الفهرس 
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Abstract
Aim
This study was carried out to compare different irrigant activation methods using Xp-endo Finisher, Ultrasonic activation or conventional needle irrigation, clinically to evaluate postoperative pain after single visit endodontic treatment in mandibular premolars with acute irreversible pulpitis; and In vitro evaluation to evaluate apical extrusion, bacterial reduction and cleaning ability of debris and smear layer.
Methods
Clinical Trial: Forty-five patients with mandibular premolar diagnosed as acute pulpitis without apical periodontitis, were randomly allocated to three groups according to activation methods: A) XP-endo Finisher, B) Ultrasonic, C) Conventional needle irrigation. Patients recorded preoperative pain levels. After thorough anesthesia, tooth was accessed, isolated and the working length was determined. Chemo-mechanical preparation was done using rotary file system and 2.5% NaOCl. Irrigant was then activated according to each activation method. After master cone verification, root canal was dried and obturated using cold lateral obturation technique. Patients recorded pain levels on 100mm Visual analogue scale at 6hrs, 24hrs, 72 hours and 1 week intervals
In vitro study: Apical Extrusion: Teeth were inserted in an artificial socket made with light body silicone material in eppendurf tubes. Each artificial silicone socket, without the tooth, was weighed using electronic analytical balance. The canals were prepared and divided into 3 groups according to activation method. The sockets were then weighed again and the difference in weight was calculated to find the weight of extruded debris.
Bacterial Reduction: The root samples were immersed in the BHI broth inoculated with E.faecalis in six-well plates for inoculation of bacteria. At the end of incubation period, three samples were subjected to environmental scanning electron microscope to ensure bacterial colonization. Bacteria sampling S1, using paper points, was done after bacterial incubation and before mechanical instrumentation of the canals. Bacteria sampling S2 was done at the end of the procedure in all groups.
Cleaning Ability: Teeth were instrumented and divided into 3 groups according to activation method. Teeth were then split longitudinally into 2 halves using diamond disc with care not to reach the root canal. The teeth were then split with a chisel and air dried to be evaluated under a scanning electron microscope (SEM) at 500X for debris and 2000X for smear layer evaluation.
Results
Postoperative pain: No difference was found in preoperative pain levels among groups. At 6 hrs. XP- endo Finisher showed significantly higher pain levels than Ultrasonic activation at 6 hours and both Ultrasonic activation and Conventional needle irrigation at 24 hours. No significant difference was found at 72 hours and 1 week follow up periods
Apical extrusion: Ultrasonic activation showed lower apical extrusion values than both XP- endo Finisher and Conventional needle irrigation and the difference was significant.
Bacterial reduction: For all groups, a significant reduction in log CFU/ml was found after root canal preparation with or without irrigant activation. After activation protocol, XP- endo Finisher and Ultrasonic activation showed lower log CFU/ml compared to Conventional needle irrigation and the difference was significant.
Cleaning ability: Debris evaluation showed that in the coronal section, insignificant difference was found between groups. In the middle section, Conventional needle irrigation showed significantly higher debris scores than Ultrasonic activation. In the apical section, difference between groups was insignificant. Smear layer evaluation revealed that in XP- endo Finisher group, apical root section showed the highest smear layer compared to Middle and coronal section. For Ultrasonic activation group, apical root section showed significant higher values compared to middle section. While for Conventional needle irrigation group, insignificant difference on smear layer between root sections.
Conclusion
Under the limitations of the current study the following conclusions could be derived:
1- XP- endo finisher cause greater post-operative pain levels on the first day.
2- XP –endo finisher and conventional irrigation groups cause greater apical extrusion than Ultrasonic activation.
3- XP endo finisher and Ultrasonic activation cause greater bacterial reduction in comparison with conventional needle irrigation.
4- Ultrasonic activation showed improved debris removal in middle and apical thirds than XP- endo finisher and conventional needle irrigation. XP- endo finisher and Ultrasonic activation showed better removal of smear layer in coronal and middle thirds than control while in the apical section, Ultrasonic activation showed better smear layer removal.
5- There is a correlation between post-operative pain levels and apical extrusion.