The Effect of XP-Endo Finisher Activation of Bioceramic Sealer on Postoperative Pain in Mandibular First Molar with Symptomatic Irreversible Pulpitis

The aim of endodontic obturation is to make a complete sealing along the length of the root canal system to ensuring the peri radicular tissue healing and sustained health. Disadvantages of gutta-percha-based root filling materials is lack of adhesiveness to canal wall dentin. So, a sealer or cement has to be used with gutta-percha to achieve a fluid-tight seal and fill the space between the canal wall dentin and the obturating material.

Drawbacks of resin-based sealer are difficult preparation technique of deep root canal cavity which also limit dentin bonding, difficult to be removed from the canal in retreatment cases and its shrinkage during setting.

Bio-ceramic root canal sealers become popular in recent years because of their unique chemical and physical properties. These sealers are consisting of biocompatible materials that resemble the of tooth structure natural composition so bio-ceramic sealers are an ideal choice for root canal treatment. Bio-ceramic sealers are better than traditional sealers due to their multiple physical properties for example excellent sealing ability, dimensional stability, and low solubility. These properties ensure that the sealers achieve a tight seal, inhibiting bacterial leakage and decreasing the risk of reinfection. Diaroot Bioaggregate (DiaDent), a white nanoparticle-sized ceramic cement composed of calcium silicate, calcium hydroxide and hydroxyapatite and considered a modified version of MTA, with the advantage of being aluminium-free in composition, a fact that contributes to its greater biocompatibility with periradicular tissue.Root canal sealers activation may improve their penetration into dentinal tubules and improve sealability and antimicrobial effects.

Recently, a non-tapered nickel-titanium rotary instrument (XP-endo Finisher; FKG, La Chaux-de-Fonds, Switzerland) has been designed to increase the efficiency in root canal wall cleaning specifically with limited impact on dentine throughout the literature, XP efficacy in decreasing microorganisms, dissolving organic tissue from artificial cavities in combination with NaOCl and penetrating into the isthmus has been analyzed.

The aim of this study to evaluate the effect of XP-Endo Finisher activation of Bioceramic sealer on postoperative pain in mandibular first molar with symptomatic irreversible pulpitis.

This study consists of 30 patients divided into 2 group each group having 15 patients.

Intervention:

Bioceramic sealer activation with XP Endo Finisher.

Control group:

Bioceramic sealer without activation.


Eligibility Criteria:
Inclusion Criteria:

* Age ranges from 18 to 40 years old.
* No sex predilection.
* Patients seeking root canal treatment.
* Systematically healthy patient (ASA I, II).
* Patient who can understand numerical rate scale and sign an informed consent.
* Mandibular first molar teeth with:

  * Preoperative sharp (moderate or severe) pain.
  * Vital response of pulp tissue to cold pulp tester (ethyl chloride spray).
  * Normal periapical radiographic appearance.

Exclusion Criteria:

* Patients with American association of anesthesiologists (ASA) classification other than ASA T\& II.
* Patients who have already ingested preoperative medication, such as analgesics, non-steroidal or steroidal anti-inflammatory drugs, within 12 hours of the start of treatment.
* Patients with NSAIDs allergy.
* Patients having two or more adjacent teeth needing root canal therapy.
* Pregnant patients.
* Patients with bleeding disorder.
* Patients with long term corticosteroid use
* Teeth having;

  * Necrotic pulp.
  * History or presence of swelling or fistulous tract.
  * Acute / chronic periapical abscess.
  * Mobility more than grade 1.
  * Pocket depth more than 5mm.
  * No possible restorability.
  * Previous root canal treatment.
  * Periapical radiolucency.
  * External or internal resorption.
  * Vertical root fracture.
* TMJ problems, bruxism, clenching or traumatic occlusion.
* Inability to understand and perform the given instructions.