Search Results (15)

Background/Objectives: The management of immature teeth with wide apical foramina presents significant challenges in endodontic treatment due to difficulties in achieving a hermetic seal. The aim of this study was to evaluate void formation in apical plugs created using three calcium silicate-based materials—Biodentine, NuSmile NeoPUTTY, and Well-Root PT—applied with the help of manual, ultrasonic, or rotary file condensation (XP-endo Shaper) in 3D-printed immature teeth. Methods: Micro-computed tomography analysis was used to assess the internal, external, and total void percentage of material volume. The statistical analysis was performed using two-way ANOVA and the post hoc Bonferroni test. Statistical significance was set at p < 0.05. Results: The materials and techniques used individually do not significantly influence the formation of internal voids, but their combination does (F(4, 99) = 2.717, p = 0.034). Both factors and their interaction are significant for external voids (F(4, 99) = 4.169, p = 0.004), and all have a notable effect on total void percentages (F(4, 99) = 3.456, p = 0.012). No significant differences were observed in internal voids across the groups (p > 0.05), ranging from 0.635% to 1.078%. External voids varied significantly, with Well-Root PT and ultrasonic condensation showing the highest values with a significant difference (p < 0.05), while NeoPUTTY and Biodentine with XP-endo Shaper exhibited the lowest. Total voids remained below 4%, with no significant differences among manual condensation groups. Neither material type nor application technique consistently influenced void formation, except for Well-Root PT with ultrasonic condensation. Conclusions: These findings suggest that modern bioceramic materials and application techniques produce comparable, low-void apical plugs, with XP-endo Shaper showing promise for minimizing external voids. The interaction between material and application technique plays a crucial role during the creation of apical plugs. Full article

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/Objectives: Since biomineralization by calcium silicate-based sealers (CSBSs) was reported, retrieving canal filling materials may be challenging during endodontic retreatment due to their adhesion to dentin. This study aimed to evaluate the possibility of removing residual mineral deposits from two kinds of CSBSs compared to the AH Plus Jet (AHJ). Methods: Root canals of mandibular premolars were prepared, obturated with the sealer-based obturation method using a WOG medium gutta-percha cone and one of the following sealers: AHJ, AH Plus Bioceramic (AHB), and Ceraseal (CER) (n = 12/group). After 3 weeks, endodontic retreatment was conducted with the WOG files, followed by instrumentation with XP-endo Finisher (XPF). Micro-computed tomography scanning was obtained after canal filling, after retreatment with WOG, and after the use of XPF. The percentage of the removed filling volume was calculated. One-way ANOVA with Tukey’s test and a non-parametric test with Bonferroni’s correction were performed. Root canal dentin after retreatment was examined using a scanning electron microscope (SEM). Results: After supplementary instrumentation with XPF, the mean residual filling volumes for the AHJ, AHB, and CER groups were 1.35 mm³, 0.55 mm³, and 0.82 mm³, respectively. The AHJ group showed greater residual volume compared to the AHB group (p < 0.05). The AHB and CER groups demonstrated higher mean percentages of removed filling volume at 94.8%, and 92.5%, respectively, compared to 87.1% for the AHJ group (p < 0.05). More mineral deposits were observed in the CER group with SEM. Conclusions: AHB and CER are retrievable during endodontic retreatment, with CER preferable due to greater mineral deposits in dentinal tubules. 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

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

Background: Biofilm removal from the root canal during endodontic treatment is necessary to prevent further complications. Irrigation is essential to success. Several irrigants have been proposed without a proper comparison. The aim of the study is to compare the antibacterial capacity of different activated irrigants using passive ultrasonic activation (PUI) or XP-Endo finisher (XPF). Methods: A total of 100 instrumented teeth were incubated in an Eppendorf tube containing 0.5 McFarland of Enterococcus faecalis and incubated for 2 weeks at 37 °C. Roots were divided into 5 groups (n = 20) according to the irrigant type: ethylenediaminetetraacetic acid (EDTA) (17%), ethydronic acid (HEDP) (9%) mixed with 5.25% sodium hypochlorite (NaOCl), EDTA (17%) mixed with 5.25% NaOCl, PBS, and a control group. Each group was divided into two subgroups (n = 10): PUI and XPF. Results: As compared to the untreated control group, the irrigators included in the study had a significant effect in bacteria reduction. The obtained results show HEDP to be the most effective irrigant, since no bacteria were recovered after treatment of this group, followed by EDTA mixed with NaOCl and, finally, the EDTA-irrigated group. Conclusions: HEDP is the best irrigating agent in combination with XPF or PUI file activation to eliminate bacteria in our experimental model. 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

Objectives: This study aims to evaluate the efficacy of the rotary instrument XP-endo Finisher for the removal of Ca(OH)₂ aided by different irrigation regimens. Methods: Sixteen double-rooted upper premolar human teeth were selected for the study. Thirty-two canals were prepared using a ProTaper Next rotary system up to X3. Then, the canals were filled with Ca(OH)₂. The volume of Ca(OH)₂ inside the canals was measured by microcomputed tomography (micro-CT). After that, the teeth were randomly allocated into two experimental groups, i.e., A and B (n = 16 canals). In group A, Ca(OH)₂ was removed using the master apical file (X3). In group B, Ca(OH)₂ was removed using a XP-endo finisher. In half of both groups (n = 8), syringe irrigation (SI) was used, while passive ultrasonic irrigation (PUI) was used for the other half. After removal, the remaining volume of Ca(OH)₂ was measured. All data were statistically analyzed using two-way ANOVA with Tukey’s post hoc test. Results: The percentages of remaining Ca(OH)₂ in the apical thirds of all canals were significantly higher as compared with the middle and coronal thirds in all groups (p < 0.05). There was no significant difference between different files and techniques (p > 0.05). Clinical Significance: This study presents a new method for the removal of Ca(OH)₂ from root canals. Full article

New tools for activating endodontic irrigants have evolved, yet their impact on root canal disinfection, in comparison to the passive placing of an inter-visit medication, have not yet been fully elucidated. The use of DNA- and rRNA-based methods may cast some new light on this issue, as they allow a comparison to be made between microbial presence and activity. Therefore, the aim of this single-arm intervention trial is to evaluate the antibacterial effect of endodontic procedures using both molecular methods. Root canal samples were obtained from 20 patients with asymptomatic apical periodontitis after each treatment step: access cavity, chemo-mechanical preparation, adjunctive procedures (XP-endo Finisher file and passive ultrasonic irrigation), calcium hydroxide medication, and 2nd-visit root canal preparation. DNA and cDNA from the samples were subjected to quantitative polymerase chain reaction with universal primers for the bacterial 16S rRNA gene. Chemo-mechanical preparation promoted a drastic reduction in bacterial levels and activity, whereas the adjunctive procedures did not make a significant contribution to further disinfection. At the 2nd visit, bacteria were active after the use of calcium hydroxide medication; however, they were significantly reduced after a 2nd-visit preparation. Consequently, the lowest bacterial levels were found at the end of the treatment. This clinical trial, which used an rRNA and rDNA combined approach, confirmed previous studies showing that root canal preparation represents the main strategy for root canal disinfection. Full article

Background. One of the most important aims of an endodontic treatment is to obtain the complete removal or reduction of root canal remaining filling material: Smear layer, bacteria, intra-canal medicaments. To meet this requirement, several irrigation activation techniques have been proposed. Our systematic review examined studies which analyzed the XP-endo Finisher (XPF) instrument efficacy in removing root canal debris during initial endodontic treatment or retreatment, comparing it with the efficacy of other irrigation activation protocols, such as passive ultrasonic irrigation (PUI), laser activation procedure (Er:YAG), and Self-Adjusting File system (SAF). Methods. A systematic review was conducted using PubMed, Chocrane Library, and Scopus databases, identifying 51 items. Thirty-four articles were excluded based on title, abstract, full text, and language. Seventeen randomized controlled trials were selected and consequently submitted to quality assessment and data collection. Results. Conventional needle irrigation (CNI) is the less effective irrigation technique, but it is still unclear whether XPF is able to guarantee greater debris removal than the PUI technique. Er:YAG laser has been proven to be more effective in apical third than XPF instrument. Conclusions. Further investigations are needed in order to establish which final irrigation activation procedure could reach the maximum root canal debris reduction. Full article