AimTo evaluate the antimicrobial effectiveness of Ca(OH)2 paste combined with Ibuprofen or Ciprofloxacin in infected root canals of teeth with asymptomatic apical periodontitis.MethodologyForty‐five patients were randomly divided into three groups using a web programme according to the medication selected: Ca(OH)2: 1 g Ca(OH)2 powder with 1 mL propylene glycol, Ca(OH)2 + Ibuprofen: 50 mg of Ibuprofen was added into 950 mg Ca(OH)2 powder and mixed with 1 mL propylene glycol, Ca(OH)2 + Ciprofloxacin: 50 mg of Ciprofloxacin was added into 950 mg Ca(OH)2 powder and mixed with 1 mL propylene glycol. Root canal bacteriological samples were collected before root canal treatment (S1) and after chemo‐mechanical procedures (S2). After root canal preparation, the intracanal medicaments were placed into the root canals to a level approximately 1 mm short of the working length using K‐files and access cavities were filled temporarily. The participants were scheduled for a second visit 7 days later when the medication was removed mechanically, and after irrigation of the root canals, the final samples (S3) were collected. Samples were subjected to quantitative real‐time polymerase chain reaction to evaluate the numbers of total bacteria, Enterococcus faecalis and Streptococcus species. For intragroup analysis, a Friedman test was used to compare reduction of counts of total bacteria, Streptococci and E. faecalis amongst the three samples (S1, S2 and S3). The chi‐square test was used to compare the number of root canals positive for bacteria in S1, S2 and S3 amongst the groups.ResultsIntragroup analysis revealed a significant reduction in the number of intracanal bacterial cells from S1 to S2 and from S2 to S3 in all medication groups (P < 0.01). Although there was no significant difference amongst the groups when comparing quantitative S1 or S2 data, there were significantly lower bacterial counts in the Ca(OH)2 + Ciprofloxacin group (0.49 × 102) than the pure Ca(OH)2 (1.25 × 102) and Ca(OH)2 + Ibuprofen groups (0.76 × 102) at S3. The percentage reduction from S1 to S3 and from S2 to S3 was significantly greater in the Ca(OH)2 + Ciprofloxacin than the pure Ca(OH)2 and Ca(OH)2 + Ibuprofen groups (P < 0.05). In the Ca(OH)2 + Ciprofloxacin group, there were significantly fewer positive cases (8/15) than the pure Ca(OH)2 (13/15) and Ca(OH)2 + Ibuprofen (13/15) groups (P < 0.05).ConclusionThe addition of Ciprofloxacin to Ca(OH)2 provided further antibacterial effectiveness when used as an intracanal medicament in vivo during root canal treatment.

Objective: To evaluate the effect of final irrigation of root canals with NaOCl solution at different temperatures on postoperative pain level and antimicrobial activity. Methodology: 45 patients were randomly divided into three groups using a web program according to the irrigation selected: NaOCl 2ºC, NaOCl 25ºC and NaOCl 45ºC. First root canal samples were collected before treatment (S1). After chemo-mechanical preparation, final irrigation was performed with the selected irrigant (NaOCl 2ºC, NaOCl 25ºC and NaOCl 45ºC) and second samples were collected (S2). Samples were subjected to quantitative real-time polymerase chain reaction to evaluate the levels of total bacteria. The root canal treatments were completed and the participants were given instructions to record postoperative pain levels at 24, 48 and 72 hours, 5 days and 1 week after treatment using a visual analog scale (VAS). Results: The reduction in the number of total bacterial cell equivalents from S1 to S2 was statistically significant in all groups (p<0.001). The NaOCl 2˚C group reported significantly less postoperative pain than the NaOCl 45˚C group (p<0.05). Postoperative analgesic intake was significantly higher in the NaOCl 45˚C group than in the NaOCl 2˚C group (p<0.05). Conclusion: We conclude that final irrigation with NaOCl at different temperatures results in similar antibacterial effectiveness. Final irrigation with cold NaOCl (2˚C) is better than NaOCl 45˚C when comparing postoperative pain levels.

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Aim: The objective of the present study was to evaluate the effect of the type of the anesthetic solution (with or without epinephrine) on the development of pulp necrosis after tooth preparation. Methods: Seventy-two patients were randomly allocated into 2 groups according to the type of the anesthetic solution used. In the first group, 4% articaine with 1:100.000 epinephrine was used as local anesthesia and in the second group, 3% plain mepivacaine was used. Before administration of the anesthetic solution, electric pulp tester (EPT) and cold test were used to test the vitality of the teeth. The teeth were then prepared and provisional crowns were fabricated chairside. After 15 days, the provisional crowns were removed and then the EPT procedures and cold test were repeated. Postoperative pain level on days 1, 3, 5 and 15 were recorded. The EPT scores and pain levels were statistically analyzed. Results: A statistically significant difference was observed between the groups in terms of percentage change in EPT scores. Conclusion: The type of the anesthetic solution does not affect the vitality of the teeth after full-crown preparation.