BACKGROUND: Bacteria and their byproducts are key contributors to the onset and perpetuation of pulpoperiapical pathosis. Intracanal medication is vital in achieving successful endodontic outcomes as it targets and eradicates remaining microorganisms following biomechanical preparation.
OBJECTIVE: The aim of the study was to compare and evaluate the antimicrobial efficacy of calcium hydroxide (CH) paste, triple antibiotic paste (TAP), and probiotics (PBs) as intracanal medicament in 12-17-year-old children undergoing root canal treatment for the management of infected pulpal tissues in young permanent teeth.
METHODS: A total of 30 patients aged 12-17 years indicated for endodontic therapy in maxillary incisors and with no systemic complications were selected. They were randomly divided into three groups, i.e., Group I - CH group, Group II - TAP, and Group III - PB allocating 10 teeth in each group. After access opening, the first sample (S1) was collected by inserting a paper point into the root canal, the second sample (S2) was collected immediately after biomechanical preparation, and the third sample (S3) was collected after 7 days, i.e., postintracanal medication. Samples were sent for microbiological analysis to assess the microbial count, and statistical analysis was done for the obtained data.
RESULTS: The three intracanal medicaments were successful in reducing the microbial counts of Enterococcus faecalis in the infected root canals. However, according to the results of the study, the PB group demonstrated greater effectiveness against E. faecalis compared to the CH group and displayed similar antimicrobial efficacy as the TAP group.
CONCLUSIONS: PB exhibited antimicrobial efficacy comparable to TAP but greater than Ca (OH) 2 paste. Hence, PB can be utilized as an intracanal medicament in young permanent teeth.

UNASSIGNED: This study aimed to investigate the frequency and type of endodontic procedural errors in cases indicated for retreatment through cone-beam computed tomography (CBCT) analysis.
UNASSIGNED: The sample consisted of 96 CBCT scans, encompassing 122 permanent teeth with fully formed roots. Errors included perforation, instrument fracture, canal transportation, missed canals, and inadequate apical limit of filling. Additionally, potential risk factors were analyzed and subjected to statistical modeling.
UNASSIGNED: The most frequent procedural error observed was the inadequate apical limit of filling, followed by canal transportation, perforation, missed canal, and instrument fracture. Statistically significant associations were identified between various procedural errors and specific factors. These include canal transportation and root canal wall, with the buccal wall being the most commonly affected; missed canal and tooth type, particularly the palatine and second mesiobuccal canal canals; inadequate apical limit of filling and root curvature, showing a higher deviation to the mesial direction in severely curved canals; inadequate apical limit of filling and the presence of calcifications, with underfilling being the most frequent; canal transportation and periapical lesion, notably with deviation to the buccal direction; and the direction of perforation and periapical lesion, most frequently occurring to buccal direction.
UNASSIGNED: CBCT emerges as a valuable tool in identifying procedural errors and associated factors, crucial for their prevention and management.

OBJECTIVE: This study aimed to identify the prevalence of the middle mesial canal (MMC) in mandibular first permanent molars in a Persian subpopulation sample using cone-beam computed tomography (CBCT). The secondary aim was to correlate the incidence of MMC with variables such as gender, age, and the presence of an additional distal canal.
METHODS: A total of 390 mandibular first molars from 314 CBCT images were retrospectively evaluated. The presence of the MMC was recorded while considering related factors such as additional distal canal and demographic information of the patients (age and gender). Fisher\'s exact tests and independent-samples t-test were used for the statistical comparisons with a significance level of 0.05.
RESULTS: Among 390 mandibular first molars, 34 teeth contained an MMC (8.7%). The number of teeth with the MMC in women was equal to that of men. There was no significant difference between the two genders in the prevalence of the MMC (p > 0.05). The prevalence of patients\' MMC had no significant relationship with their age (p > 0.05). However, there was a significant association between the presence of the MMC and an additional distal canal (p < 0.05).
CONCLUSIONS: The incidence of an additional distal canal in teeth with a diagnosed MMC was statistically significant. The prevalence of the MMC in mandibular first molars in the study population was low; however, accurate knowledge of root canal morphology in terms of the presence of an additional root canal in these teeth should be considered.

Introduction: The basis of successful root canal therapy is the reduction of microorganisms. The aim of this in vitro study was to compare the antibacterial effect of three different irrigation methods with two laser wavelengths on Enterococcus faecalis biofilm. Methods: Ninety-five single-canal teeth were prepared, sterilized, and divided randomly into a negative control, a positive control, and five test groups. They were inoculated with the standard strain of E. faecalis. The test groups were conventional irrigation (group 1), Passive ultrasonic irrigation (group 2), Gentle file finisher brush (group 3), 810 nm diode laser (group 4), and 980 nm diode laser (group 5). Microbial sampling, cultivation, and colony counting were done. Data were analyzed with the Kruskal-Wallis test and a negative binomial regression model. Results: There was a significant difference in the colony count between the groups (P<0.001). the 810 nm diode had the highest and the conventional irrigation group had the lowest reduction in the microbial load. Passive ultrasonic, 980 nm diode laser, and Gentle file finisher brush groups were also ranked respectively from the highest to the lowest in terms of decreasing effect on the number of colonies. Conclusion: The 810 nm diode laser and conventional irrigation were respectively the most and the least effective methods for reducing the number of E. faecalis colonies.

This randomized clinical trial aims to evaluate cryotherapy as a therapeutic option for pain prevention after endodontic treatment with and without foraminal enlargement, in patients with asymptomatic apical periodontitis.120 teeth of patients with preoperative Visual Analogue Scale score indicating zero were treated. Specimens were randomly allocated into 4 groups: Control, Cryotherapy (ICT), Foraminal Enlargement (FE), and Cryotherapy and Foraminal Enlargement (ICT + FE). Working length was determined with an Electronic Apex Locator (EAL). Cryotherapy groups passed through a final irrigation protocol using 20 ml (2.5 ℃) of cold saline solution delivered at working length for 5 min. In FE groups a #40 K-file was used up to the 0.0 mark on the EAL display. Obturation was performed and postoperative pain was checked at 6, 12, 24, 48, and 72 h and 7 days after endodontic treatment.All experimental groups showed an increase in the level of postoperative pain, which started to decrease after 12 h. Foraminal enlargement caused a statistically significant increase in postoperativepain compared to ICT and control groups within the first 6 h (p < 0.05). Cryotherapy did not influence postoperative pain, regardless of whether or not foraminal enlargement was performed.

BACKGROUND: The probability of a positive outcome of root canal therapy is substantially higher if the infection is eradicated successfully before the obturation of the root canal system. Irrigation is an essential aspect of root canal debridement, as it enables more thorough cleaning than is possible with root canal instrumentation alone. To overcome the side effects of chemical irrigants, there has been a search for herbal medicines as substitutes.
OBJECTIVE: The aim of the present study was to explore the antimicrobial efficacy of white tea-mediated silver nanoparticles (AgNPs) formulated as an intracanal irrigant against Enterococcus faecalis, and to compare it with the efficacy of chlorhexidine and sodium hypochlorite irrigants.
METHODS: The experimental groups were as follows: group I - white tea-mediated AgNPs; group II - 2% chlorhexidine; and group III - 2.5% sodium hypochlorite. The characterization of AgNPs was performed using ultraviolet-visible (UV-Vis) spectroscopy and transmission electron microscopy (TEM) analysis. Enterococcus faecalis was inoculated onto Mueller-Hinton agar plates. The disks impregnated with irrigants were placed on the inoculated plates and incubated aerobically at 37°C for 24 h. Then, the growth inhibition zones were measured. Statistical analysis was performed using the one-way analysis of variance (ANOVA) and the post hoc tests.
RESULTS: A concentration of 50 μL of white tea-mediated AgNPs exhibited the greatest zone of inhibition (32 ±2 mm), followed by 2% chlorhexidine (25 ±1 mm) and 2.5% sodium hypochlorite (23 ±3 mm).
CONCLUSIONS: White tea-mediated AgNPs showed promising results in the elimination of E. faecalis, being superior to chlorhexidine and sodium hypochlorite irrigants.

OBJECTIVE: The aim of this retrospective study was to compare the clinical results of two root canal sealers and three obturation techniques used for non-surgical root canal treatment.
METHODS: A total of two hundred eighty-three root canal treated teeth in two hundred thirty-seven patients with minimum a 6-month follow-up was included for this study. The canals were filled with three different modes: 1) cold lateral condensation (CLC) and AH Plus Sealer; 2) continuous wave condensation technique (CWC) and AH Plus Sealer, and 3) sealer-based obturation technique (SBO) and AH Plus Bioceramic Sealer. The treatment outcome was analysed based on clinical signs and symptoms, and periapical radiograph (periapical index, PAI).
RESULTS: There were no significant differences in treatment outcome between various sealers and filling techniques applied. The sealer extrusion was found most frequently in the CWC group (60.67%), followed by SBO (59.21%) and CLC (21.19%) with statistically significant differences (p < .05). The initial diagnosis, previous treatment and sealer extrusion (p < .05) were prognostic factors that affected treatment outcome.
CONCLUSIONS: Based on the findings of this study, neither the sealer type nor the filling technique affected the treatment success while preoperative diagnosis, previous treatment and sealer extrusion had significant effect on the outcome.
CONCLUSIONS: A bioceramic sealant applied along with the single-cone technique might be considered as an alternative method in root canal obturation.

criteria were randomized to each irrigant, 65 in the NaOCl and 60 in the NSS groups. ProRoot® MTA was used as a pulp dressing material in both groups and teeth were followed for 12 months. The primary outcome was the success of VPT; requiring both clinical and radiographic success to be considered as success. The hypothesis was that the absolute difference of VPT success in the NSS group was not worse than that in the NaOCl group, by a margin of 5%. The secondary outcome was discoloration; percentages of discolorations between both groups were compared. Results: Using a per protocol analysis, the absolute difference of VPT success between the NSS and NaOCl groups was 2.08% (95% CI: -1.95, 6.1). Perceptible gray discolorations were 80% and 63% in NaOCl and NSS groups (difference -17%; 95% CI: -40.0, 6.2; p=0.15). Conclusions: For MTA-VPT procedure, irrigation with NSS was not worse than that with NaOCl. However, both irrigants caused discoloration. (EEJ-2023-05-065).

OBJECTIVE: The purpose of this prospective study was to evaluate the incidence and intensity of postoperative pain in oncological patients with infected teeth subjected to nonsurgical root canal treatment or retreatment.
METHODS: Teeth with apical periodontitis from healthy control patients and oncological patients (n = 70 per group) were root canal treated/retreated and evaluated for the development of postoperative pain. Patients from the two groups were matched for tooth type, gender, clinical manifestation of apical periodontitis, and intervention type. A visual analogue scale (VSA) was used to evaluate the incidence of postoperative pain at 24 h, 72 h, 7d, and 15d after chemomechanical procedures. Data were statistically analyzed for the incidence and intensity of postoperative pain in the two groups.
RESULTS: Preoperative pain occurred in 10% of the individuals and in all these cases pain showed a reduction in intensity or was absent after endodontic intervention at 24-h evaluation. The overall incidence of postoperative pain at 24 h was 14% in oncology patients and 30% in controls (p = 0.03). At 72 h, the respective corresponding figures were 4% and 8.5% (p > 0.05). At 7 and 15 days, all patients were asymptomatic, irrespective of the group.
CONCLUSIONS: No significant differences in postoperative pain were found between control and oncological patients. The low incidence of postoperative pain observed in both groups supports the routine use of nonsurgical root canal treatment/retreatment as valid options in oncological patients.
CONCLUSIONS: Oncological patients had no increased risk of postoperative pain in comparison with control patients.

The mandibular first premolar, which is the anteriormost tooth in the mandibular arch, differs from other teeth in that it typically has two roots and two to four canals. The current case involves treating a mandibular first premolar with two canals through endodontic therapy. The 42-year-old male patient\'s left mandibular first premolar was diagnosed with irreversible pulpitis. The lateral view X-ray depicted two canals. In the dental procedure, endodontic treatment involves working under an operating microscope and using magnification to treat the affected tooth. After canal shaping the tooth was treated with the crown after it had been cleaned and then adjusted for the bite. As aforementioned, no signs of periapical disease were observed when the tooth was rediscovered a year later. However, this case study indicates that any shift in the anatomy of the canal in premolars should be well monitored and controlled to improve endodontic treatment outcomes of such teeth as the mandibular first premolars.