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Introduction: various irrigation devices and chemical solutions are being developed and improved nowadays for better penetration deep into the complex root canal system. Activation of irrigating solutions enhances the solution effectiveness. Evidence in the literature suggests that ultrasonic irrigation is much more effective in this respect than syringe irrigation alone. Passive ultrasonic irrigation (PUI) and/or ultrasonically activated irrigation (UAI): nowadays, the two terms, PUI and UAI, are interchangeable in the literature and represent the same technique. Literature data have shown that combining ultrasonically activated NaOCl with EDTA results in significantly greater removal of the smear layer. Conclusion: the use of ultrasonic activation of the irrigating solution after root canal preparation significantly improves the removal of debris from hard-to-reach areas such as isthmuses, lateral canals and the apical delta.

Vertical root fractures (VRFs) are characterized by complete or incomplete fractures that extend through the long axis towards the apex. They may occur when the root fractures are fatigued by external forces. Endodontic treatment is efficient in the treatment of root canals, where the infection of the pulp is eliminated. The treatment can be used to avoid contamination of the infected area by microbes. However, complications are likely to be experienced if recontamination is experienced on the teeth. Therefore, the endodontist should have the necessary skills and qualifications in treating the condition. This literature review discusses vertical root fractures in teeth with endodontic treatment and the likely complications. This literature review found that the relationship between VRF in teeth that were endodontic treated may be affected by personal and social factors. The general health status of an individual may influence the response to endodontic treatment. Tooth factors, microbes, foreign bodies, and epithelial cells may affect the impact of endodontic procedures. These effects may influence the prevalence of VRF. The studies analyzed indicated that premolars and molars are at high risk of VRF as compared to incisors. Therefore, the diagnostic procedures may focus on the prevalence factors. However, personal responsibility, including hygiene, regular check-ups, and follow-ups, may eradicate post-endodontic complications.

The aim of this case report is to describe a mandibular first molar with large periapical lesions, which after shaping and disinfection of the root canals obturation with bioceramic sealer was done. A 12-month follow-up was done using radiographic examination as the analysis of the periapical reduction was evaluated with Periapical Index (PAI) by Ǿrstavik. For a year the periapical lesion reduced from PAI 5 to PAI 2 as the tooth remains asymptomatic.

The aim of this case report is to describe a mandibular second molar with periapical lesion and rare anatomy of the endodontic system which was treated with additional method of root canal disinfection. Intra oral radiograph revealed a tooth with not exacting endodontic treatment and with relatively large apical radiolucency. The additional disinfection performed after the root canal preparation was finished with diode laser for 20 sec. The 18-month follow-up revealed complete resolution of the periapical radiolucency.