Endo z

The clinical procedure was started by performing the dental prophylaxis of the patients with poor oral hygiene and the administration of 2% lignocaine hydrochloride with 1:200,000 adrenaline (Aquacaine plus, Mumbai, India). Following which caries excavation and the straight-line access cavity was prepared with sterile Endo access (Dentsply Sirona, Charlotte, NC, USA) and Endo Z (Dentsply Sirona, USA) burs under rubber dam isolation (Hu-Friedy, Frankfurt, Germany) which was disinfected with 2.5% sodium hypochlorite (Cerkamed, Stalowa Wola, Poland). If a Class II access cavity was present, after total caries excavation and access opening, pre-endodontic build-up was carried out with composite resin (3M ESPE Filtek Z350XT, Maplewood, MN, USA) before the application of a rubber dam. Dam seal material (Prevest Gingiva Shield VLC, Jammu, India) was used in case of any leakage. The canal orifice location was carried out with DG-16 explorer (Hu-Friedy, Rockwell, Chicago, IL, USA), followed by glide path establishment with no.10 K file (Mani, INC, Utsunomiya, Tochigi, Japan) and pulp extirpation with sterile broach (Mani, INC, Utsunomiya, Tochigi, Japan), without using any irrigant. Using an electronic apex locator (Root X mini-J Morita, CA, USA), working length was calculated. An intraoral periapical radiograph was then used to confirm the results.

All dental treatments were provided at the Damascus‐Faculty of Dentistry‐Department of pediatric dentistry. After applying the local anesthetic gel, lidocaine was administered 2% with 1:80000 epinephrine, and isolation was done with a rubber dam.
Enamel and dentin were removed using a high‐speed diamond bur with a water‐cooled handpiece, ensuring the removal of the caries area near the pulp by using an excavator from the periphery toward the center to reduce the amount of bacterial contamination.
The pulp chamber access was refined with Endo‐z (Dentsply Maillefer, Ballaigues, Switzerland) with water cooling and then the remainder of the coronal pulp was removed using a sharp excavator.
Hemostasis was achieved with cotton pellets moistened with 2.5% sodium hypochlorite for 2 min, and the process was repeated, if necessary, until the bleeding stopped within 10 min. If hemostasis was not achieved, the patient was excluded and pulpectomy treatment was performed.
Then, BC putty (Well‐Root pt) or MTA angelus (MTA angelus) was applied depending on the group to which the patient was assigned. A base layer of glass ionomer cement was applied (Fuji IX®, GC Corporation, Tokyo, Japan) and then the tooth was restored with a stainless‐steel crown (Kids Crown; Shinhung, Seoul, Korea).