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BACKGROUND: This is a triple-blinded, prospective split-mouth clinical trial. It is important to shed light on the effect of different apical preparation sizes regarding postoperative pain within the same patient with the same pulpal histological status. The aim is to compare and evaluate the severity of postoperative pain following apical enlargement with two different sizes after the IBF using the visual analogue scale. METHODS: Fifty "teeth" in 25 patients were assigned into two equal groups (25 per group) using E3 Azure rotary files; Group A was prepared two sizes greater than the Initial binding file (IBF) (the largest K file to bind at the actual working length) mesial canals, which were enlarged to 35#/0.04 and 40#/0.04 for the distal canals. Group B was prepared in three sizes larger than the IBF: 40#/0.04 for mesial canals and 45#/0.04 for the distal canals. On a modified VAS form, patients were questioned to indicate the degree of their pain and assisted in narrating their pain intensity during the following periods: 12, 24, and 72 h, and after a week. VAS data were non-parametric and analyzed using the signed-rank test for intergroup comparisons, Freidman's test, and the Nemenyi post hoc test for intragroup comparisons. The significance level was set at p < 0.05. RESULTS: showed that regardless of measurement time, enlargement of apical preparation was significantly associated with higher pain scores (p < 0.001). Within both groups, there was a significant reduction of measured pain score with time, with values measured after 12 and 24 h being significantly higher than values measured at other intervals (p < 0.001) and with values measured after three days being significantly higher than 1-week value (p < 0.001). CONCLUSION: The size of apical preparation had a significant effect on postoperative pain. TRIAL REGISTRATION NUMBER & DATE: NCT05847738, 08/05/2023.

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Enterococcus faecalis plays the key role in endodontic infections and is responsible for the formation of biofilm on dentin, which causes a resistance against periradicular lesions treatment, consequently the aim of this study is to use nanoparticles entrapping anibacterial agents coated with chitosan that in authors previous study showed a successful in vitro biofilm inhibition, additionally incorporated in thermoresponsive gel.to benefit nanoparticles` small size, and the positive charge of their surfaces that binds with the negatively charged surface of bacterial cell causing its destruction, in addition to the sustained release pattern of the drug based nanoparticles in gel. Therefore, Ciprofloxacin hydrochloride (CIP) encapsulated in PLGA nanoparticles coated with chitosan (CIP-CS-PLGA-NPs), in addition to free CIP, were incorporated in Pluronic® 407/188 to form thermosensitive gels (F1) and (F2), respectively. The thermosensitive gels were tested with regards to rheology, gelling temperature and the release pattern of the drug. A clinical study of the efficacy of F1 and F2 as antibacterial treatments was conducted on patients followed by a comparative studies against CIP and Ca(OH)2 pastes in terms of biofilm inhibition assay and total bacterial reduction count and percent.The results revealed that F1 and F2 exhibited gelation temperature of 36.9 ± 0.3 °C and 36.0 ± 0.4 °C, viscosity was 15,000 ± 360.6 and 7023.3 ± 296.8 cP respectively. The cumulative release of F1 and F2 after 72 h was 50.03% ± 0.7345 and 77.98% ± 3.122 respectively. F1 was the most efficient treatment against recurrent E.faecalis infection in endodontics that was evident by the highest total bacterial reduction count and percent and biofilm inhibition percent that were recorded in the group treated with F1followed by the group treated with F2. Nanocarriers succeeded in carrying the drug deeply in the root canal and sustaining its effect to abolish the obstinate E. faecalis recurrent infection and its biofilm formation.

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Background: This study evaluated the effect of using chitosan, nano-chitosan, and ethylenediaminetetraacetic acid (EDTA) as final irrigating solutions on smear layer cleanliness and Ca/P ratio of dentin. Methodology: Forty-eight decoronated human single-rooted teeth were used. They were divided randomly into four groups (n = 12) based on the final irrigating solution used as follows: (a) control group (IA; n = 6) normal saline, (IB; n = 6) were left unprepared; group II - 0.2% chitosan; group III - 0.2% nano-chitosan; and group IV - 17% EDTA. Samples were prepared using ProTaper Next and irrigated with 2.6% NaOCl 5 ml after each instrument using 31-gauge needle. Final rinse was used 5 ml/3 min according to the assigned group. The specimens were prepared for evaluation. Results: Best smear layer removal was observed in group IV. No statistically significant differences (P > 0.05) were observed between the experimental groups (II, III, and IV) coronally; however, a statistically significant difference (P < 0.05) was observed between groups II and IV at middle and apical thirds. Intragroup comparison showed that apical third exhibited the highest mean smear layer score among all experimental groups. The highest mean Ca/P ratio was in the 0.2% nano-chitosan group, while the highest calcium loss was in the 17% EDTA group. Conclusions: 17% EDTA is a potent chelating agent that can successfully remove the smear layer but compromises the Ca/p ratio of dentin. However, 0.2% chitosan and its nanoparticles have comparable chelating effects and induce remineralization of the root canal dentin.

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