Trends in Contemporary Endodontic Practice of Pakistan: A National Survey

The outcome of endodontic treatment is largely dependent on the selection of right armamentarium. The objective of this study was to determine the trends in contemporary endodontic practice of dental practitioners performing root canal treatment in Pakistan using a questionnaire based survey.  This was a cross sectional study. To meet the objective of this study 518 questionnaires were distributed among the dental practitioners performing root canal treatment and associated with the academic dental institutions of Pakistan. Incompletely filled questionnaires and practitioners not willing to participate were excluded from the study. The questionnaire comprised of 22 questions addressing various aspects of endodontic treatment and the responses to these questions were analyzed using SPSS 22 to calculate frequencies and percentages.  A total of 409 completed questionnaires were returned bringing the response rate to about 79%. Most of the respondents performed more than 10 root canal treatment procedures in a month (51.8%) comprising of a combination of anterior and posterior teeth including retreatment cases (40.1%). The diagnosis of endodontic cases was primarily established by history and radiographs alone (39.1%). Only 19.3% of the respondents reported the use of dental loupes for magnification. The use of preoperative angled radiographs for endodontic procedures was reported by 51.3% of the respondents while only 36.7% made use of film holding devices. About 46.9% reported only occasional use of rubber dam. Most preferred obturation technique and type of endodontic sealer was identified as cold lateral compaction (53.1%) and Calcium hydroxide (32.5%) respectively. While 68.5% respondents preferred multiple appointments with Calcium hydroxide as the most commonly used intracanal medicament (57.2%). The use of anesthesia was restricted to access preparation (36.9%) while 44.5% relied on a combination of antibiotics and NSAIDs for interappointment pain management. Radiographs (39.9%) were the most preferred means for working length determination. Sodium Hypochlorite (39.1%) was the most preferred irrigant with 63.6% making occasional use of EDTA. Activation of irrigants (58.4%) was not routinely employed and use of NiTi (54.5%) rotary instruments was reported to be occasional.  This study observed deficiencies among dental practitioners in Pakistan providing endodontic treatment which should be addressed to improve the quality of endodontic care.

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title: Current trends in endodontic treatment by general dental practitioners: report of a United States national survey.
abstract: In the United States almost 70% of root canal treatment (RCT) is performed by general dentists (GPs), yet little is known about their treatment protocols.



A paper survey was mailed to 2000 United States GPs with questions about the types of endodontic cases treated, routine treatment protocols, use of newer technologies, and endodontic continuing education (CE).



Completed surveys were returned by 479 respondents (24%). GPs who perform RCT (84%) reported providing anterior (99%), bicuspid (95%), and molar (62%) RCT and retreatment (18%). Rubber dam was used always (60%), usually (16%), sometimes (13%), and never (11%). Newer technologies used by GPs included digital radiography (72%), magnification (80%), electronic apex locator (70%), and nickel-titanium rotary instrumentation (74%). Compared with GPs with >20 years of experience, those in practice for ≤10 years were more likely to use rubber dam (P < .05), nickel-titanium rotary instrumentation (P < .001), apex locators (P < .001), and magnification (P < .01); in contradistinction, GPs in practice >20 years were more likely to perform retreatments (P < .05). Women were less likely to perform retreatment or molar RCT (both P < .05). GPs with >5 hours of CE were more likely to use rotary instrumentation (P < .001), irrigant activation devices (P < .01), and apex locators (P < .001) and perform molar RCT (P < .001) and retreatment (P < .05), but no more likely to use rubber dam.



Recent GP graduates (≤10 years) were more likely to adopt new technologies and use rubber dam than those who practiced for >20 years. More experienced GPs were more likely to take on complicated cases than those with fewer years of practice. There was no association between hours of CE and compliance with rubber dam usage.

title: A comparative evaluation of endodontic practice trends in India: "the Mumbai study".
abstract: Multiple treatment protocols are available to the Indian endodontist. Hence a survey is required to recognize the common trends in endodontics and set a basic standard of treatment.



The aim of this article is to present practice trends among Indian endodontists and compare the same with established practice trends internationally through various surveys that have been conducted respectively.



Questionnaires were mailed to 1085 endodontists in dental schools and private practice in India. A response rate of 42% was observed. The data was analyzed and compared with other studies.



Most of the endodontists in India follow the basic protocols and techniques in their practices. 40% of the Endodontists preferred digital radiography technique. 2.5% NaOCl is the most preferred irrigant of choice for primary root canal treatment and 2% chlorhexidine in retreatment cases. Calcium hydroxide was the most preferred intracanal medicament in all clinical situations. Lateral compaction (70.8%) was the most widely used method. AH Plus was the most preferred root canal sealer (46.6%).



Indian endodontists are following the basic protocol but when compared to other studies there were concepts like, the use of rubber dam and microscope which need to be improved and raised to a level that ensures international standards in clinical practice.

title: The status of root canal therapy in Switzerland in 1993.
abstract: No data are available on materials or techniques used by Swiss clinicians for root treatments. Two questionnaires were posted to almost all dentists in Switzerland. The first concerned the materials and techniques used while the second detailed the endodontic procedures carried out during 10 consecutive working days. Reply rates for both questionnaires were 62 per cent and 30 per cent, respectively. Major results showed that 50 per cent of the responding clinicians used AH26 to obturate canals, 45 per cent Endomethasone and 36 per cent N2. Canals were disinfected using Ledermix (81 per cent), Asphaline (67 per cent), Ca(OH)2 (60 per cent), and CMCP (22 per cent). Clinicians used H2O2 and NaOCl equally frequently (75 per cent). Hedström files, reamers and flexo-files were used by 52 per cent, 29 per cent and 26 per cent of the clinicians, respectively. Canals were obturated by the single-cone technique (68 per cent), lateral condensation (34 per cent), or by using only a paste or sealer (23 per cent). Too many Swiss clinicians still use formaldehyde-containing products in root canal therapy coupled with a "single cone" or a "no cone" obturation technique. During the 10 day period Swiss dentists began 4 root treatments or retreatments, changed 2 root canal dressings and root filled 5 teeth. They also completed 8 retreatments and 1 definitive pulpotomy every 100 days.

title: A survey of endodontic practice amongst Flemish dentists.
abstract: The purpose of this study was to gather information on routine endodontic treatment performed by Flemish (Dutch-speaking Belgian) dentists.



A postal questionnaire was sent to all the 4545 Dutch-speaking dentists registered in Belgium. The questionnaire was made up of 38 questions with multiple-choice answers. Results from 32 questions are presented, covering subjects, such as demographic and professional activity, root-canal preparation and instrumentation, emergency procedures and postoperative complications, choice of irrigants and disinfectants, and choice of obturation techniques.



A total of 1143 questionnaires (25.1%) were returned. Approximately 94% of the respondents were general practitioners. The results indicate that there are discrepancies between daily practice and academic teaching, especially regarding the use of rubber dam (only 3.4% report using it as a standard procedure) and the detection and preparation of a second mesiobuccal canal in maxillary first molars (70% never or seldom). Most GDPs reported that they completed treatment in two visits. The majority of practitioners used manual instruments manipulated with a filing technique; 38.9% of the respondents prepared root canals 1 mm short of the radiographic apex. The most popular emergency procedure for acute pain was pulpectomy (40.2%); 48% performed pulpectomy, prescribed analgesics and antibiotics for acute apical periodontitis. Approximately 35% reported complications after cases with chronic apical periodontitis were treated. The first-choice root-canal irrigant was sodium hypochlorite and approximately 65% used intracanal medication. The most popular obturation technique was cold lateral condensation (60%) with 29% using AH26 as a sealer. A high proportion of GDPs (80%) performed re-treatments.



The results of this study confirm that many Flemish general practitioners are not following quality guidelines for endodontic treatment.

title: An Investigation of Current Endodontic Practice in Turkey
abstract: The aim of this study was to gather information about the quality and quantity of root canal treatments carried out by general dental practitioners in Turkey.  Questionnaires were given to 1400 dentists who attended the 16th National Congress organized by the Turkish Dental Association. The participants were asked to answer 34 multiple-choice questions. The questions were subdivided into 3 main topics; general information; general approach to endodontic treatment; and cleaning, shaping, and obturation of root canals. The statistical analysis was carried out by an χ 2-test to compare the means at a significance level of P < 0.05.  The response rate for this study was 43%. There was a wide variation in the number of root canal treatments completed per month. Nearly 92% of practitioners stated that they never used rubber dam. The most commonly used working length determination technique was radiographic evaluation (P < 0.05). Sodium hypochlorite was the irrigant of choice with varying concentrations and AH Plus was the sealer of choice (P < 0.05). Resin composite was the most frequently used material for final restorations.  Endodontic procedures in general practice in Turkey have differences from widely acknowledged quality guidelines. Despite the introduction of new instruments and techniques, most of the general practitioners chose conventional methods.

title: Survey of attitudes, materials and methods employed in endodontic treatment by general dental practitioners in North Jordan
abstract: BackgroundGeneral dental practitioners provide the majority of endodontic treatment in Jordan. The aim of this study was to gather information on the methods, materials and attitudes employed in root canal treatment by dentists in North Jordan, in order to evaluate and improve the quality of current practice.MethodsA questionnaire was posted to all registered general dental practitioners working in private practice in Irbid Governate in North Jordan (n = 181). The questionnaire included information on methods, materials and techniques used in endodontic treatment.ResultsReply rate was 72% (n = 131). The results demonstrated that only five dentists used rubber dam occasionally and not routinely. The majority used cotton rolls for isolation solely or in combination with a high volume saliva ejector (n = 116). The most widely used irrigants were sodium hypochlorite and hydrogen peroxide, which were used by 32.9% (n = 43) and 33.6% (n = 44) of the respondents, respectively. Forty eight percent of the respondents (n = 61) used the cold lateral condensation technique for canal obturation, 31.3% (n = 41) used single cone, 9.9% (n = 13) used vertical condensation and 12.2% (n = 16) used paste or cement only for the obturation. The majority used zinc oxide eugenol as a sealer (72.5%). All, but one, respondents used hand instruments for canal preparation and the technique of choice was step back (52.7%). More than 50% (n = 70) of the dentists took one radiograph for determining the working length, whilst 22.9% (n = 30) did not take any radiograph at all. Most practitioners performed treatment in three visits for teeth with two or more root canals, and in two visits for teeth with a single root canal.ConclusionsThis study indicates that dentists practicing in North Jordan do not comply with international quality standards and do not use recently introduced techniques. Many clinicians never take a radiograph for determining the working length and never used rubber dam or intra-canal medicaments.

title: Current trends in endodontic practice: emergency treatments and technological armamentarium.
abstract: The current clinical practice of endodontics includes the utilization of a variety of new technological advances and materials. The last comprehensive survey that compared treatment modalities used in endodontic practices was conducted in 1990. The purpose of the current survey was to determine the frequency with which these new endodontic technologies and materials are being used in endodontic practices today. An e-mail questionnaire was sent to the 636 active diplomates of the American Board of Endodontics with current e-mail addresses. Two hundred thirty-two diplomates responded for a response rate of 35%. Calcium hydroxide was found to be the most frequently used intracanal medicament for all cases diagnosed with necrotic pulps. Ibuprofen was the most frequently prescribed medication for pain, and penicillin was the most frequently prescribed antibiotic when an active infection was present. Eighty-two percent of the respondents are still incorporating hand files in some fashion during the cleansing and shaping phase of treatment. Lateral condensation and continuous wave were the most common methods used for obturation. Digital radiography was reported as being used by 72.5% of the respondents, whereas 45.3% reported using the microscope greater than 75% of the patient treatment. Ultrasonics was used by 97.8% of the respondents. It appears from the results that new endodontic technology is currently being used in the endodontic offices of those who responded to the survey.

title: Radiographic practices of dentists undertaking endodontics in New Zealand.
abstract: To determine the radiographic practices of New Zealand dentists undertaking root canal treatment, and to investigate the relationship between radiographic practices and educational and clinical factors.



A questionnaire was sent to all 1200 general dental practitioners and five specialist endodontists in New Zealand. Data were subjected to descriptive and analytical statistics.



The response rate was 79%. The mean number of root canal treatments done by general dentists in the previous 12 months was 103, and for the specialists 938. Pre-operative views were taken by 57.1% of respondents all the time and by 34.8% in most cases. The long cone paralleling and bisecting angle techniques were in regular use by similar numbers of respondents, and over one half of the practitioners regularly used film holders and electronic apex locators. Working length films were taken by 67% of practitioners all the time and by 18% in most cases. One-quarter of practitioners took a master point view all the time, and 15% did this for most cases. Almost 65% always took a film of the completed root filling and 21% did for most cases. Twenty-three per cent of practitioners did not follow up their work.



The majority of respondents used radiographs pre-operatively, for working length assessment and to assess the final root filling. There was a general improvement in radiographic practices compared with data from a previous national survey held in 1980.

title: Effect of magnification on locating the MB2 canal in maxillary molars.
abstract: The purpose of this study was to determine if the surgical operating microscope and/or dental loupes could enhance the practitioner's ability to locate the second mesiobuccal canal (MB2) canal of maxillary molars in an in vivo, clinical setting. The participating endodontists documented 312 cases of root canal therapy on maxillary first and second molars. Participants that used the microscope or dental loupes located the MB2 canal with a frequency of 57.4% and 55.3%, respectively. Those using no magnification located the MB2 canal with a frequency of 18.2%. When no magnification was used, significantly fewer MB2 canals were located based by Chi-square analysis at p < 0.01. There was no significant difference between the use of the microscope and dental loupes in the frequency of locating the MB2 canal. When the maxillary first molars were considered separately, the frequency of MB2 canal detection for the microscope, dental loupes, and no magnification groups was 71.1%, 62.5%, and 17.2%, respectively. The results of this study show that the use of magnification in combined groups leads to a MB2 detection rate approximately three times that of the nonmagnification group and that the use of no magnification results in the location of significantly fewer MB2 canals. Based on these results, more emphasis should be placed on the importance of using magnification for locating the MB2 canal.

title: Survey of attitudes, materials and methods preferred in root canal therapy by general dental practice in Turkey: Part 1
abstract: To gather information on the materials and methods employed in root canal treatment by dentists in Turkey.  A questionnaire was distributed to 1,527 dentists who attended the Turkish Dental Association Congress. Respondents were asked to choose one or more suitable answers for the questions. Data was gathered for demographic and professional information regarding stages, materials, and methods commonly used in endodontic therapy. The collected data was analyzed using the statistical package SPSS. Descriptive statistics were given as frequencies (n) and percent (%). Chi-square (χ2) test was used to investigate the influence of gender and the years of professional activity for the materials and techniques employed.  The response rate was 49%. A total of 97% of respondents were working in a general dental practice. Of respondents, 44% were using an agent containing arsenic or aldehyde. Only 5.1% of the respondents preferred the rubber dam isolation method. Sodium hypochlorite was the most popular choice (73%) as a root canal irrigation solution. Calcium hydroxide was the most commonly used medicament (53%). Most of the practitioners (77%) preferred radiographs for working-length determination. Root canal preparation done solely with K-Files or in combination with other instruments was preferred by 73.1% of the respondents. Ni-Ti hand or rotary files were used by 79.7% of the practitioners. Polymer based root canal sealers were the sealers most frequently chosen (48.4%). The majority of the respondents (66.2%) preferred cold lateral condensation as an obturation technique. Gender affected the preference of intracanal medicament, periapical radiographs for working-length determination, root canal instrument, root canal sealers, and root canal obturation technique (P<.05). Years of professional experience affected the preference of devitalizing agents, irrigation solutions, intracanal medicament, root canal instrument, root canal sealer, and root canal obturation technique (P<.05).  It is clear that a number of dentists, irrespective of the time elapsed since their graduation, relied on techniques, and used products and materials that are currently favoured by expert opinion. Unfortunately, it was noted that some practitioners are still using arsenic- and aldehyde-containing devitalizing agents, and most did not use rubber dam as an isolation method.

title: Technical quality of a matching-taper single-cone filling technique following rotary instrumentation compared with lateral compaction after manual preparation: a retrospective study
abstract: ObjectivesThe objectives of the study were to evaluate the radiographic technical quality of root canal treatment before and after the implementation of a nickel-titanium rotary (NiTiR) preparation followed by a matching-taper single-cone (mSC) obturation and to detect the procedural errors associated with this technique.Materials and methodsA random sample of 535 patients received root canal treatment at the Department of Conservative Dentistry and Periodontology at the University of Würzburg: 254 teeth were treated in 2002–2003 by using stainless steel instruments (SSI) for preparation and a lateral compaction (LC) technique (classic group (CG)). Two hundred eighty-one teeth were root filled in 2012–2013 employing NiTiR instruments for the root canal shaping and a mSC technique (advanced group (AG)). The quality assessments were based on the radiographic criteria of the European Society of Endodontology. The presence of voids was recorded separately for the apical, central and cervical thirds of the root canals. Procedural errors, such as ledges, apical transportations, perforations and fractured instruments, were detected. The root canal fillings in the CG and AG were compared using chi-squared and Fisher’s exact tests. Multivariable logistic regression was performed to investigate the association between the independent variables (patient age, tooth type and type of treatment) and the dependent variables (density and length).ResultsAdequate length was achieved significantly more often in the AG compared to the CG for molars (p = 0.017), mandibular teeth (p = 0.013) and primary root canal treatments (p = 0.024). No significant difference was detected between the AG and CG regarding adequate length in general (p = 0.051) or adequate overall quality of root canal filling (p = 0.1). In the AG, a significant decrease in procedural errors was evident (p = 0.019) and decreases in the densities of the root canal fillings in the cervical (p = 0.01) and central (p = 0.01) thirds of the root canals were also observed. Moreover, root canals in elderly patients exhibited fewer voids (p = 0.009).ConclusionsRotary root canal preparation followed by a matching-taper single-cone filling technique provides a reliable shaping of the root canal, with fewer procedural errors and a more acceptable filling quality in terms of length and homogeneity in the apical third. Less favourable results were achieved in the central and cervical parts of the root canals.Clinical relevanceThe matching-taper single-cone technique seems to effectively obturate well-tapered root canals after adequate rotary instrumentation. Irregularly shaped canals require additional lateral or warm vertical condensation to avoid voids.

title: Effectiveness of different final irrigant activation protocols on smear layer removal in curved canals.
abstract: A final flush with chelating agents and antiseptic irrigating solutions is needed to remove the smear layer. The improvement of these protocols is possible by using specific delivery and agitation techniques. This study examined the effect of different final irrigation regimens and methods of activation on smear layer removal in curved canals after root canal instrumentation.



Mesial root canals of 50 extracted mandibular molars were prepared using ProTaper rotary files (Dentsply Maillefer, Ballaigues, Switzerland) and 3% NaOCl. Teeth were then allocated to two control groups and four experimental groups (n = 10) for final irrigation as follows: no-activation group (final rinse with a 27-gauge needle and 17% EDTA/3% NaOCl), manual-dynamic activation group (final rinse 17% EDTA/3% NaOCl + gutta-percha agitation), automated-dynamic activation group (final rinse 17% EDTA/3% NaOCl + RinsEndo [Dürr Dental GmbH & Co KG, Bietigheim-Bissingen, Germany]), and sonic-activation group (final rinse 17% EDTA/3% NaOCl + Endoactivator [Advanced Endodontics, Santa Barbara, CA]). All mesial roots were split with a new approach to allow visualization of every third of the canal, particularly the apical third. The samples were prepared for scanning electron microscopic observation to assess the smear layer removal. Blind scoring was performed by two calibrated observers using a five-score scale. The differences in smear layer scores between the experimental groups were analyzed with the Kruskal-Wallis test and the Mann-Whitney U test. The level of significance was set at p = 0.05.



Very high levels of root canal cleanliness (< or = score 3) were found for each test group with activation. For the middle and apical third, the no-activation group was significantly less effective than the three other activation groups (p < 0.05). The manual-dynamic activation group (final rinse 17%EDTA/3%NaOCl + gutta-percha agitation) and the sonic-activation group (final rinse 17%EDTA/3%NaOCl + Endoactivator) showed significantly better smear layer removal (p < 0.05) in comparison with the other test groups in the apical third.



Root canal cleanliness benefits from solutions activation (especially sonic activation and manual-dynamic activation) in comparison with no activation during the final irrigation regimen.

title: Micro-CT evaluation of root filling quality in oval-shaped canals.
abstract: To assess the percentage volumes of filling materials and voids in oval-shaped canals filled with either cold lateral compaction or warm compaction techniques, using micro-computed tomography (micro-CT).



Twenty-four single-rooted maxillary premolar teeth with oval-shaped canals were selected and the root canals prepared and assigned to two groups (n = 12), according to the filling technique: cold lateral compaction (CLC) or warm vertical compaction (WVC). Each specimen was scanned using a micro-CT device at an isotropic resolution of 12.5 μm. Percentage volumes of root filling materials and voids were calculated, and data were statistically analysed using Student's t-test and Friedman's test, with a significance level of 5%.



Overall, mean percentage volumes of gutta-percha, sealer and voids were 82.33 ± 3.14, 13.42 ± 2.91 and 4.26 ± 0.74 in the CLC group and 91.73 ± 4.48, 7.70 ± 4.44 and 0.57 ± 0.44 in the WVC group, respectively, with a statistically significant difference between groups (P < 0.05). At the apical level, differences in the percentage volumes of filling materials and voids between groups were not significant (P > 0.05).



No root fillings were void free. Warm vertical compaction produced a significantly greater volume of gutta-percha and a significantly lower percentage of voids than those achieved with cold lateral compaction. Distribution of sealer and voids within the root canal space after root filling was unpredictable, irrespective of the technique used.

title: Outcome of root canal obturation by warm gutta-percha versus cold lateral condensation: a meta-analysis.
abstract: The purpose of this study was to evaluate clinical outcome differences of root canal obturation by warm gutta-percha (GP) or cold lateral condensation (CLC) through a systematic review and meta-analysis. There were 10 clinical studies evaluated. Postoperative pain, long-term outcomes, obturation quality, and overextension were the characteristics investigated. The results suggest that the two obturation techniques are not significantly different except in overextention. The relative risk (RR) value of warm GP versus CLC and 95% confidence interval (CI) of the first three criteria were 1.10 (0.71, 1.71), 0.78 (0.58, 1.05), and 1.31 (0.98, 1.76), respectively. Overextension was more likely to occur in the warm GP obturation group in comparison with the CLC group. The RR value and 95% CI were 1.98 (1.33, 2.93). In conclusion, warm GP obturation demonstrated a higher rate of overextension than CLC. Postoperative pain prevalence, long-term outcomes, and obturation quality were similar between the two groups.

title: Radiographic healing after a root canal treatment performed in single-rooted teeth with and without ultrasonic activation of the irrigant: a randomized controlled trial.
abstract: The aim of this study was to compare the outcome of a root canal treatment with and without additional ultrasonic activation of the irrigant.



Single-rooted teeth with radiographic evidence of periapical bone loss were randomly assigned to 2 treatment groups. In both groups syringe irrigation was performed, and in one group the irrigant was also activated by ultrasound. Ten to 19 months after treatment, the teeth were examined by using periapical radiography (PA) and cone-beam computed tomography (CBCT). Area and volume of the periapical lesions were measured, and the outcome was presented in 4 categories: absence, reduction or enlargement of the radiolucency, or uncertain. Lesions were classified as reduced or enlarged when the change in size of the radiolucency was 20% or more.



The recall rate was 82%, and 84 teeth were analyzed. CBCT detected significantly more post-treatment lesions than PA (P = .038), but the percentages of absence and reduction of the radiolucency together revealed by CBCT and PA were similar (P = .383). The CBCT results showed that absence of the radiolucency was observed in 16 of 84 teeth (19%) and reduction of the radiolucency in 61 of 84 teeth (72.6%), but there was no significant difference between the results of the 2 groups (P = .470). Absence and reduction of the radiolucency together were observed in the ultrasonic group in 39 of 41 teeth (95.1%) and in the syringe group in 38 of 43 teeth (88.4%).



Root canal treatments with and without additional ultrasonic activation of the irrigant contributed equally to periapical healing.

title: Outcome of endodontic treatment of teeth filled using lateral condensation versus vertical compaction (Schilder's technique).
abstract: The purpose of this prospective clinical and radiographic investigation was to assess the treatment results following endodontic therapy of teeth filled with lateral condensation versus teeth filled with vertical compaction of warm gutta-percha. A total of 290 patients were treated using the standardized step-back technique for canal preparation, which were filled with either lateral condensation or vertical compaction in one single session. Five years later, the treatment results were assessed clinically and radiographically and related to the type of the obturation technique using Chi-square analysis. Of the 340 teeth that were reexamined, 160 teeth were filled with lateral condensation, and 180 teeth were filled with vertical condensation. The results showed a significantly higher success rate for the vertical compaction versus the lateral condensation technique of teeth presented with preoperative periapical lesions P<0.04. Regardless of the preoperative periapical status of the teeth, no statistically significant difference was found between the two techniques. The overall success rate of both filling techniques was 80.3%.