Search Results (11)

Recently, the single-cone hydraulic canal filling technique using bioceramic sealers was found to hinder retreatment due to the mechanical properties of the bioceramic sealers. This study assessed the effectiveness of four nickel–titanium rotary files in removing gutta-percha and bioceramic sealer from molar root canals in vitro. Eighty-eight root canals from extracted molars were instrumented with Vortex Blue rotary files and filled with gutta-percha and bioceramic sealer using a single-cone technique. After 30 days, the filled canals were randomly divided into four groups according to the file used for re-instrumentation: ProTaper Gold (PTG), Endo ReStart (ERS), XP-3D Shaper (XPD), and HyFlex Remover (HFR). This study assessed whether root canal filling material removal and patency were achieved within a 10-min time frame, recording the time required in seconds. The rate of regaining patency and the time required to achieve patency were compared among groups using a generalized linear model. Scanning electron microscopy was used to evaluate the mechanical changes to the files after use. The patency rate of XPD and HFR was significantly higher than PTG. ERS and XPD demonstrated shorter patency times than HFR and significantly shorter patency times than PTG. SEM images revealed a varied range of reverse windings across file groups. PTG and ERS exhibited microcracks and fractured tips, while XPD and HFR did not display these mechanical alterations. The four file systems in this study displayed varying levels of effectiveness in the retreatment of root canals filled with bioceramic sealers. Full article

Background and Objectives: In teeth with open apices, performing single session apexification is a challenging treatment due to the difficulty in handling mineral trioxide aggregate (MTA). Minimally invasive approaches in dentistry have also influenced the cavity designs in endodontics. Until now, different techniques have not been investigated in addition to manual condensation during the process of placing MTA in traditional (TradACs) or conservative (ConsACs) endodontic access cavities. The aim of this in vitro study was to compare and evaluate the obturation quality of MTA apical plugs placed with different techniques in TradACs or ConsACs. Materials and Methods: Sixty upper central teeth were divided into two main groups based on cavity design, and then each main group was further divided into three subgroups according to MTA placement techniques (n = 10): TradAC-manual, TradAC-manual + indirect ultrasonic activation, TradAC-manual + XP-endo Shaper (XPS), ConsAC-manual, ConsAC-manual + indirect ultrasonic activation, and ConsAC-manual + XPS. Subsequently, the porosity percentages in the MTA apical plug were analyzed using micro-computed tomography. The statistical analysis was performed using the Kruskal–Wallis H test and Mann–Whitney U test. Statistical significance was set at p < 0.05. Results: There were differences in volume of porosity percentages (%) according to cavity designs and MTA application techniques (p < 0.05). Except for the XPS group, more porosity was observed in ConsACs compared to TradACs. In TradACs, the significantly lowest open and total porosity was observed in the manual, ultrasonic, and XPS techniques, respectively. In ConsACs, the significantly lowest porosity was observed in the manual, XPS, and ultrasonic techniques, respectively (p < 0.05). Conclusions: In MTA obturation, cavity designs and application techniques had an impact on the MTA porosity. Creating an apical plug in ConsACs may result in more porosity compared to TradACs, especially when manual or indirect ultrasonic activation is preferred. Opting for the manual technique alone may be considered sufficient for controlling porosity for both TradACs and ConsACs. Full article

Background: The aim of this investigation was to assess the apical extrusion potential of sodium hypochlorite (NaOCl) in agarose-embedded mandibular first premolars employing four final agitation procedures. Methods: Based on CBCT confirmation of single oval-shaped canals, one hundred extracted mandibular first premolars were chosen. Using 5.25% NaOCl, the teeth were prepared using the XP Endo Shaper and divided into experimental and control groups. The following were the experimental groups: Group 1 comprised the XP-Endo Finisher, Group 2 the Ultrasonic Activation, Group 3 the Gentle File Finisher Brush, and Group 4 the 27-gauge side-vented needle. To test extrusion, the teeth were placed in a 0.2% agarose gel that contained the pH-sensitive dye m-cresol purple, allowing pixel quantification via ImageJ software (version 1.54i). Results: The XP Endo Finisher featured the most pixels, depicting higher apical extrusion (p < 0.01), followed by the side-vented needle, Gentle File Finisher Brush, and PUI, while the Control Group endured no extrusion. Conclusions: The effective irrigation method for root canal therapy is critical, especially in situations of open apices, resorption, or perforation. According to in vitro experiments, the XP-Endo Finisher has the maximum sodium hypochlorite extrusion, which is determined by parameters such as apical preparation size and irrigation system. Full article

Background and Objectives: Successful root canal treatment depends on the thorough removal of biofilms through chemomechanical preparation. This study aimed to investigate and compare the cleaning and disinfecting efficiency of oval-shaped root canals using XP-endo Shaper (XPS), ProTaper Next (PTN), and HyFlex CM (HCM) in combination with passive ultrasonic irrigation (PUI). Materials and Methods: Ninety extracted teeth were contaminated and randomly divided into three groups: XPS, PTN, and HCM. Each group was assigned to three subgroups: subgroup A (sterile saline), subgroup B (3% sodium hypochlorite and 17% ethylenediaminetetraacetic acid), and subgroup C (3% sodium hypochlorite, 17% ethylenediaminetetraacetic acid, and PUI). Bacterial sampling was conducted both from baseline samples and samples after chemomechanical preparation. Scanning electron microscopy (SEM) was used to evaluate the residue bacterial biofilms, hard tissue debris, and smear layers on the buccolingual walls of oval-shaped root canals. Results: When combined with sterile saline, XPS demonstrated a higher reduction of bacterial counts and was more effective in eradicating Enterococcus faecalis in the middle third of the canals compared to the other instruments (p < 0.05). Additionally, when used with antimicrobial irrigants, XPS was more effective in disinfecting the coronal third of the canals than the other instruments (p < 0.05). Furthermore, XPS reduced hard tissue debris more effectively in the middle third of canals than in the apical third (p < 0.05). Conclusions: XPS outperforms PTN and HCM in disinfecting oval-shaped root canals. Despite the fact that combining XPS and PUI improves cleaning and disinfecting, removing hard tissue debris from the critical apical area remains challenging. Full article

This study aimed to determine the incidence of dentinal microcracks after instrumenting the root canals of maxillary premolars using two novel rotary instrumentation systems. Micro-computed tomography (microCT) scans and images generated by sectioning and observation with a stereomicroscope were used to assess the specimens. Twenty-two freshly extracted maxillary premolars were collected and the specimens were divided into two groups of eleven. The tested radicular shaping systems were XP-Endo shaper and TRUShape (i.e., single file). The specimens were scanned with microCT pre- and post-instrumentation, and the newly formed microcracks were detected. The post-instrumentation scans were also compared with images obtained by sectioning method and stereomicroscope inspection, comparing the incidence of microcracks in either microCT scans or images. The results identified an overall incidence of 0.49% of newly formed microcracks, with no statistically significant differences (p = 0.689) between the shaping systems (0.11% for TRUShape and 0.87% for XP-Endo shaper). There were statistically significant differences (p < 0.001) between the microcracks incidence in microCT scans and the sectioning method (16.6% more for the latter). In conclusion, the results show that neither TRUShape nor XP-Endo shaper created dentinal microcracks during root canal instrumentation. The sectioning method with stereomicroscope evaluation overestimates the presence of microcracks with a statistically significant difference compared to microCT scans. Full article

Background and Objectives. To differentiate the intensity of postoperative pain after primary molar pulpectomy employing manual instrumentation versus two single-file systems with different kinetics (the XP-Endo shaper file with adaptive instrumentation vs. the Kedo-SG blue file with continuous rotation instrumentation). Materials and Methods. This three-arm, single-blind, randomized clinical trial included assessing 75 healthy children between 4 to 9 years who required pulpectomy for primary molars (mandibular first and second). The three groups each had an equal number of children. Children in Group 1 had their teeth instrumented with the XP-endo Shaper, children in Group 2 had their teeth instrumented with the Kedo-SG Blue file, and children in Group 3 had their teeth instrumented manually using K-files. The degree of postoperative pain was measured using a four-point pain scale at 6-, 12-, 24-, 48-, and 72-h following therapy. Each participant’s parent received five flashcards with four faces and a word characterizing each face. The data were analyzed using Kruskal–Wallis and chi-square tests. The level of significance was set to 5%. Results. During the follow-up period, there was a significant difference in postoperative pain intensity between the three groups. The XP-endo shaper was associated with considerably decreased post operative at the 6- and 12-h interval followed by Kedo-SG. The highest post-operative discomfort across the groups was related to the patients who underwent manual instrumentation. Conclusion. In comparison to rotary and manual instrumentation, postoperative pain severity was reduced with adaptive instrumentation. Full article

This investigation aimed to examine the post-operative pain experienced following single-visit root canal treatment using the XP-endo shaper sequence (XPS), full-sequence self-adjusting file (SAF), and manual K-files (HKF). A randomized equivalence parallel design, double-blinded clinical study was conducted on 120 patients with symptomatic irreversible pulpitis, with or without clinical signs of apical periodontitis. Only teeth with fully formed roots and no periapical lesions were incorporated in the study. Patients were apportioned to one of three groups (n = 40) randomly: Group 1—XPS, Group 2—SAF, and Group 3—HKF. Pre- and post-instrumentation pain was rated utilizing Visual Analog Scale (VAS) with a spectrum of 0–100 mm. The descriptive statistics and one-way ANOVA with 95% confidence intervals were used for statistical analysis. The mean VAS scores before instrumentation were consistent in all three groups. At 6, 24, 48, and 72 h, patients with root canals instrumented by SAF had the lowest post-instrumentation mean VAS score, followed by XPS. For all time intervals, the patients in the HKF group had the highest VAS score. The full-sequence SAF instrumentation resulted in less post-operative pain than the XP-endo plus protocol, while manual instrumentation with K-files resulted in the highest post-operative pain. Full article

We evaluated the mechanical properties and torque/force generated during canal shaping by four NiTi files with innovative designs. Each of the 52 TruNatomy Prime, XP-endo Shaper, Spring Endo files with unheated finish (Spring Endo), and Spring Endo files with heated finish (Spring H) were subjected to bending, buckling, cyclic fatigue, and torsional resistance tests (n = 10 per NiTi file type). Canal shaping was simulated with J-shaped resin blocks (n = 10). Phase transformation behavior was investigated using differential scanning calorimetry (n = 2). Statistical analysis was performed by one-way ANOVA and the Games-Howell test. Spring Endo and Spring H files showed higher bending and buckling resistances, ultimate torsional strength, and elastic modulus than TruNatomy and XP-endo Shaper (p < 0.05). XP-endo Shaper demonstrated the highest cyclic fatigue resistance and angle of rotation to fracture (p < 0.05). The elastic modulus increased in the order of XP-endo Shaper, TruNatomy Prime, Spring H, and Spring Endo. During simulated canal shaping, XP-endo Shaper generated greater clockwise torque and less screw-in force compared to Spring Endo files, with superior cutting ability. TruNatomy Prime generated the least clockwise torque and screw-in force. At room temperature, TruNatomy and XP-endo Shaper files consisted of mixed phases of austenite, martensite, and R-phase; Spring H files consisted of martensite; and Spring Endo files consisted of austenite. Full article

The purpose of this study was to explore the influence of instrumentation and the potential for debris deposition using XP-endo shaper plus (XP-SP) and full-sequence SAF (F-SAF) on the adaption of thermoplastic root canal fillings in oval canals. Following the manufacturer’s instructions, ninety human permanent mandibular incisors with a single oval canal 6 mm from the apex (verified using pre-operative CBCT scanning) were instrumented with XP-SP and F-SAF. Obtura III Max apparatus was used for root canal obturation without the use of a root canal sealer. The roots were then sectioned 6 mm from the apex and examined with a digital stereomicroscope at x25 magnification to assess the root canal fillings. The F-SAF was associated with a significantly higher (p < 0.01) percentage of entire adaptation of the root fillings (76%) compared to the XP-SP (57%). Furthermore, the XP-SP group was also associated with higher (p < 0.01) defective obturation with debris at 17% and with voids at 26%. However, the F-SAF had lower percentages of defective obturations (7% with debris and 17% with voids). The quality of obturation of oval canals instrumented using full-sequence SAF was better. Full article

This clinical trial focused on collating the instrumentation time and quality of root canal obturation in primary molars treated with three instrumentation techniques: adaptive, rotary, and manual. A triple-armed, randomized controlled clinical trial was performed on 75 primary molars requiring pulpectomy treatment, divided into three groups (n = 25 per group). The teeth in Group 1 were instrumented with an adaptive technique (XP-endo Shaper, FKG Dentaire, La Chaux-de-Fonds, Switzerland), Group 2 with pediatric rotary files (Kedo-S; D1 and E1), and Group 3 with a manual technique (hand K-files). The apical size of the final instrumentation was maintained at #30 for all groups. Instrumentation time and the grade of the root canal obturation were evaluated. Instrumentation duration was recorded, employing a digital stopwatch from the insertion of the first file until the completion of final irrigation. Obturation quality was assessed using radiographs. The criteria taken as a reference for obturation were: optimal (1 mm short of the apex), underfilled (2 mm short of the apex), or overfilled (beyond the apex). The use of an adaptive technique was associated with the lowest instrumentation time (p < 0.0001) when used for instrumenting primary molars and with the highest root canal filling quality of the three groups. The application of the new concept of adaptive instrumentation for pulpectomy of primary molars was a favorable technique, considering the significant reduction in instrumentation time and better obturation. Full article

Apical extrusion of debris (AED) by the full sequence of the self-adjusting file (SAF) system was compared with that of the XP-endo shaper plus sequence. Sixty permanent mandibular incisors were randomly assigned to two groups (n = 30) for root canal instrumentation: Group A: Stage 1—pre-SAF OS, pre-SAF 1 and pre-SAF 2 files, followed by Stage 2—1.5 mm SAF; and Group B: Stage 1— hand K-file 15/0.02, followed by Stage 2—XP-endo shaper and Stage 3—XP-endo finisher. The AED produced during instrumentation at each stage was collected in pre-weighed Eppendorf tubes. The weights of AED by the two methods were compared using t tests with significance level set at 5%. Group A produced significantly less total AED than Group B (p < 0.001), with no significant difference in debris extrusion between the two stages (p = 0.3014). Conversely, in Group B, a significant difference was noted between Stage 1 and Stages 2 and 3 (p < 0.01), with no significant difference between Stages 2 and 3 (p = 0.488). Both sequences resulted in measurable amounts of AED. Each phase, in either procedure, made its own contribution to the extrusion of debris. Full article