals during obturation, and it is the main reason for the failure of root canal treatment.Root canal irrigation using a conventional irrigation system is ineffective for smear layer removal, especially from the apical third region, where mostlateral canals are present. For successful endodontic treatment, the smear layer should be removed from the apical third region using an effective irrigation activation system. Aim This study aimed to compare smear layer removal by conventional irrigation, XP Endo Finisher (XPF), endoactivator (EA), passive ultrasonic activation, and root canal brushusing 17% ethylenediaminetetraacetic acid (EDTA) as a chelating solution and 5.25% sodium hypochlorite after chemomechanical preparation, using scanning electron microscopy (SEM). Method A total of 50 extracted human mandibular single canal premolars with mature roots were selected for this study. Samples were decoronated to obtain a standard working length (WL) of 15 mm. Canal patency was achieved using a 10 k file. Samples were sealed with sticky wax to obtain the vapor lock effect. Biomechanical preparation is done till F3. The samples were divided into five groups according to the final irrigation activation protocol: Group 1, control group; group 2, XPF; group 3, EA; group 4, passive ultrasonic irrigation (PUI); and group 5,, root canal brush. Samples were divided into two equal halves longitudinally. Each sample was analyzed for a smear layer under SEM at 2000x magnification. Statistical analysis was done using the one-way Anova "F" test and Tukey's post-hoc test. Results Group 3 showed the least presence of a smear layer, followed by groups 4, 2, 5, and 1. All the groups exhibited highly significant differences between each other (p < 0.001). Group B shows no significant difference with groups C, D, and E. Group C shows no significant difference with groups D and E. Group D shows no significant difference with group E. Conclusion The EA removes the smear layer effectively as compared with other groups. All the irrigation activation system shows the presence of smear layer. No activation systems were able to remove the smear layer completely.

The Effectiveness of Three Different Irrigant Activation Methods in the Elimination of Enterococcus faecalis from Root Canals.

Background and Objective: Eliminating intracanal Enterococcus faecalis (E. faecalis) is challenging because of its ability to penetrate deep dentinal tubules and its high resistance to many chemicals. This study evaluated the effectiveness of conventional needle irrigation and three different irrigant activation methods in reducing E. faecalis. Methods: The root canals of extracted teeth were shaped, contaminated with E. faecalis, and incubated for three weeks. They were randomly allocated to four experimental groups of 15 teeth each according to the final irrigation method: group 1, conventional needle irrigation; group 2, passive ultrasonic (PU) irrigation; group 3, XP-endo Finisher (XPF); and group 4, laser-activated (LA) irrigation. Bacterial samples were taken and cultured before and after these final irrigation procedures. The colony-forming units were counted, and the bacterial reduction percentages of each group were calculated. The Kruskal-Wallis and Dunnet tests were used for statistical analysis. Results: All irrigant activation methods were significantly more effective than conventional needle irrigation. Although the LA group generated more negative samples than PU, there was no statistically significant difference between the LA and PU groups. LA was significantly more effective than the XPF, whereas PU and XPF were statistically similar. Conclusions: Within the limitations of this study, the final irrigation with LA and PU showed the best reductive effect on E. faecalis colonies. Considering that the LA group had more negative samples, it may be chosen as an alternative to enhance root canal disinfection, especially in difficult cases.

Laser-assisted Root Canal Filling Removal of Lower Incisors - A Micro-CT Study.

To compare the efficiency of root canal filling removal from oval-shaped root canals with high-energy Er:YAG laser and additional instrumentation with a rotary Ni-Ti XP-Endo Finisher R system. The in vitro study was accomplished on 12 freshly extracted single-rooted mandibular incisors with one straight oval-shaped root canal, shaped with XP-Endo Shaper 30/.04 and obturated by using the warm vertical condensation technique subjected to further endodontic orthograde retreatment. Group 1: the first retreatment was carried out using a high-energy Er:YAG laser (n = 12). Group 2: the additional retreatment of the same specimens was performed with the XP-Endo Finisher-R system (n = 12). The effectiveness of the retreatment techniques was evaluated by a threefold micro-CT examination. The amount of the remaining root canal filling material was analyzed by Mann-Whitney U test and Friedman tests. A significant decrease in the quantity of the root canal filling was found following the first and after the second retreatment, compared to the initial values in all examined sections (P < 0.001). Within groups, additional application of the Ni-Ti system resulted in no significant removal of the filling materials (P > 0.05). None of the systems resulted in complete root canal filling removal. Despite the improved results after the application of the supplementary retreatment protocol, none of the root canal walls were completely clean in the apical area. The high-energy Er:YAG laser and XP-Endo Finisher R rotary system can be successfully used in endodontic orthograde retreatment under relevant operating parameters.

Effectiveness of EndoActivator, PATS Vario system, and XP-endo Finisher files on smear layer removal under scanning electron microscope: A comparative study.

The smear layer may harbor many bacteria; hence, alternative methods are used to disrupt and remove biofilm. The aim of the study was to compare the effectiveness of EndoActivator, PATS Vario System, and XP-endo Finisher files on smear layer removal using a scanning electron microscope. Sixty single-rooted extracted premolars with Vertucci Type 1 configuration were decoronated and divided into four groups. The groups were instrumented with the rotary ProTaper file system. All specimens were flushed with 1 ml of 3% sodium hypochlorite. Group 1 was irrigated with a conventional needle and syringe. In Group 2, the irrigant was activated with an EndoActivator. In Group 3, the irrigant was activated with PATS Vario system, and in Group 4, XP-endo Finisher files were used after biomechanical preparation to remove debris and smear layer. All specimens were finally rinsed with 3 ml of 3% sodium hypochlorite. The teeth underwent longitudinal splitting and grooving in the coronal, middle, and apical thirds, and then, the samples were taken for scanning electron microscopy to evaluate the amount of smear layer removal in each third. The middle and coronal thirds Showed that almost similar efficacy to remove smear layer in both Group II and Group III. At the apical third, Group III showed comparatively better results than Group I, II, and IV, respectively. Equal amount of smear layer was seen with EndoActivator and PATS Vario system when used as sonic irrigation devices.

Effect of Disinfection Protocols on Bacterial Reduction in Mandibular Molars.

Evaluate the bacterial reduction effect of disinfection protocols used in lower molars infected by Enterococcus faecalis. Eighty extracted lower molars were prepared and inoculated with E. faecalis for 2 months. The teeth were then distributed into 2 control groups (n = 4) and 4 experimental groups (n = 18) in function of the disinfection protocol utilized: G1. WaveOne Gold (WOG), passive ultrasonic irrigation (PUI) and Ultracal; G2. WOG, PUI and calcium hydroxide (CH); G3. WOG, XP-Endo Finisher (XPF) and Ultracal; G4. WOG, XPF and CH. Bacteriological samples were collected previously (S1), after preparation (S2), final agitation (S3) and intracanal dressing (S4). Microbial growth was assessed according to culture turbidity and UV spectrophotometry. Statistical analyses used the Friedman test for paired samples and Kruskal-Wallis test for non-paired data (p<0.05). No protocol eliminated E. faecalis effectively. The S2, S3 and S4 samples were statistically different from the S1 samples in G1, G2, G3 and G4 (p<0.05). Statistical differences were observed in bacterial reduction between G1 and G2 and G1 and G3 after the intracanal medicament (S4) (p<0.05). The WOG + PUI + CH disinfection protocol showed higher percentages of bacterial reduction.

In Vitro Cone Beam CT Analysis of the Efficacy of Three Supplementary Steps In the Removal of Obturation Material in Endodontic Retreatment.

To evaluate and compare the efficacy of XP-endo Finisher R (FKG Dentaire, Le Locle, Neuchatel, Switzerland), EDDY (VDW Dental, Munich, Germany), and passive ultrasonic irrigation (PUI) as supplementary steps following the D-RaCe retreatment file system (FKG Dentaire) in the removal of root canal obturation material using cone beam CT. A total of 45 two-rooted permanent maxillary first premolars were selected. Following access preparation, cleaning, and shaping with Hero Shaper (Micro Mega,Besançon, BFC, France)rotary file up to 25/04%, thermoplasticized obturation was performed with TotalFill BC sealer (FKG Dentaire) and gutta-percha. The specimens were subjected to routine retreatment using the D-RaCe retreatment file system. Cone beam computed tomography (CBCT) and volumetric analysis were performed before and after this procedure. The samples were divided into group A (XP-endo Finisher R: n=15), group B (EDDY: n=15), and group C (PUI: n=15). Finally, a third CBCT was taken and a volumetric analysis was done. Statistical analysis was done using SPSS Statistics version 26.0 (IBM Corp., Armonk, NY, USA). The lowest mean residual volume of obturation material was seen with XP-endo Finisher R (1.6 mm3), followed by PUI (1.7 mm3). The EDDY showed the least efficiency in complete debridement of the root canals (3.6 mm3). This difference in values was statistically significant. The XP-endo Finisher R and PUI showed superior performance than EDDY in the removal of remaining obturation material from the root canal system after retreatment with the D-RaCe retreatment file system. However, none of the systems were able to completely remove the root canal obturation materials.

Spectrophotometric Analysis of Apical Extrusion of Sodium Hypochlorite using Different Irrigation Protocols in an Ex Vivo Model of Immature Teeth.

To evaluate the effect of different agitation methods on apical extrusion of 1.5% sodium hypochlorite (NaOCl) in an ex vivo model of immature teeth. Sixty extracted human inferior incisors were prepared to simulate immature teeth and embedded in an artificial root socket made of silicone impression material. The teeth were then divided into four groups: Conventional needle irrigation (CNI) alone, CNI supplemented with Ultrasonic Irrigant Activation (UIA), EasyClean (EC), or XP-endo Finisher (XPF). Extruded NaOCl was collected, reacted with m-cresol purple, and its absorbance values were measured. The data were statistically analyzed using One-way analysis of variance with a significance level of 5%. All groups showed apically extruded irrigating solution, and the mean volumes of extruded NaOCl did not differ significantly between any of the test groups (p⟩0.05). The activation of 1.5% NaOCL by UIA, EC, or XPF as supplementary to CNI does not promote greater apical extrusion when compared to CNI alone in simulated immature teeth.

Exploring morphometric transformations in temperature-sensitive NiTi instruments alongside real-time intracanal temperature dynamics.

This study was twofold: (i) it aimed to investigate the morphometric changes of three temperature-sensitive nickel-titanium (NiTi) instruments at different temperatures, and (ii) to conduct an invivo real-time analysis of intracanal temperature changes. Changes in the shape and length of XP-Endo Shaper, XP-Endo Finisher, and XP-Endo Finisher-R were evaluated in real time whilst heated in a temperature-controlled water bath from 22 to 45°C. Instruments were fixed to a laminated water-resistant 1 mm graph paper attached to a stone block. Instruments were imaged whilst subjected to increasing temperature using a digital camera attached to an operating microscope. From recorded videos, still frames were extracted at 10-s intervals and changes in the length and shape of each instrument were measured and changes were plotted against time. Moreover, the intracanal temperature of distal roots of lower molars was measured invivo for patients attending the clinic for non-surgical root canal treatments. The temperature was measured using a K-type thermocouple probe inserted into the mid-root level after irrigating the canal with a solution set at room temperature (22°C) or heated to 45°C. The intraoral and intracanal temperatures were recorded using a video camera for 180 s at 5-s intervals to plot the change in the intraoral and intracanal temperature, after both irrigation solution temperatures, with time. The shape transformation of XP-Endo Shaper began at 31.5 ± 2.0°C and reached its optimal transformation at 35.1 ± 1.0°C. For the Finisher and Finisher-R, shape transformations began at 29.2 ± 1.9 and 26.9 ± 2.2°C reaching the optimal transformation at 33.9 ± 1.4 and 32.7 ± 1.7°C, respectively. The average decreases in lengths of XP-Endo Shaper, Finisher, and Finisher-R after full transformation were 0.43 ± 0.23, 1.07 ± 0.22, and 1.15 ± 0.22 mm, respectively. The intracanal temperature reached 32.9 ± 0.8 and 33.2 ± 1.0°C after 3 min of application of irrigation solutions set at 22 or 45°C, respectively. The tested instruments exhibited diverse changes in their shapes and lengths at varying temperatures. Despite the temperature of the irrigation solution, the intracanal temperature consistently remained lower than the intracanal temperature once equilibrium was reached. This highlights the importance of considering the temperature of irrigation solution during invitro testing of endodontic instruments.

Efficiency of ultrasonic, sonic and mechanical complementary cleaning methods in the removal of filling material remaining of oval curved canals

The aim of this study was to compare efficacy in removing filling material remaining in oval and curved canals using different complementary cleaning methods. Material and methods: Sixty single[1]rooted tooth with oval shaped canal with curvature were prepared up to size 25 and .08 taper, filled and subsequently retreated. The teeth were then scanned in micro-CT and divided into 6 groups (n = 10) according to the complementary cleaning method: CUI with Irrisafe, CUI with NiTiSonic, PUI with Irrisafe, PUI with NiTiSonic, Eddy and XP-endo Finisher R. After, the teeth were newly scanned in micro-CT. The volume of the filling material remaining before and after the application of the complementary methods was calculated and then calculated the percentage of material removed total and in the apical region. Data were submitted to the Kruskal-Wallis, Dunn and Wilcoxcon tests with a significance level of 5%. Results: No suplementary cleaning method completely removed the remaining of filling material, however, all significantly reduced the volume, both in the apical region and in the total root canal (p&lt;0.05). There was no significant difference among the groups tested, regardless of the region analyzed (p&gt;0.05). Conclusion: No method was effective in completely removing the remaining filling material. All complementary cleaning methods significantly reduce the volume of material, with no difference among them.

Comparative effects of 17% ethylenediaminetetraacetic acid and 9% etidronic acid applied with different irrigant activation techniques on the release of growth factors from dentin: in vitro study.

Growth factors embedded in the extracellular matrix of the dentin play an important role in the migration, proliferation, and differentiation of dental pulp stem cells in regenerative endodontics. In regenerative endodontic treatments, the type of irrigation solution used is crucial for the release of growth factors (GFs) from the dentin matrix. This study evaluated the effectiveness of different irrigant activation techniques (IAT) using two different chelating agents, 17% ethylenediaminetetraacetic acid (EDTA) and 9% etidronic acid (HEDP), in terms of their GF release. Seventy-two mandibular premolar teeth were prepared to simulate an open apex. The root fragments were irrigated with 20ml of 1.5% sodium hypochlorite and 20ml of saline solution. Eight root fragments were randomly separated for the control group, and the remaining 64 fragments were randomly separated into eight groups based on two different chelating agents (17% EDTA and 9% HEDP) and four different IAT ((conventional needle irrigation (CNI), passive ultrasonic irrigation (PUI), sonic activation with EDDY, and XP-endo Finisher (XPF)). TGF-β1, VEGF-A, BMP-7 and IGF-1 release levels were determined using an ELISA, and statistical analysis was performed using the Kolmogorov-Smirnov test, ANOVA, and the Tukey test (p < .05). Compared to the control group, the experimental groups showed significantly higher GF release when using EDTA or HEDP. Among the activation groups, the EDDY group triggered the highest GF release, and the CNI group triggered the lowest. IAT with EDTA and HEDP can increase GF release, with EDDY being the most effective IAT method. Using chelating agents with IAT may be beneficial in regenerative endodontic treatments.

Impact of using XP-endo finisher and nanobubble water during EDTA dentin conditioning on TGF-β1 release in regenerative endodontic procedures.

Transforming Growth Factor-Beta 1 (TGF-β1) plays a crucial role in the success of Regenerative Endodontic Procedures (REPs) as they directly impact the proliferation and differentiation of stem cells. TGF-β1 is released by conditioning of the dentin matrix using 17% EDTA. EDTA was found to have deleterious effects on dentin especially in immature teeth with fragile dentin walls. Decreasing the irrigation time was reported to decrease these effects. Accordingly, enhancement and activation of the EDTA solution to maintain its efficiency in TGF-β1 release from dentin and thus compensating the reduction in irrigation time was employed. EDTA solution was enhanced by adding Nanobubble (NB) water which contains oxygen filled cavities less than 200nm in diameter. Additionally, EDTA was activated with XP-endo Finisher rotary file. The aim of this study was to assess the impact of NB enhancement and/or XP-endo Finisher activation of the EDTA solution on the TGF-β1 release from dentin. Fifty standardized root segments with open apex were allocated to two main groups according to whether EDTA was enhanced with NB water or not, and within each group whether XP-endo Finisher activation was used or not in addition to a Negative Control group. The concentration of the released TGF-β1 in the root canal was measured using enzyme-linked immunosorbent assay (ELISA). The statistical analysis was done using the Shapiro- Wilk, Kolmogorov Smirnov, ANOVA and Post-hoc Tukey tests. All groups released a considerable amount of TGF-β1 with the highest values in the EDTA/NB/XP group, followed by EDTA/NB, EDTA/DW/XP, EDTA/DW and Negative Control groups respectively. The results of this study suggest that NBs can promote the success of REPs since it revealed a significant increase in the TGF-β1 release following its use in the enhancement of the EDTA solution. A comparable effect was obtained by XP-endo finisher activation of the EDTA solution. The combined use of NBs and XP-endo Finisher can be a promising addition in REPs. Accordingly, Enhancement and activation of the EDTA solution may compensate decreasing the EDTA irrigation time attempted to avoid the deleterious effect of EDTA on dentin.

Evaluation of canal patency and cleanliness following retreatment of bioceramic sealer-obturated root canals using three different irrigant activation protocols.

This study evaluated the effectiveness of three different irrigant activation techniques in cleaning and establishing patency during retreatment of root canals obturated with gutta-percha and bioceramic sealer. 60 extracted premolars with oval-shaped canals were instrumented and obturated with gutta-percha and EndosequenceBC sealer using the 'warm hydraulic condensation' technique. The teeth were retreated using Protaper Universal Retreatment and XP-Endo Shaper system and divided into four groups according to the irrigant activation protocol used: control, passive ultrasonic irrigation (PUI), Endovac irrigation (EVI) and XP-Endo Finisher R (XPFR). Apical patency was achieved in all the samples of the XPFR group (100%), which showed a significantly higher success rate compared with the control (73.3%) and EVI groups (73.3%) (p < 0.05). The scanning electron microscopic evaluation revealed significantly cleaner middle and apical third root canals in the PUI and XPFR groups compared with the control group (p < 0.05). These findings suggest that XPFR effectively cleans and establishes patency in root canals filled with bioceramic sealers.

The effect of different irrigation activation methods on the penetration of the irrigation solution into the dentinal tubules in teeth with calcium hydroxide applied and oval-shaped canals: Confocal laser scanning microscope analysis.

This study aimed to evaluate the efficacy of different irrigation techniques including standard needle irrigation (SNI), passive ultrasonic irrigation (PUI), EndoActivator (EA), XP-Endo Finisher (XPF), photon-induced photoacoustic streaming (PIPS), and shock wave enhanced emission photo-acoustic streaming (SWEEPS) systems on the penetration of irrigation solutions into dentinal tubules in teeth with calcium hydroxide (CH) applied and oval-shaped canals by confocal laser scanning microscope (CLSM). Ninety mandibular incisor teeth with oval-shaped canals were included in this study. After the preparation of teeth using Resiproc Blue R25 (VDW, Munich, Germany) canals were filled with a paste based on CH. The teeth were stored in 100% humidity at a temperature of 37°C for 14 days. According to the irrigation activation systems, the teeth were divided into six groups (n = 15); SNI, PUI, EA, XPF, PIPS, and SWEEPS. In each group, 3 irrigation/activation cycles of 20 s of irrigation and 20 s of activation were performed with the relevant activation method. The root canals were filled with fluorescein sodium (Sigma, Alldrich Co., St. Louis, MO, USA) and activated with the relevant activation method for 30 s. Specimens were sectioned horizontally to 1 ± 0.1 mm at 2, 5, and 8 mm from the apex and then examined under the CLSM. Maximum penetration depth, maximum penetration area and penetration percentage were measured by using Image J software. Data were analyzed using a two-way analysis of variance (ANOVA) and posthoc Tukey tests (p = .05). No difference was found between the activation systems in terms of maximum penetration depth and maximum penetration area of irrigation solutions in the apical section (p > .05). The penetration percentage of irrigation solutions was higher in PUI and PIPS compared with EA and XPF at the apical section (p < .05). No difference was found between SNI, PUI, PIPS, and SWEEPS in terms of the penetration percentage of irrigation solutions in all sections (p > .05). The penetration percentage of irrigation solutions was higher in the middle and coronal sections compared to the apical section in EA and XPF (p < .05). Tubule penetration of irrigation solutions in SNI was similar between sections. The Tubule penetration area of irrigation solutions in PUI, EA, XPF, PIPS, and SWEEPS was lower in the apical section than in the middle and coronal sections. RESEARCH HIGHLIGHTS: The tubule penetration depth and area of the irrigation solutions were similar between the activation systems tested in the apical sections. The Tubule penetration area of irrigation solutions in middle and coronal sections was higher in PUI and PIPS than in SNI.