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Romeiro K, Gominho LF, Rôças IN, Siqueira JF. Postoperative pain in oncological patients subjected to nonsurgical root canal treatment: a prospective case-control study. Clin Oral Investig 2024; 28:472. [PMID: 39110264 DOI: 10.1007/s00784-024-05866-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 07/30/2024] [Indexed: 09/18/2024]
Abstract
OBJECTIVES The purpose of this prospective study was to evaluate the incidence and intensity of postoperative pain in oncological patients with infected teeth subjected to nonsurgical root canal treatment or retreatment. METHODS Teeth with apical periodontitis from healthy control patients and oncological patients (n = 70 per group) were root canal treated/retreated and evaluated for the development of postoperative pain. Patients from the two groups were matched for tooth type, gender, clinical manifestation of apical periodontitis, and intervention type. A visual analogue scale (VSA) was used to evaluate the incidence of postoperative pain at 24 h, 72 h, 7d, and 15d after chemomechanical procedures. Data were statistically analyzed for the incidence and intensity of postoperative pain in the two groups. RESULTS Preoperative pain occurred in 10% of the individuals and in all these cases pain showed a reduction in intensity or was absent after endodontic intervention at 24-h evaluation. The overall incidence of postoperative pain at 24 h was 14% in oncology patients and 30% in controls (p = 0.03). At 72 h, the respective corresponding figures were 4% and 8.5% (p > 0.05). At 7 and 15 days, all patients were asymptomatic, irrespective of the group. CONCLUSIONS No significant differences in postoperative pain were found between control and oncological patients. The low incidence of postoperative pain observed in both groups supports the routine use of nonsurgical root canal treatment/retreatment as valid options in oncological patients. CLINICAL RELEVANCE Oncological patients had no increased risk of postoperative pain in comparison with control patients.
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Affiliation(s)
- Kaline Romeiro
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil.
- Department of Oral Medicine, Royal Portuguese Hospital of Charity in Pernambuco, Recife, PE, Brazil.
| | - Luciana F Gominho
- Department of Restorative Dentistry, Federal University of Paraíba (UFPB), Paraíba, PB, Brazil
| | - Isabela N Rôças
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
- Department of Endodontics, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil
| | - José F Siqueira
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
- Department of Endodontics, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil
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Angın AE, Özkan HD, Saral İP, Aydın B. The incidence and intensity of postoperative pain and Flare-up following the use of three different intracanal medicaments in teeth with posttreatment apical periodontitis: a randomized clinical trial. Clin Oral Investig 2024; 28:362. [PMID: 38849655 PMCID: PMC11161537 DOI: 10.1007/s00784-024-05760-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/31/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVES This randomized clinical trial aimed to compare the effect of intracanal medicaments on the incidence of postoperative pain and flare-up with posttreatment apical periodontitis (PTAP) of retreatment cases. MATERIALS AND METHODS One hundred twenty patients diagnosed with PTAP with single-rooted teeth with single-canal without spontaneous pain or swellings were included and randomly divided into three groups according to the intracanal medicament used. Intracanal medicaments were placed into the root canals following the removal of previous root canal fillings and re-instrumentation. Calcium hydroxide (Ca (OH)2), chlorhexidine gel (CHX), calcium hydroxide and chlorhexidine gel combinations were used as intracanal medicaments. Postoperative pain scores were recorded at 6 and 12 h and 1, 2, 3, 4, 5, 6, and 7 days using a visual analog scale (VAS). Sensitivity on percussion, spontaneous pain, swelling, antibiotic and analgesic requirements of the patients were evaluated during clinical examinations performed postoperatively after 2 and 7 days. RESULTS There were no statistically significant differences between groups in terms of VAS scores following the intracanal medicament application (p > 0.05). However, compared to the patients of 20-34 and 50-65 age groups, greater VAS scores were observed in patients of 35-49 age groups at 12 h, and 3, 4, 7 days (p < 0.05). Flare-up was observed in only one patient in the CHX gel group, and no flare-up was observed in other groups. CONCLUSIONS Similar postoperative pain incidence in all experimental groups indicates that all three medicaments are clinically acceptable in inter-appointment management of retreatment cases in terms of post-endodontic pain and flare-up. CLINICAL RELEVANCE In this randomized clinical trial, three different intracanal medicaments were utilized in nonsurgical endodontic retreatment and their effect on postoperative pain and flare-up incidence was examined. Thus, this study will be a significant contribution in the decision-making during clinical practice; since there are a limited number of prospective clinical trials in the literature about the severity of pain following retreatment procedures including intracanal medicament use.
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Affiliation(s)
- Adile Esen Angın
- Department of Endodontics, Faculty of Dentistry, Aydın Adnan Menderes University, Aydın, 09100, Turkey
| | - Hicran Dönmez Özkan
- Department of Endodontics, Faculty of Dentistry, Aydın Adnan Menderes University, Aydın, 09100, Turkey.
| | - İlkim Pınar Saral
- Department of Endodontics, Faculty of Dentistry, Aydın Adnan Menderes University, Aydın, 09100, Turkey
| | - Berdan Aydın
- Department of Endodontics, Faculty of Dentistry, Dokuz Eylül University, İzmir, Turkey
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Alghazaly A, Al Habib L. Management of Endodontic Flare-Up in the Presence of Periapical Radiolucency: Case Report and Overview. Cureus 2023; 15:e49719. [PMID: 38161823 PMCID: PMC10757558 DOI: 10.7759/cureus.49719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Flare-ups following root canal therapy (RCT) are of significant concern in dentistry. They are characterized by the occurrence of pain or swelling during or even after a root canal procedure. They affect a considerable proportion of cases, up to 16% and occasionally even 50%, and they often necessitate unscheduled appointments. Whenever a flare-up occurs within hours or days following RCT, it demands emergency treatment. Flare-ups can be attributed to multiple factors, including mechanical, chemical, and microbial causes. Identifying these factors beforehand and utilizing the expertise of clinicians can help better manage patients after the procedure and assure a long-term successful outcome. It has been observed that retreatment cases with periapical periodontitis treated in a single appointment have higher flare-up rates. Despite the prevalence and the impact of flare-ups, the endodontic community has yet to adopt scientifically validated and approved preventive measures to manage and prevent flare-ups. Hence, in this case report, the ethical letter was approved (TUCDREC/250923). It provides insight into the management of an interappointment flare-up with an overview.
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Affiliation(s)
- Amira Alghazaly
- Restorative Dental Sciences, Collage of Dentistry/Taibah University, Madinah, SAU
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Nosrat A, Valancius M, Mehrzad S, Dianat O, Verma P, Aminoshariae A, Fouad AF. Flare-ups After Nonsurgical Retreatments: Incidence, Associated Factors, and Prediction. J Endod 2023; 49:1299-1307.e1. [PMID: 37451334 DOI: 10.1016/j.joen.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/28/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION The aims of this study were to determine the incidence, associated factors, and predictability of flare-ups after nonsurgical retreatments (NSRetx). METHODS All patients (n = 3,666) who received NSRetx by 3 endodontists in 2 endodontic offices during a period of 6 years (2016-2022) were included. Demographic, diagnostic, and procedural data were collected. A flare-up was defined as moderate-severe pain with/without swelling that took place within 14 days of initiation of NSRetx and resulted in an unscheduled appointment. Bivariate analyses on the entire cohort and multivariable analyses on cases with complete dataset (n = 2,846) were performed to identify significant associations. A Random Forest algorithm was used to make a prediction model. RESULTS Incidence of flare-ups was 3.95% (n = 145). Increased risk of flare-ups was associated with diabetes (adjusted odds ratio [AOR] = 2.01; 95% confidence interval [CI], 1.01-3.97), mandibular teeth (AOR = 1.67; 95% CI, 1.11-2.52), moderate-severe preoperative pain on percussion (AOR = 2.13; 95% CI, 1.31-3.50), and pain on palpation (AOR = 1.63; 95% CI, 1.01-2.64). Lower risk of flare-up was associated with high blood pressure (AOR = 0.44; 95% CI, 0.21-0.82) (P < .05). The prediction model was not able to predict flare-ups with sufficient confidence (precision = 0.13). CONCLUSIONS Incidence of flare-ups following NSRetx was low (∼4%) and had a weak but significant association with the history of diabetes. Moderate-severe pain on percussion, pain on palpation (any intensity), and mandibular teeth had a significant association with flare-ups. The history of high blood pressure was associated with lower risk of flare-ups. Flare-ups were difficult to predict in this clinical setting.
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Affiliation(s)
- Ali Nosrat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland; Private Practice, Centreville Endodontics, Centreville, Virginia.
| | - Michael Valancius
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Sahar Mehrzad
- Bernard J. Dunn School of Pharmacy, Shenandoah University, Fairfax, Virginia
| | - Omid Dianat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland; Private Practice, Centreville Endodontics, Centreville, Virginia
| | - Prashant Verma
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland; Private Practice, Centreville Endodontics, Centreville, Virginia; Private Practice, Capitol Endodontics, Washington, District of Columbia
| | - Anita Aminoshariae
- Department of Endodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Ashraf F Fouad
- Department of Endodontics, School of Dentistry, The University of Alabama at Birmingham, Birmingham, Alabama
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Baaij A, Visscher CM, Jansen M, Özok AR. Incidence of interappointment emergencies in multiple-visit root canal treatments performed with or without intracanal medicament by undergraduate students. Restor Dent Endod 2023; 48:e31. [PMID: 37675442 PMCID: PMC10477423 DOI: 10.5395/rde.2023.48.e31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/27/2023] [Accepted: 05/07/2023] [Indexed: 09/08/2023] Open
Abstract
Objectives This retrospective cohort study examined the incidence of interappointment emergencies during multiple-visit molar root canal treatments conducted by undergraduate students. Treatments performed without the use of intracanal medicament were compared to treatments that incorporated calcium hydroxide as an intracanal medicament. Materials and Methods Interappointment emergencies, defined as instances of pain or swelling that required the patient to make an unscheduled follow-up visit, were recorded for up to 2 months after the intervention. To avoid the influence of obturation on the observed incidence of emergency visits, only unscheduled visits occurring between the start and end of the root canal treatment were included. Results Of the 719 patients included in this study, 77 (10.7%) were recorded as experiencing interappointment emergencies. Of these emergencies, 62% occurred within 2 weeks following the most recent intervention. In the group of patients who did not receive intracanal medicament, the incidence of interappointment emergencies was 11.9% (46 of 385 patients). In comparison, this rate was 9.3% (31 of 334 patients) among those who received calcium hydroxide as an intracanal medicament (odds ratio, 1.33; 95% confidence interval, 0.82-2.15; p = 0.249). Conclusions Interappointment emergencies may arise at any point during root canal treatment, but they most commonly occur within the first 2 weeks following intervention. The omission of intracanal medicament in multiple-visit molar root canal treatments, performed by undergraduate students, did not significantly increase the incidence of these emergencies.
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Affiliation(s)
- Annemarie Baaij
- Department of Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Corine Mirjam Visscher
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Manon Jansen
- Department of Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ahmet Rifat Özok
- Department of Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Sharma A, Sharma R, Sharma M, Jain S, Rai A, Gupta S. Endodontic Flare-Ups: An Update. Cureus 2023; 15:e41438. [PMID: 37546112 PMCID: PMC10403811 DOI: 10.7759/cureus.41438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/08/2023] Open
Abstract
Root canal treatment deals with mechanical and chemical cleaning followed by obturation that promotes healing and repair of periradicular tissues. Flare-ups can occur in between or some days after endodontic therapy leading to unscheduled visit by the patient. This complication is characterized by severe pain and/ or swelling. There is a correlation between number of appointments, intracanal medicament used and flare-ups. However, there is no sure procedure that can avoid this complication. Therefore, this review article has discussed about causes and some procedures to prevent and treat flare-ups.
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Affiliation(s)
- Anjali Sharma
- Conservative Dentistry and Endodontics, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, IND
| | - Rohit Sharma
- Conservative Dentistry and Endodontics, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, IND
| | - Madhurima Sharma
- Prosthodontics and Crown and Bridge, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, IND
| | - Saloni Jain
- Conservative Dentistry and Endodontics, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, IND
| | - Aparna Rai
- Conservative Dentistry and Endodontics, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, IND
| | - Sheersh Gupta
- Conservative Dentistry and Endodontics, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, IND
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Aneja K, Gupta A, Abraham D, Aggarwal V, Sethi S, Chauhan P, Singh A, Kurian AH, Jala S. Influence of vehicle for calcium hydroxide on postoperative pain: a scoping review. J Dent Anesth Pain Med 2022; 22:75-86. [PMID: 35449780 PMCID: PMC8995678 DOI: 10.17245/jdapm.2022.22.2.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/15/2022] [Accepted: 02/15/2022] [Indexed: 11/28/2022] Open
Abstract
This review aims to identify the influence of the vehicle and its concentration used to carry calcium hydroxide (Ca(OH)2) medicament on postoperative pain. The protocol for this review was registered in the open science framework (Registration DOI-10.17605/OSF.IO/4Y8A9) and followed the guidelines provided by the Joanna Briggs Institute. Reporting was based on the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR). Literature screening and searches were performed on PubMed/Medline, Scopus, and EBSCO hosts. Furthermore, additional records were manually analyzed using various sources. The selected studies were published in English and included the use of any vehicle adjunct to Ca(OH)2 to evaluate postoperative pain using qualitative and quantitative pain assessment tools. Descriptive analysis was conducted to review the study design, vehicle elements, and their effects. A preliminary search yielded 7584 studies, of which 10 were included. According to the data collected, the most commonly used Ca(OH)2 vehicles were chlorhexidine (CHX), normal saline, and camphorated paramonochlorophenol/glycerine (CPMC/glycerine), which had a significant effect on postoperative pain. Among the included studies, six evaluated the effect of CHX as a vehicle. It was observed that a higher concentration of the vehicle (2%) showed a favorable response in reducing postoperative pain. A majority of studies have validated a positive consequence of using a vehicle on postoperative pain. Although higher vehicle concentrations were found to alter postoperative pain levels, the data were insufficient to draw a firm conclusion. Our scoping review indicates that further clinical studies should focus on using different vehicles at various concentrations and application times to check for feasible and safe exposure in addition to providing pain relief.
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Affiliation(s)
- Kritika Aneja
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Faridabad, Haryana, India
| | - Alpa Gupta
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Faridabad, Haryana, India
| | - Dax Abraham
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Faridabad, Haryana, India
| | - Vivek Aggarwal
- Department of Conservative Dentistry and Endodontics, Jamia Milia Islamia, New Delhi, India
| | - Simar Sethi
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Faridabad, Haryana, India
| | - Parul Chauhan
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Faridabad, Haryana, India
| | - Arundeep Singh
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Faridabad, Haryana, India
| | - Ansy Hanna Kurian
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Faridabad, Haryana, India
| | - Sucheta Jala
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Faridabad, Haryana, India
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Ordinola-Zapata R, Noblett C, Perez-Ron A, Ye Z, Vera J. Present status and future directions of intracanal medicaments. Int Endod J 2022; 55 Suppl 3:613-636. [PMID: 35322427 PMCID: PMC9321724 DOI: 10.1111/iej.13731] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 11/27/2022]
Abstract
Two fundamental goals of endodontic treatment are to prevent or treat apical periodontitis. From a predictive perspective, several variables can affect the outcome of root canal treatment. Some of these variables depend on intraoperative factors, which include irrigation technique, size of the apical preparation, use of intracanal medicaments or the number of appointments necessary to complete the treatment. However, the outcome may also be affected by host and microbial factors. The intensity of periradicular bone loss or tissue damage, the presence of preoperative pain and associated conditions such as mechanical allodynia and central sensitization, the anatomical complexity of the apical portion of the canal, and the virulence and longevity of the bacterial infection can all have a profound influence on the outcome. Furthermore, numerous medical conditions have been reported to decrease the capability of the immune system to heal the periapical tissues. It is the clinician's responsibility to analyse these variables and incorporate them into the disinfection strategy to maximize the chances of healing. This narrative review will focus on the present status of intracanal medicaments, the clinical indications for their use and future directions for research.
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Affiliation(s)
- R Ordinola-Zapata
- Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - C Noblett
- Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | | | - Z Ye
- Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R, China.,Minnesota Dental Research Center for Biomaterials and Biomechanics (MDRCBB), School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - J Vera
- Division of Endodontics, School of Dentistry, University of Missouri, Kansas City, MO, USA
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9
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Milani AS, Froughreyhani M, Taghiloo H, Nouroloyouni A, Jafarabadi MA. The effect of antibiotic use on endodontic post-operative pain and flare-up rate: a systematic review with meta-analysis. Evid Based Dent 2022:10.1038/s41432-021-0205-z. [PMID: 35165442 DOI: 10.1038/s41432-021-0205-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/14/2021] [Indexed: 06/14/2023]
Abstract
Aim Antibiotics are widely used to prevent flare-ups after endodontic treatment of non-vital teeth. This systematic review assessed the effect of antibiotic administration on post-endodontic treatment pain and flare-up rate.Methods Five major databases including Web of Science, Cochrane Library, PubMed, Scopus and Embase were searched to identify randomised clinical trials (RCTs) published until September 2020. Retrieved papers were critically appraised using the revised Cochrane risk of bias tool (RoB 2). To reduce the clinical heterogeneity, the included studies were divided into two groups: studies on symptomatic non-vital teeth and studies on asymptomatic non-vital teeth. The primary outcomes were 'post-operative pain' and 'flare-up rate'. The data of included studies were statistically combined through meta-analysis using random-effect model. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of evidence.Results Six RCTs involving two RCTs (N = 61) on symptomatic teeth and four RCTs (N = 310) on asymptomatic teeth were included. In two RCTs on asymptomatic teeth, prophylactic antibiotic had been used, while in the remaining two RCTs, antibiotics had been administered after treatment. Quantitative synthesis of the RCTs showed that antibiotic administration following endodontic treatment of symptomatic non-vital teeth has no effect on pain severity at 24 hours following treatment (weighted mean difference [WMD] = -0.03; 95% confidence interval [CI]: -0.53 to 0.47), and the use of antibiotics before endodontic treatment of asymptomatic non-vital teeth has no effect on flare-up rate (relative risk [RR] = 0.58; 95% CI: 0.22-1.54). The GRADE approach revealed that the overall quality of evidence on the topic is low.Conclusions The antibiotic administration following endodontic treatment of symptomatic non-vital teeth has no effect on pain severity at 24 hours following treatment. Also, prophylactic antibiotics are ineffective in reducing the flare-up rate following treatment of asymptomatic non-vital teeth. However, to evaluate the effect of post-treatment antibiotics on flare-up rate in asymptomatic non-vital teeth, more high-quality RCTs are needed.
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Affiliation(s)
- Amin Salem Milani
- Associate Professor of Endodontics, Research Centre for Evidence-Based Medicine (EBM), Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mohammad Froughreyhani
- Professor of Endodontics, Department of Endodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Taghiloo
- Assistant Professor, Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Tabriz University of Medical sciences, Tabriz, Iran
| | - Ahmad Nouroloyouni
- Assistant Professor of Endodontics, Department of Endodontics, Faculty of Dentistry, Ardebil University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari Jafarabadi
- Department of Statistics and Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
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10
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Abbott PV. Present status and future directions - managing endodontic emergencies. Int Endod J 2021; 55 Suppl 3:778-803. [PMID: 34958512 DOI: 10.1111/iej.13678] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/20/2021] [Accepted: 12/26/2021] [Indexed: 11/28/2022]
Abstract
Endodontic emergencies are common in both general dental practices and specialist Endodontic practices. The aim of this review is to provide an overview of endodontic emergencies. Endodontic emergencies can be a result of many different conditions of the pulp, root canal and periradicular tissues. They may occur before endodontic treatment has been started, between appointments when treatment is being performed over multiple visits, or after endodontic treatment has been completed. In the latter situation, the emergency may be very soon after the treatment or it may occur many years later, in which case it is usually a new disease process as a result of the root canal system becoming infected. An emergency can be a stressful situation for both the patient and the dentist (or endodontist) as it is usually an unexpected event. It is incumbent on dental professionals to provide timely assistance to patients who have an emergency, and it is also important to allow sufficient time to manage the situation comprehensively. Management of endodontic emergencies should follow the principles of the 3D's - Diagnosis, Definitive dental treatment and Drugs - and in that sequence. An accurate diagnosis, the first "D", is essential so the appropriate treatment can be provided. Diagnosis requires a thorough understanding of the various conditions that can cause the emergency and this can be helped by having a comprehensive classification of the various conditions. The diagnosis should also direct the clinician to the appropriate definitive dental treatment, the second "D". Root canal treatment will not always be required as some cases can be managed conservatively. Other cases may require root canal re-treatment. The specific details of how the treatment is done can also vary, according to the diagnosis. The final "D" is Drugs - the use of drugs should also be dependent on the diagnosis and the dental treatment. Drugs should only be an adjunct following the treatment. The clinician must also differentiate between inflammation and infection in order to provide the appropriate treatment and to prescribe the appropriate medication for effective pain relief and resolution of other symptoms or signs such as swelling.
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Affiliation(s)
- Paul V Abbott
- UWA Dental School, The University of Western Australia, Western Australia, Australia
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11
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Alves-Silva EG, Arruda-Vasconcelos R, Louzada LM, de-Jesus-Soares A, Ferraz CCR, de Almeida JFA, Marciano MA, Steiner-Oliveira C, Bello-Silva MS, Shemesh H, Paula Figueiredo de Almeida Gomes B. The effect of photodynamic therapy on postoperative pain in teeth with primary endodontic infection. Photodiagnosis Photodyn Ther 2021; 37:102700. [PMID: 34954090 DOI: 10.1016/j.pdpdt.2021.102700] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/10/2021] [Accepted: 12/20/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The objective of this study was to investigate the action of photodynamic therapy on pain control after endodontic treatment in asymptomatic teeth with a primary infection, within a single visit. METHODS Sixty (60) single-rooted teeth with pulp necrosis and periapical lesions were selected and randomly divided into two (2) groups (n=30), according to the protocol; a control group (CG) and a group using photodynamic therapy (aPDT). The canals were instrumented with Reciproc files # 25 up to 40 along the entire length of the canal, using 2% chlorhexidine gel as the auxiliary chemical substance, followed by irrigation with sterile saline. The canals were filled with Endomethasone N cement, 0.005% methylene blue, using AsGaAl diode laser, 660 nm wavelength, 100 mW of power and 9 J of energy, using optical fibers with 365 µm in diameter. RESULTS Pain intensity was assessed at 8, 12, 24, 48, 72 hours and 1 week after endodontic treatment using a visual analogue scale. The level of pain was classified as none (0), mild (1-3), moderate (4-7) or severe (8-10). The data were at a significance level of 5%. There was a statistically significant difference (p<0.05) in the periods of 8, 12, 24, 48 and 72 hours between the control group and the aPDT group. After 1 week, there was no statistically significant difference. CONCLUSIONS It is concluded that photodynamic therapy had a significant effect on decreasing post-endodontic treatment pain in teeth with necrotic pulp and asymptomatic periapical lesions.
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Affiliation(s)
- Esdras Gabriel Alves-Silva
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil.
| | - Rodrigo Arruda-Vasconcelos
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil.
| | - Lidiane Mendes Louzada
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil.
| | - Adriana de-Jesus-Soares
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil.
| | - Caio Cezar Randi Ferraz
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil.
| | - José Flávio Affonso de Almeida
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil.
| | - Marina Angélica Marciano
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil.
| | - Carolina Steiner-Oliveira
- Department of Health Sciences and Pediatric Dentistry, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil.
| | - Marina Stella Bello-Silva
- Special Laboratory of Lasers in Dentistry (LELO), Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil.
| | - Hagay Shemesh
- Department of Endodontology, Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands..
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12
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Ahmad MZ, Sadaf D, Merdad KA, Almohaimeed A, Onakpoya IJ. Calcium hydroxide as an intracanal medication for postoperative pain during primary root canal therapy: A systematic review and meta-analysis with trial sequential analysis of randomised controlled trials. J Evid Based Dent Pract 2021; 22:101680. [DOI: 10.1016/j.jebdp.2021.101680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/08/2021] [Accepted: 11/28/2021] [Indexed: 12/01/2022]
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13
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Çanakçi BC, Er Ö, Genç Şen Ö, Süt N. The effect of two rotary and two reciprocating NiTi systems on postoperative pain after root canal retreatment on single-rooted incisor teeth: A randomized controlled trial. Int Endod J 2021; 54:2016-2024. [PMID: 34383324 DOI: 10.1111/iej.13609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 08/07/2021] [Accepted: 08/10/2021] [Indexed: 01/07/2023]
Abstract
AIM This randomized clinical trial aimed to assess the effect of two rotary (ProTaper Retreatment + ProTaper Gold and Hyflex EDM) and two reciprocating (Reciproc Blue and WaveOne Gold) NiTi systems on postoperative pain after root canal retreatment on single-rooted incisor teeth. METHODOLOGY One hundred and eighty patients scheduled for root canal retreatment were randomly assigned to one of the four groups according to the NiTi system (ProTaper Retreatment + ProTaper Gold, Hyflex EDM, Reciproc Blue or WaveOne Gold) used for the removal of root canal fillings and further canal preparation. The working length was determined to be 1 mm shorter than the '0.0' mark of the apex locator. Root canals were filled with gutta-percha and an epoxy resin-based root canal sealer using a lateral compaction technique. The teeth were restored using a resin composite material. A single operator performed the retreatments in a single visit. The incidence and intensity of postoperative pain were rated on a numeric rating scale by patients 24, 48 and 72 h after retreatment. The number of analgesic tablets (400 mg Ibuprofen) taken by patients was also recorded. Data were analysed using the Mann-Whitney U, Wilcoxon and chi-square tests. RESULTS For the intensity of postoperative pain, the difference between the four groups was not significantly different (p > .05). No significant difference was found between the groups in terms of analgesic medication intake (p > .05). CONCLUSIONS The rotary and reciprocating NiTi systems tested in this study were associated with similar intensity of postoperative pain and intake of analgesics following root canal retreatment on single-rooted incisor teeth completed in one visit.
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Affiliation(s)
- Burhan Can Çanakçi
- Department of Endodontics, Faculty of Dentistry, Trakya University, Edirne, Turkey
| | - Özgür Er
- Department of Endodontics, Faculty of Dentistry, Trakya University, Edirne, Turkey
| | - Özgür Genç Şen
- Department of Endodontics, Faculty of Dentistry, Yüzüncü Yıl University, Van, Turkey
| | - Necdet Süt
- Department of Biostatistics, Medical Faculty, Trakya University, Edirne, Turkey
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14
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Shubham S, Nepal M, Mishra R, Dutta K. Influence of maintaining apical patency in post-endodontic pain. BMC Oral Health 2021; 21:284. [PMID: 34078331 PMCID: PMC8173919 DOI: 10.1186/s12903-021-01632-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 05/12/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The concept of instrumentation beyond the apical foramen by small flexible file to prevent apical blockage is apical patency. However, this procedure might endow postoperative pain, thus to maintain apical patency or not is the matter of dilemma. Hence, the primary objective of this study was to compare postoperative pain between apical patency and non-patency groups and secondary objective was to evaluate the influence of number of visits, vitality of teeth, group of teeth and preoperative pain on post-operative pain. METHODS Preselected (n = 178) patients based on group of teeth and status of pulp were randomly divided into 2 groups, apical patency and non-patency which was further treated in either single or multiple visits. After exclusion, 160 patients were included. Each group (n = 80) was subdivided in single visit (n = 40) and multiple visits (n = 40), including vital (n = 20) and non-vital teeth (n = 20) and single-rooted (n = 10) and multiple-rooted teeth (n = 10). Apical patency was maintained with a size 10 K-file during conventional hand filing step-back shaping procedure. Intensity of pain was recorded before treatment and on days 1, 2, and 7 after treatment using Numerical Rating Scale (NRS-11). Statistical analysis was done using Mann-Whitney U test, Spearman correlation and Multiple linear regression analysis. RESULTS The primary outcome of this study showed statistically significant difference (p < 0.05) in postoperative pain scores between patency and non-patency groups with higher pain scores in patency group on 1st, 2nd and 7th day follow up. The secondary outcome showed postoperative pain in patency-maintained group was influenced by status of the pulp and preoperative pain only. Vital teeth of patency-maintained group treated in multiple visits showed statistically significant (p = 0.02) post-operative pain in day 1 follow up. Pre-operative pain showed positive correlation with postoperative pain with statistically significant difference. CONCLUSIONS Our study concluded that maintenance of apical patency increased postoperative pain. Evaluation of influence of number of visits, status of pulp, group of tooth and preoperative pain revealed status of pulp and preoperative pain as influencing factors for postoperative pain in patency group.
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Affiliation(s)
- Snigdha Shubham
- Department of Conservative Dentistry and Endodontics, Universal College of Medical Sciences, Ranigaon, Bhairahawa, Nepal
| | - Manisha Nepal
- Department of Conservative Dentistry and Endodontics, Universal College of Medical Sciences, Ranigaon, Bhairahawa, Nepal
| | - Ravish Mishra
- Department of Oral and Maxillofacial Surgery, Universal College of Medical Sciences, Ranigaon, Bhairahawa, Nepal
| | - Kishor Dutta
- Department of Orthodontics and Dentofacial Orthopaedics, Universal College of Medical Sciences, Ranigaon, Bhairahawa, Nepal
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15
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Medications Used for Prevention and Treatment of Postoperative Endodontic Pain: A Systematic Review. Eur Endod J 2021; 6:15-24. [PMID: 33609020 PMCID: PMC8056801 DOI: 10.14744/eej.2020.85856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: Prevention and management of postoperative endodontic pain is a common challenge for the endodontists. This systematic review was conducted to evaluate the efficacy and safety of medicament therapeutic protocols in the prevention and management of endodontic pain. Methods: A literature search was undertaken in MEDLINE, Cochrane Library, LILACs, and SciELO, for articles published until December 2017, without year restriction and written only in English. An additional search was performed in the references of the retrieved studies. Study eligibility criteria, participants, and interventions: The inclusion criteria were randomised clinical trials that evaluated the use of medications to prevent or control moderate to severe pain in adult patients, using a visual analog scale as a tool for pain measurement. The primary outcome evaluated was the reduction of pain scores. The second outcome evaluated was the need for additional analgesia and the occurrence of adverse events. Study appraisal and synthesis methods: The quality assessment of the included studies was performed following the Jadad scale to measure the likelihood of bias in pain research reports. Results: After removing duplicates and excluding the studies that did not meet the selection criteria, ten studies were included tin the systematic review. Among these studies, five studies administered the medications before the endodontic procedures and five studies after. These studies evaluated non-opioid analgesics (acetaminophen), opioid analgesics (tramadol and codeine), nonsteroidal anti-inflammatories (ibuprofen, flurbiprofen, ketorolac tromethamine, etodolac, tenoxicam, and naproxen), steroidal anti-inflammatory (prednisolone) or the association of medications to prevent or control postoperative pain. It was possible to establish a significant relationship between the use of additional analgesics and periapical diagnosis. Adverse events were not observed when the administration occurred before the endodontic procedure. When it was administered after the procedure, adverse reactions were reported in 2 of 3 trials included in the analysis. Limitations: A restricted number of randomised clinical trials were found, and the difference in the methodology of the studies did not meet the definition of a systemic treatment protocol for prevention or control of postoperative pain. Conclusion: Nonsteroidal anti-inflammatory drugs are the most common medicament to prevent and control postoperative pain, with ibuprofen being the most investigated. There is a significant association between the use of additional analgesics and periapical diagnoses.
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16
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Jang YE, Kim Y, Kim BS. Influence of Preoperative Mechanical Allodynia on Predicting Postoperative Pain after Root Canal Treatment: A Prospective Clinical Study. J Endod 2021; 47:770-778.e1. [PMID: 33516824 DOI: 10.1016/j.joen.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/04/2021] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Odontogenic pain can manifest as pulpal pain, periapical pain (mechanical allodynia), or both. This study aimed to assess the changes in the intensity of mechanical allodynia (MA) and to identify predictors of postoperative pain after root canal treatment (RCT). METHODS In total, 579 consecutive patients who required RCT were enrolled; we included patients with asymptomatic pulpal diagnoses to avoid any effects of preoperative spontaneous pain on postoperative pain and to evaluate MA independently. Using a visual analog scale (VAS), patients separately indicated the intensity of spontaneous pain, tenderness to percussion, and pain on biting; these measurements were performed before treatment (preoperative pain), at the beginning of each visit (postpreparation pain), and daily for 1 week after RCT (postobturation pain). For analytical purposes, patients were subdivided into 2 groups based on the intensity of preoperative MA (none to mild [VAS <4] or moderate to severe [VAS ≥4]) to evaluate changes in MA and predictive factors of moderate to severe postoperative pain. A generalized estimating equation, repeated-measures analysis of variance, and logistic regression analysis were used. RESULTS Although the intensity of MA was significantly higher in the moderate to severe group after the initiation of RCT (P < .05), 93% of them experienced alleviation in MA, and 30% of patients in the none to mild group experienced an increase in MA. After adjusting for clinical variables, moderate to severe preoperative MA and the presence of necrotic pulp were significantly correlated with moderate to severe postoperative pain with an odds ratio of 4.107 and 0.286, respectively. CONCLUSIONS Moderate to severe preoperative MA was a predictive factor of postoperative pain in patients undergoing RCT.
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Affiliation(s)
- Young-Eun Jang
- Department of Conservative Dentistry, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Yemi Kim
- Department of Conservative Dentistry, College of Medicine, Ewha Womans University, Seoul, Korea.
| | - Bom Sahn Kim
- Department of Nuclear Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
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Shabbir J, Khurshid Z, Qazi F, Sarwar H, Afaq H, Salman S, Adanir N. Effect of Different Host-Related Factors on Postoperative Endodontic Pain in Necrotic Teeth Dressed with Interappointment Intracanal Medicaments: A Multicomparison Study. Eur J Dent 2021; 15:152-157. [PMID: 33511602 PMCID: PMC7902120 DOI: 10.1055/s-0040-1721909] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objectives
The current study aimed to assess the impact of factors such as age, gender, and the tooth type on postoperative endodontic pain in necrotic teeth with symptomatic periapical periodontitis and radiolucency dressed randomly with either calcium hydroxide or propolis paste.
Materials and Methods
The standard chemomechanical root canal preparation of 80 teeth was performed by the primary investigator. The intracanal medicaments were inserted by the secondary operator. Patients self-recorded their postoperative endodontic pain intensity with the help of visual analog scale at 4, 12, 24 (day 2), 48 (day 3), and 72 (day 4) hours. During analysis, patients (68/80) were grouped according to gender, age, and the tooth type.
Statistical Analysis
Mann–Whitney’s
U
test was applied for mean pain score comparison between genders and between tooth type. Kruskal–Wallis’ test was applied for mean pain score comparison between the age groups.
Results
No significant difference (
p
> 0.05) in pain scores was found between the age groups and between the tooth types. Males had significantly higher pain scores as compared with females at days 2 (
p
= 0.035), 3 (
p
= 0.023), and 4 (
p
= 0.020).
Conclusion
The results suggested that there was no impact of age and tooth types on postoperative endodontic pain.
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Affiliation(s)
- Juzer Shabbir
- Department of Operative Dentistry and Endodontics, Dow International Dental College, Dow University of Health Sciences, Karachi, Pakistan.,Department of Operative Dentistry and Endodontics, Liaquat College of Medicine and Dentistry, Karachi, Pakistan
| | - Zohaib Khurshid
- Department of Prosthodontics and Dental Implantology, College of Dentistry, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Fazal Qazi
- Department of Operative Dentistry and Endodontics, Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan
| | - Huma Sarwar
- Department of Operative Dentistry and Endodontics, Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan
| | - Hasan Afaq
- Department of Operative Dentistry and Endodontics, Baqai Medical University, Karachi, Pakistan
| | - Saima Salman
- Department of Operative Dentistry and Endodontics, Hamdard University Dental Hospital, Karachi, Pakistan
| | - Necdet Adanir
- Department of Restorative Dentistry, College of Dentistry, King Faisal University, Al Ahsa, Saudi Arabia
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18
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Nosrat A, Dianat O, Verma P, Nixdorf DR, Law AS. Postoperative Pain: An Analysis on Evolution of Research in Half-Century. J Endod 2020; 47:358-365. [PMID: 33271179 DOI: 10.1016/j.joen.2020.11.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/23/2020] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Examining the evolution of research parameters helps scientists to discover the well-developed and neglected aspects of knowledge. Pain after root canal treatment is a health problem affecting millions of patients. Research in this field has a meaningful impact on quality of lives. The aim of this study was to analyze the evolution of research on postoperative pain over the past 50 years. METHODS Electronic searches were performed in Scopus and MEDLINE databases to identify studies on pain after nonsurgical root canal treatments/retreatments. The full texts of eligible articles were reviewed to determine the study category and to extract and analyze the methodological variables. A series of statistical analyses were performed to determine the trend of publications based on the variable of interest over time. RESULTS Four hundred twenty-four articles were included. There was a positive trend for systematic reviews, studies with sample size <200, studies on single-visit treatment, and clinical trials on instrumentation and adjunct treatments (P < .05). There was a negative trend for the use of numeric rating scales, studies on multiple-visit treatments, clinical trials on medication/medicament, and studies on pain in maxillary incisors (P < .05). No trend was observed based on pulpal diagnosis or for studies with longer observation periods (>8 weeks) (P > .05). CONCLUSIONS A paradigm shift is needed toward clinical studies with larger sample sizes, longer observation periods, and more focus on pulpal diagnoses associated with higher rates of postoperative pain. There is a need to view postoperative pain as an important patient-centered outcome and to develop and disseminate standard reporting guidelines for future studies.
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Affiliation(s)
- Ali Nosrat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Maryland; Private Practice, Centreville Endodontics, Centreville, Virginia.
| | - Omid Dianat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Maryland
| | - Prashant Verma
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Maryland; Private Practice, Centreville Endodontics, Centreville, Virginia; Private Practice, Capitol Endodontics, Washington, DC
| | - Donald R Nixdorf
- Division of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, Minneapolis, Minnesota; Department of Neurology, Medical School, University of Minnesota, Minneapolis, Minnesota; HealthPartners Institute for Education and Research, Bloomington, Minnesota
| | - Alan S Law
- Private Practice, The Dental Specialists, Lake Elmo, Minnesota; Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, Minnesota
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The top risk factors for endodontic flare-up: a Monte Carlo simulation. Clin Oral Investig 2020; 25:3681-3690. [PMID: 33215302 DOI: 10.1007/s00784-020-03692-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 11/10/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of this study was to analyze the strength of risk factors related to endodontic flare-ups and rank them in order of their importance MATERIALS AND METHODS: A systematic literature search of PubMed, Cochrane Central Register of Controlled Trials, Scopus, and ISI Web of Knowledge, and grey literature was conducted up to November 2019. One hundred ninety-eight publications were identified. Twelve records fulfilled the eligibility criteria, and eight significant risk factors for flare-up, namely, "Periapical lesion," "multiple-visit treatment," "preoperative pain," "necrotic teeth," "female gender," "retreatment," "percussion pain," and "analgesics," were selected to construct the simulation model. The final data pool was established by the integration of data of common risk factors in the included articles. Monte Carlo method was used to analyze of combined numerical data, for simulation of the risk factor impacts. Ten thousand iterations were generated in the simulation model. RESULTS The results of the simulation revealed that the risk estimates of the factors had varying ranges of influence and probability on the flare-up risk. "Periapical lesion" was found to be the most sensitive risk factor, following by "preoperative pain" which was ranked the second place. The third-ranked risk factor was "multiple-visit treatment." The least sensitive risk factors for endodontic flare-up were "retreatment," "female gender," "necrotic teeth," and "analgesics." CONCLUSIONS The present study provides better comprehension on the importance of risk factors for flare-up based on their risk estimates. CLINICAL RELEVANCE A Monte Carlo simulation was adopted to identify the most influential risk factors for endodontic flare-up with a ranking, which can be used to provide meaningful predictions and further insights into clinicians' perception of flare-up risk.
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20
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Villa-Machado PA, Restrepo-Patiño DM, Calvo-Trejos JP, Restrepo-Restrepo FA, Tobón-Arroyave SI, Provenzano JC, Siqueira JF, Alves FRF. Cone-beam Computed Tomographic and Micro-computed Tomographic Evaluations of the Root Apexes of Teeth with Posttreatment Apical Periodontitis. J Endod 2020; 46:1695-1701. [PMID: 32682792 DOI: 10.1016/j.joen.2020.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/05/2020] [Indexed: 01/06/2023]
Abstract
INTRODUCTION This study evaluated the association of different variables that may influence the outcome of root canal treatment through cone-beam computed tomographic (CBCT) and micro-computed tomography (micro-CT) assessments of root apexes obtained by endodontic microsurgery of teeth with posttreatment apical periodontitis (AP), the agreement between CBCT and micro-CT findings, and the association of these variables with symptoms or lesion size. METHODS Clinical and CBCT records and root apexes obtained by endodontic microsurgery from 11 cases of symptomatic AP and 22 cases of asymptomatic AP were available. Apical root specimens were further scanned using micro-CT imaging. CBCT parameters included periapical radiolucency size, apical extent/density of root canal filling, and occurrence of procedural errors. Micro-CT images evaluated the same parameters plus the presence of filling material in lateral canals and ramifications, the volume of the filled/nonfilled apical root canal, and the percentage of the nonfilled canal space. The agreement between CBCT/micro-CT observations was evaluated. RESULTS Mandibular teeth, a lesion size <5 mm, a nonfilled volume <0.04 mm3, and the decreased percentage of the nonfilled canal volume were significantly associated with symptomatic AP. Maxillary teeth and inadequate apical filling density were significantly associated with larger lesions. Agreement between CBCT/micro-CT scores varied from fair (procedural errors) to satisfactory (extent/density of filling). CONCLUSIONS Tooth location, lesion size, the nonfilled apical canal volume, and the percentage of the nonfilled apical canal volume were associated with symptomatic AP. In addition, lesion size was significantly associated with tooth location and apical root canal filling density. CBCT imaging may not provide a reliable evaluation of procedural errors associated with posttreatment disease.
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Affiliation(s)
- Paula A Villa-Machado
- POPCAD Research Group, Laboratory of Immunodetection and Bioanalysis, Faculty of Dentistry, University of Antioquia, Medellín, Colombia
| | - Diana M Restrepo-Patiño
- POPCAD Research Group, Laboratory of Immunodetection and Bioanalysis, Faculty of Dentistry, University of Antioquia, Medellín, Colombia
| | - Juliana P Calvo-Trejos
- POPCAD Research Group, Laboratory of Immunodetection and Bioanalysis, Faculty of Dentistry, University of Antioquia, Medellín, Colombia
| | - Felipe A Restrepo-Restrepo
- POPCAD Research Group, Laboratory of Immunodetection and Bioanalysis, Faculty of Dentistry, University of Antioquia, Medellín, Colombia
| | - Sergio I Tobón-Arroyave
- POPCAD Research Group, Laboratory of Immunodetection and Bioanalysis, Faculty of Dentistry, University of Antioquia, Medellín, Colombia.
| | - José C Provenzano
- Department of Endodontics and Dental Research Group, Iguaçu University, Nova Iguaçu, Rio de Janeiro, Brazil
| | - José F Siqueira
- Department of Endodontics and Dental Research Group, Iguaçu University, Nova Iguaçu, Rio de Janeiro, Brazil; Postgraduate Program in Dentistry, University of Grande Rio, Duque de Caxias, Rio de Janeiro, Brazil
| | - Flávio R F Alves
- Department of Endodontics and Dental Research Group, Iguaçu University, Nova Iguaçu, Rio de Janeiro, Brazil; Postgraduate Program in Dentistry, University of Grande Rio, Duque de Caxias, Rio de Janeiro, Brazil
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21
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Effect of calcium hydroxide mixed with lidocaine hydrochloride on postoperative pain in teeth with irreversible pulpitis and symptomatic apical periodontitis: a preliminary randomized controlled prospective clinical trial. Clin Oral Investig 2020; 25:203-210. [PMID: 32462277 DOI: 10.1007/s00784-020-03354-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To investigate the effect of calcium hydroxide mixed with lidocaine HCl on postoperative spontaneous pain. MATERIALS AND METHODS Sixty patients having irreversible pulpitis and symptomatic apical periodontitis with a preoperative spontaneous pain and percussion pain which was more than 50 on a visual analogue scale (100 mm VAS) were included in this study. After the preparation of the root canals, the patients were randomly distributed into two groups according to the calcium hydroxide vehicle, control group (mixed with saline) and calcium hydroxide mixed with lidocaine HCl (n = 30). Postoperative spontaneous pain scores were recorded by a VAS every day for a week. Data were analysed using one-way analysis of variance, chi-squared test and Mann-Whitney U tests (p = 0.05). RESULTS The calcium hydroxide mixed with lidocaine HCl group resulted in significantly less pain compared with the calcium hydroxide mixed with saline group during days 1 to 4 (p < 0.05). There were no significant differences between the groups in terms of postoperative percussion pain levels (p > 0.05). CONCLUSION Within the limitations of this study, it can be concluded that the calcium hydroxide mixed with lidocaine HCl can be beneficial in reducing postoperative pain in teeth with irreversible pulpitis and symptomatic apical periodontitis. CLINICAL RELEVANCE The calcium hydroxide mixed with lidocaine HCl can be beneficial in reducing postoperative pain in teeth with irreversible pulpitis and symptomatic apical periodontitis. CLINICAL REGISTRATION NUMBER TCTR20181121003.
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22
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Bansal R, Jain A. An insight into patient's perceptions regarding root canal treatment: A questionnaire-based survey. J Family Med Prim Care 2020; 9:1020-1027. [PMID: 32318461 PMCID: PMC7114049 DOI: 10.4103/jfmpc.jfmpc_880_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 12/16/2019] [Accepted: 12/27/2019] [Indexed: 12/26/2022] Open
Abstract
Background: A key setback of root canal treatment (RCT) is that most patients lack adequate knowledge about it. Understanding and identifying the factors that hinder or discourage patients from undergoing RCT is necessary to adequately address the issue. The review of literature shows that there is a paucity of data about the awareness and acceptance of RCT among patients in Indian population. Thus, the study was conducted with aim to assess patients’ awareness of RCT among patients reporting in Desh Bhagat Dental College and Hospital, Mandi Gobindgarh. By surveying the patients, a broad patient perspective on the issue was sought. Materials and Methods: This survey was conducted with the help of prestructured questionnaire consisting of 15 questions, distributed to random 450 patients coming to the outpatient department of Conservative dentistry and Endodontics in Desh Bhagat Dental College and Hospital. The completed questionnaires were then analyzed to assess patients’ experiences, concerns, and perceptions about RCT. Results: There is a lack of awareness among patients regarding RCT. Conclusion: It is important to create more awareness among the populace of our country about the significance of maintaining a healthy dentition and attendant sequel if not done so. More patients would consider having endodontic procedures if properly made aware of.
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Affiliation(s)
- Ramta Bansal
- Department of Conservative Dentistry and Endodontics, Desh Bhagat Dental College and Hospital, Mandi Gobindgarh, District Fatehgarh Sahib, India
| | - Aditya Jain
- Department of Physiology, Government Medical College, Patiala, Punjab, India
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23
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Coelho MS, Vilas-Boas L, Tawil PZ. The effects of photodynamic therapy on postoperative pain in teeth with necrotic pulps. Photodiagnosis Photodyn Ther 2019; 27:396-401. [DOI: 10.1016/j.pdpdt.2019.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/19/2019] [Accepted: 07/08/2019] [Indexed: 10/26/2022]
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24
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Alonaizan FA, AlFawaz YF. Is phototherapy effective in the management of post-operative endodontic pain? A systematic review of randomized controlled clinical trials. Photodiagnosis Photodyn Ther 2019; 26:53-58. [DOI: 10.1016/j.pdpdt.2019.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 02/25/2019] [Accepted: 03/01/2019] [Indexed: 10/27/2022]
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25
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Genc Sen O, Kaya M. Effect of Root Canal Disinfection with a Diode Laser on Postoperative Pain After Endodontic Retreatment. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2019; 37:85-90. [PMID: 31050927 DOI: 10.1089/photob.2018.4539] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: The aim of this randomized clinical trial was to evaluate the influence of root canal disinfection with a 940-nm diode laser on the intensity of pain after endodontic retreatment. Background data: Microorganisms are the most common causes of tooth pain. Therefore, clinical studies are needed to explore the effect of disinfection techniques on postoperative pain. Methods: Eighty-four patients scheduled for endodontic retreatment were allocated to two groups in a 1:1 ratio (n = 42 each). After root canal filling removal and chemomechanical procedures, the root canals were disinfected with a 940-nm diode laser in one group [laser disinfection (LD) group]. In the other group, a mock application of laser was made with the power off [pseudo-laser disinfection (PLD) group]. All retreatment procedures were completed in a single visit. The patients assessed their pain levels at 24, 48, and 72 h after retreatment using a numeric rating scale. The number of analgesic pills used during this period was also recorded. The collected data were statistically analyzed using Mann-Whitney U and Wilcoxon tests. Results: Postoperative pain on the first 2 days was significantly lesser in the LD group than in the PLD group (p < 0.05), and the difference became insignificant on the third day (p > 0.05). Moreover, analgesic intake over 3 days and pain on percussion on the fourth day were significantly lesser in the LD group than in the PLD group (p < 0.05). Conclusions: Elimination of microorganisms from root canals is important for preventing postoperative complications. Our findings suggest that diode LD can reduce postoperative pain and provide comfort after endodontic retreatment. This study is registered in www.ClinicalTrials.gov database with the identifier number NCT03584880.
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Affiliation(s)
- Ozgur Genc Sen
- Department of Endodontics, Faculty of Dentistry, Yuzuncu Yil University, Van, Turkey
| | - Melih Kaya
- Department of Endodontics, Faculty of Dentistry, Yuzuncu Yil University, Van, Turkey
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Effect of Low-level Laser Therapy on Postoperative Pain in Molars with Symptomatic Apical Periodontitis: A Randomized Placebo-controlled Clinical Trial. J Endod 2018; 44:1610-1615. [DOI: 10.1016/j.joen.2018.07.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/27/2018] [Accepted: 07/02/2018] [Indexed: 11/17/2022]
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Costa FFNP, Pacheco-Yanes J, Siqueira JF, Oliveira ACS, Gazzaneo I, Amorim CA, Santos PHB, Alves FRF. Association between missed canals and apical periodontitis. Int Endod J 2018; 52:400-406. [DOI: 10.1111/iej.13022] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 09/30/2018] [Indexed: 12/28/2022]
Affiliation(s)
- F. F. N. P. Costa
- Faculty of Dentistry; Department of Endodontics; Estácio de Sá University; Rio de Janeiro Brazil
| | - J. Pacheco-Yanes
- Faculty of Dentistry; Department of Endodontics; Estácio de Sá University; Rio de Janeiro Brazil
| | - J. F. Siqueira
- Faculty of Dentistry; Department of Endodontics; Estácio de Sá University; Rio de Janeiro Brazil
| | - A. C. S. Oliveira
- Faculty of Dentistry; Department of Endodontics; Estácio de Sá University; Rio de Janeiro Brazil
| | - I. Gazzaneo
- Faculty of Dentistry; Department of Endodontics; Estácio de Sá University; Rio de Janeiro Brazil
| | - C. A. Amorim
- Faculty of Dentistry; Department of Endodontics; Estácio de Sá University; Rio de Janeiro Brazil
| | | | - F. R. F. Alves
- Faculty of Dentistry; Department of Endodontics; Estácio de Sá University; Rio de Janeiro Brazil
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Postoperative pain after removal of gutta-percha from root canals in endodontic retreatment using rotary or reciprocating instruments: a prospective clinical study. Clin Oral Investig 2018; 22:2623-2631. [DOI: 10.1007/s00784-018-2361-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/24/2018] [Indexed: 11/28/2022]
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Jenarthanan S, Subbarao C. Comparative evaluation of the efficacy of diclofenac sodium administered using different delivery routes in the management of endodontic pain: A randomized controlled clinical trial. J Conserv Dent 2018; 21:297-301. [PMID: 29899633 PMCID: PMC5977779 DOI: 10.4103/jcd.jcd_140_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Introduction Pain of endodontic origin is of concern to both the patient and the clinician. Expectation of a painful experience can increase the patient's anxiety levels, making treatment more difficult. Management of endodontic pain is one of the challenging aspects in endodontics. Objective To evaluate whether the intraligamentary mode of administration of diclogfenac sodium is effective in abating endodontic pain during interappointment visits. Aim The purpose of this clinical trial is to evaluate the analgesic efficacy of diclofenac sodium administered through oral and intraligamentary routes in reducing postendodontic pain. Materials and Methods Thirty patients were randomly allocated into three groups. Group A - placebo (Vitamin B12), Group B - diclofenac sodium (intraligamentary), and Group C - diclofenac sodium tablets. The tablets were given 30 min before the start of the procedure, while the intraligamentary injection was administered before commencing the endodontic procedure. The visual analog scale was used to evaluate the pain score at baseline and 6, 12, 24, and 48 h postoperatively. Results Prophylactic intraligamentary injection of diclofenac sodium was found to be highly effective in reducing postendodontic pain than the oral route of administration. Conclusion In patients with low pain threshold, intraligamentary route of administration is effective in controlling pain of endodontic origin postoperatively.
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Affiliation(s)
- Sowjanyaa Jenarthanan
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
| | - Chandana Subbarao
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
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Arslan H, Doğanay E, Karataş E, Ünlü MA, Ahmed HMA. Effect of Low-level Laser Therapy on Postoperative Pain after Root Canal Retreatment: A Preliminary Placebo-controlled, Triple-blind, Randomized Clinical Trial. J Endod 2017; 43:1765-1769. [DOI: 10.1016/j.joen.2017.06.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/10/2017] [Accepted: 06/18/2017] [Indexed: 01/27/2023]
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Elzaki WM, Ziada HM, Abubakr NH, Ibrahim YE. Gender and arch effects on the use of non-opioid analgesics for post endodontic pain reduction. AUST ENDOD J 2017; 44:215-224. [PMID: 29034602 DOI: 10.1111/aej.12218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This study aimed to evaluate the secondary outcomes of gender and arch and their impact on pain reduction following initial endodontic therapy. 185 medications, including placebo were prepared, and 170 participants completed the trial. Group 1, received a single dose of Paracetamol alone (G-1), Group 2 received combined Ibuprofen/Paracetamol (G-2). Group 3 received combined Mefenamic acid/Paracetamol (G-3), group 4 received combined Diclofenac K/Paracetamol (G-4) and Group 5 received a placebo (G-5). There were no statistically significant differences in pain reduction between males and females whilst there were statistically significant differences between them and the placebo group. All combinations of Paracetamol performed better in pain reduction than the placebo among females, while there were no statistically significant differences among males. In conclusion, there were no differences in pain reduction between males and females, and arch for the tested analgesics taken immediately following initial endodontic therapy in teeth with irreversible pulpitis.
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Affiliation(s)
- Wail M Elzaki
- Faculty of Dentistry, King Khalid University, Abha, Saudi Arabia.,Department of Oral Rehabilitation, Faculty of Dentistry, University of Khartoum, Khartoum, Sudan
| | - Hassan M Ziada
- Department of General Dental Practice, Faculty of Dentistry, Health Sciences Center, Kuwait University, Kuwait, Kuwait
| | - Neamat H Abubakr
- Department of Clinical Dental Science, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Yahia E Ibrahim
- Department of Oral Rehabilitation, Faculty of Dentistry, University of Khartoum, Khartoum, Sudan
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Bıçakcı H, Çapar İD, Genç S, İhtiyar A, Sütçü R. Influence of Rotary Instrumentation with Continuous Irrigation on Pain and Neuropeptide Release Levels: A Randomized Clinical Trial. J Endod 2017; 42:1613-1619. [PMID: 27788771 DOI: 10.1016/j.joen.2016.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 08/03/2016] [Accepted: 08/11/2016] [Indexed: 01/24/2023]
Abstract
INTRODUCTION The first objective was to determine correlation among various experimental and clinical pain measurement procedures. The second objective was to evaluate the influence of rotary instrumentation with continuous irrigation on pain and neuropeptide release levels. METHODS Forty patients who had preoperative pain at the levels of 3-8 on the visual analogue scale were included. Gingival crevicular fluid (GCF) samples were collected. Patients were randomly assigned to 2 treatment groups, the standard preparation group and the preparation with continuous irrigation group. Apical fluid samples (AFS) were collected after instrumentation. In the second visit, the patients' pain levels were recorded, and GCF and AFS were obtained. Substance P, calcitonin-gene related peptide (CGRP), interleukin (IL)-1β, and IL-10 levels were analyzed from the GCF and AFS samples. For comparison between groups, the Mann-Whitney test was used (P < .05). RESULTS In terms of clinical data, no significant difference was detected in the first and second sessions between groups. The IL-10 level obtained from AFS significantly decreased in the second session in both groups (P < .001). Visual analogue scale scores of spontaneous pain correlated with percussion pain positively (r = 0.718, P < .001). CGRP (GCF) (second session) and IL-10 (GCF) (second session) positively correlated with percussion pain (r = 0.425, P < .01) (r = 0.379, P < .05). CONCLUSIONS Rotary preparation with continuous irrigation has not been more effective than the standard preparation method for reducing pain. Because of determination of the correlation between CGRP and IL-10 with percussion pain, these neuropeptides can be used in further studies.
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Affiliation(s)
| | | | - Selin Genç
- Department of Periodontology, Faculty of Dentistry, İzmir Katip Çelebi University, İzmir, Turkey
| | - Alperen İhtiyar
- Department of Biochemistry and Clinical Biochemistry, School of Medicine, İzmir Katip Çelebi University, İzmir, Turkey
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Nair M, Rahul J, Devadathan A, Mathew J. Incidence of Endodontic Flare-ups and Its Related Factors: A Retrospective Study. J Int Soc Prev Community Dent 2017; 7:175-179. [PMID: 28852632 PMCID: PMC5558250 DOI: 10.4103/jispcd.jispcd_61_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/12/2017] [Indexed: 11/17/2022] Open
Abstract
Aims and Objectives: The aim and objective of the study were to determine the incidence of flare-ups during endodontic treatment and to identify the risk factors associated with flare-ups. Subjects and Methods: A total of 1725 patients who were treated during the time period of 2009–2014 by the same endodontist were reviewed. Incidence of flare-up, patients' age, gender, status of pulp, tooth position, number of roots, and treatment provided were taken from their dental records. Relationship between these factors and flare-ups was examined. Statistical analysis was done using Pearson Chi-square test and Fisher's exact test. Results: A total of 2% incidence of endodontic flare-ups was seen out of 1725 cases. Patient's age, gender, and diagnosis had a significant effect on the development of flare-ups (P < 0.05). Tooth type, position of tooth, number of root canals, number of visits, and treatment modality had no significant effect on flare-up incidence. Conclusions: Diagnosis plays an important role in predicting the incidence of flare-ups. Patients in the age group of 40–60 years had a higher risk of developing flare-ups. Women compared to men are more prone to flare-ups.
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Affiliation(s)
- Manuja Nair
- Department of Conservative Dentistry and Endodontics, Pushpagiri College of Dental Sciences, Pathanamthitta, Kerala, India
| | - J Rahul
- Department of Conservative Dentistry and Endodontics, Pushpagiri College of Dental Sciences, Pathanamthitta, Kerala, India
| | - A Devadathan
- Department of Conservative Dentistry and Endodontics, Pushpagiri College of Dental Sciences, Pathanamthitta, Kerala, India
| | - Josey Mathew
- Department of Conservative Dentistry and Endodontics, Pushpagiri College of Dental Sciences, Pathanamthitta, Kerala, India
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Asnaashari M, Ashraf H, Daghayeghi AH, Mojahedi SM, Azari-Marhabi S. Management of Post Endodontic Retreatment Pain With Low Level Laser Therapy. J Lasers Med Sci 2017; 8:128-131. [PMID: 29123632 PMCID: PMC5662501 DOI: 10.15171/jlms.2017.23] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction: Pharmacotherapy with analgesics and non-steroidal anti-inflammatory drugs has been traditionally used to relief post-operative pain of endodontic treatments. However, due to the side effects reported for these drugs, some efforts have been made to decrease the post-operative pain of the endodontic treatments through laser irradiation. The present study aimed to evaluate the effects of low level laser therapy (LLLT) on the reduction of pain after root canal retreatment. Methods: In this clinical trial, 61 patients requiring endodontic retreatments in posterior teeth were selected. A single visit endodontic retreatment was performed. After biomechanical preparation, low level laser was irradiated to the buccal and lingual mucosa overlying the apices of the target tooth in the experimental group. In the control group patients received placebo laser to eliminate the probable psychological effects of laser. Laser irradiation was done with a single dose of 808 nm wavelength (Whitening Lase II- Laser DMC, Samsung, Korea) with 100 mW power, and dose of 70 J/cm2 for 80 seconds. Pain severity was recorded before, immediately after and 4, 8, 12, 24 and 48 hours after the treatment by visual analogue scale (VAS). The pain scores were statistically analyzed by chi-square test between 2 groups. The effects of different variables on the post-operative pain experience were also studied by means of Logistic regression. Results: Pain scores decreased significantly through time until 48 hours after treatment. No significant differences were observed between the 2 modalities regarding pain scores at any time. According to regression analysis, pain severity scores were lower in the laser-irradiated specimens than control groups (OR = 5.69); however, this difference was not statistically significant. Consumption of analgesics after the treatment had significant effect in decreasing post-operative pain experience (OR = 56) while factors of age, gender, laser irradiation, pre-treatment pain scores and education level did not. Conclusion: Low level laser irradiation had limited effects to decrease pain associated with the endodontic retreatments in the first and second molars; however, more studies are required to assess the effects of different parameters of low level laser in this regard.
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Affiliation(s)
- Mohammad Asnaashari
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hengameh Ashraf
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Houshang Daghayeghi
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Masoud Mojahedi
- Department of Laser, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saranaz Azari-Marhabi
- Department of Oral Medicine, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Mohammadi Z, Jafarzadeh H, Shalavi S, Kinoshita JI. Establishing Apical Patency: To be or not to be? J Contemp Dent Pract 2017; 18:326-329. [PMID: 28349913 DOI: 10.5005/jp-journals-10024-2040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The apical portion of the root canal is very complex and challenging during endodontic treatment. Root canal preparation and obturation to the apical constriction may provide the best prognosis. Incomplete debridement, foramen transportation, and inadequate seal in the apical portion are considered to be responsible for treatment failure. The technique "apical patency" is considered as a way for maintaining the apical part the free of the debris by recapitulation, using a small K-file through the area of the apical foramen. This term was firstly proposed by Buchanan. In this technique, the smallest diameter file is set 1 mm longer than working length and recapitulated after each instrument to prevent packing of debris in the apical part. Apical patency has been found to be effective in achieving an apical seal with gutta-percha. Teeth prepared with a step back method and with maintained apical patency may show less leakage when obturated with cold lateral condensation technique. Data regarding the effect of apical patency on the healing of periapical tissue are very scarce, and it has been shown that the patency file has detrimental effect on the healing of periapical tissues in animal studies. However, using patency file in endodontic treatment is controversial and further studies are needed. The purpose of this article is to review the effect of using a patency file on the extrusion of root canal contents, the apical seal, postoperative pain, and healing of periapical tissues. Furthermore, the effect of establishing patency on reaching irrigation solutions to the apical portion of the canal and prognosis of root canal treatment are discussed. CLINICAL SIGNIFICANCE Keywords: Apical patency, Apical seal, Apical transportation, Postoperative pain, Prognosis.
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Affiliation(s)
- Zahed Mohammadi
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shaheed Beheshti University of Medical Sciences, Iranian National Elite Foundation, Tehran, Islamic Republic of Iran
| | - Hamid Jafarzadeh
- Department of Endodontics, Dental Research Center, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad Islamic Republic of Iran, Phone: +00985138829501, e-mail:
| | | | - Jun-Ichiro Kinoshita
- Department of Conservative Dentistry, Showa University Dental Hospital, Tokyo, Japan
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Combination Analgesics Reduce Postoperative Pain in Teeth With a Pulpal Diagnosis of Irreversible Pulpitis. J Evid Based Dent Pract 2017; 17:68-70. [DOI: 10.1016/j.jebdp.2017.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Iranmanesh F, Parirokh M, Haghdoost AA, Abbott PV. Effect of Corticosteroids on Pain Relief Following Root Canal Treatment: A Systematic Review. IRANIAN ENDODONTIC JOURNAL 2017; 12:123-130. [PMID: 28496516 PMCID: PMC5421265 DOI: 10.22037/iej.2017.26] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 02/02/2017] [Accepted: 03/04/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Post-operative pain and flare-up may occur in up to 58% of patients following root canal treatment. The aim was to conduct a systematic review and a possible meta-analysis to determine the effect of glucocorticosteroid (GCS) on pain following root canal treatment. METHODS AND MATERIALS Scopus, MEDLINE and CENTRAL databases were searched up to 30th January 2017 with broad key words. In addition, the reference lists in eligible papers and text books were hand-searched. Assessment of the eligibility of papers and data extraction were performed by two independent reviewers. RESULTS Of 9891 articles, 18 were recruited as eligible papers. Most of these papers showed pain reducing effect of GCS on post-endodontic pain. Because of wide heterogeneity among the recruited papers, it was not possible to perform meta-analysis. CONCLUSION Based on the results of this systematic review, there is a vast heterogeneity amongst articles regarding the use of GCS and their effect on post-operative pain after endodontic treatment. Further investigations with similar methods and materials are needed before meta-analysis on the effect of GCS on post-operative pain following root canal treatment can be performed.
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Affiliation(s)
- Foad Iranmanesh
- Department ofEndodontics, Dental School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran;
| | - Masoud Parirokh
- Endodontology Research Center, Dental School, Kerman University of Medical Sciences, Kerman, Iran;
| | - Ali Akbar Haghdoost
- Research Center for Modeling in Health, Kerman University of Medical Sciences, Kerman, Iran;
| | - Paul V. Abbott
- Dental School, University of Western Australia, Perth, Australia
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Singbal K, Jain D, Raja K, Hoe TM. Comparative evaluation of apically extruded debris during root canal instrumentation using two Ni-Ti single file rotary systems: An in vitro study. J Conserv Dent 2017; 20:64-67. [PMID: 28855748 PMCID: PMC5564245 DOI: 10.4103/0972-0707.212236] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Apical extrusion of debris during instrumentation is detrimental to the patient. AIM The aim of this study was to evaluate the apical extrusion of debris during root canal instrumentation using two single file rotary Ni-Ti systems. MATERIALS AND METHODS Thirty freshly extracted mandibular premolars with straight roots were sterilized and divided into two groups instrumented using: One Shape rotary Ni-Ti system with Endoflare orifice shaper (Group 1) and Neo-Niti rotary Ni-Ti system with C1 orifice shaper (Group 2). Preweighed Eppendorf tubes fitted for each tooth before instrumentation. During instrumentation, 1 mL of distilled water with a 30-gauge needle was used to irrigate after every instrument. Tips of the tooth were irrigated with 2 ml distilled water after removal from Eppendorf tubes. The total volume of irrigant in each group was the same 8 ml. All tubes were incubated at 68°C for 15 days and subsequently weighed. The difference between pre- and post-debris weights was calculated, and statistical analysis was performed using independent t-test and level of significance was set at 0.05. RESULTS The difference between pre- and post-weights was significantly greater for the One Shape system. CONCLUSIONS The Neolix Niti single file was associated with less extrusion compared to One Shape single file system.
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Affiliation(s)
- Kiran Singbal
- Department of Conservative Dentistry, Mahsa University, Selangor, Malaysia
| | - Disha Jain
- Department of Conservative Dentistry and Endodontics, K.M. Shah Dental College, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Kranthi Raja
- Department of Conservative Dentistry, Mahsa University, Selangor, Malaysia
| | - Tan Ming Hoe
- Department of Conservative Dentistry, Mahsa University, Selangor, Malaysia
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Saumya-Rajesh P, Krithikadatta J, Velmurugan N, Sooriaprakas C. Post-instrumentation pain after the use of either Mtwo or the SAF system: a randomized controlled clinical trial. Int Endod J 2016; 50:750-760. [DOI: 10.1111/iej.12702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 09/19/2016] [Indexed: 12/14/2022]
Affiliation(s)
- P. Saumya-Rajesh
- Department of Conservative Dentistry and Endodontics; Meenakshi Ammal Dental College and Hospital; Meenakshi University; Chennai Tamil Nadu India
| | - J. Krithikadatta
- Department of Conservative Dentistry and Endodontics; Meenakshi Ammal Dental College and Hospital; Meenakshi University; Chennai Tamil Nadu India
| | - N. Velmurugan
- Department of Conservative Dentistry and Endodontics; Meenakshi Ammal Dental College and Hospital; Meenakshi University; Chennai Tamil Nadu India
| | - C. Sooriaprakas
- Department of Conservative Dentistry and Endodontics; Meenakshi Ammal Dental College and Hospital; Meenakshi University; Chennai Tamil Nadu India
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Azim AA, Azim KA, Abbott PV. Prevalence of inter-appointment endodontic flare-ups and host-related factors. Clin Oral Investig 2016; 21:889-894. [DOI: 10.1007/s00784-016-1839-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 04/24/2016] [Indexed: 11/24/2022]
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Comparison of the Incidence of Postoperative Pain after Using 2 Reciprocating Systems and a Continuous Rotary System: A Prospective Randomized Clinical Trial. J Endod 2016; 42:171-6. [DOI: 10.1016/j.joen.2015.10.011] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 10/21/2015] [Accepted: 10/21/2015] [Indexed: 11/21/2022]
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The Effect of Foraminal Enlargement of Necrotic Teeth with the Reciproc System on Postoperative Pain: A Prospective and Randomized Clinical Trial. J Endod 2016; 42:8-11. [DOI: 10.1016/j.joen.2015.09.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 09/08/2015] [Accepted: 09/30/2015] [Indexed: 11/21/2022]
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Onay EO, Ungor M, Yazici AC. The evaluation of endodontic flare-ups and their relationship to various risk factors. BMC Oral Health 2015; 15:142. [PMID: 26577095 PMCID: PMC4647657 DOI: 10.1186/s12903-015-0135-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 11/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the incidence of flare-ups and identify the risk factors including age, gender, tooth type, number of root canals, initial diagnosis, the type of irrigation regimen, treatment modality and the number of visits, in patients who received root canal treatment from January 2002 to January 2008. METHODS Records of 1819 teeth belonging to 1410 patients treated by 1 endodontics specialist during 6-year period were kept. Patient, tooth, and treatment characteristics were evaluated and the relationships between these characteristics and flare-ups were studied. Statistical analysis was carried out by using Pearson Chi-square test, Fisher's Exact test, and Binary Logistic regression analyses. RESULTS The incidence of flare-ups was 59 (3.2 %) out of 1819 teeth that received endodontic therapy. Pulpal necrosis without periapical pathosis was the most common indication for flare-up (6 %) (p < 0.01). Teeth undergoing multiple visits had a higher risk of developing flare-ups compared to those with single appointments (OR: 3.14, CI: 1.414-7.009, p < 0.01). There were also no statistically significant differences in the incidence of flare-ups regarding to age, gender, tooth type, number of root canals, treatment modality, and the irrigation solutions that used during the treatment. CONCLUSIONS The incidence of flare-up is minimal when teeth are treated in one visit. Absence of a periapical lesion in necrotic teeth is a significant risk factor for flare-ups.
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Affiliation(s)
- Emel Olga Onay
- Department of Endodontics, Baskent University, School of Dentistry, 82 sok No 26, 06490, Bahcelievler, Ankara, Turkey.
| | - Mete Ungor
- Department of Endodontics, Baskent University, School of Dentistry, 82 sok No 26, 06490, Bahcelievler, Ankara, Turkey.
| | - A Canan Yazici
- Department of Biostatistics, Baskent University, School of Medicine, Ankara, Turkey.
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Nur BG, Ok E, Altunsoy M, Ağlarci OS, Çolak M, Güngör E. Evaluation of technical quality and periapical health of root-filled teeth by using cone-beam CT. J Appl Oral Sci 2015; 22:502-8. [PMID: 25591019 PMCID: PMC4307763 DOI: 10.1590/1678-775720140110] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 09/01/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE This study aimed to assess the quality of root fillings, coronal restorations, complications of all root-filled teeth and their association with apical periodontitis (AP) detected by cone-beam computed tomography (CBCT) images from an adult Turkish subpopulation. MATERIAL AND METHODS The sample for this study consisted of 242 patients (aging from 15 to 72 years) with 522 endodontically treated teeth that were assessed for technical quality of the root canal filling and periapical status of the teeth. Additionally, the apical status of each root-filled tooth was assessed according to the gender, dental arch, tooth type and age classification, undetected canals, instrument fracture, root fracture, apical resorption, apical lesion, furcation lesion and type and quality of the coronal structure. Statistical analysis was performed using percentages and chi-square test. RESULTS The success rate of the root canal treatment was of 54.4%. The success rates of adequate and inadequate root canal treatment were not significantly different (p>0.05). Apical periodontitis was found in 228 (45.6%) teeth treated for root canals. Higher prevalence of AP was found in patients aging from 20 to 29 years [64 (27%) teeth] and in anterior (canines and incisors) teeth [97 (41%) teeth]. CONCLUSIONS The technical quality of root canal filling performed by dental practitioners in a Turkish subpopulation was consistent with a high prevalence of AP. The probable reasons for this failure are multifactorial, and there may be a need for improved undergraduate education and postgraduate courses to improve the clinical skills of dental practitioners in endodontics.
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Affiliation(s)
- Bilge Gülsüm Nur
- Department of Pedodontics, Faculty of Dentistry, Şifa University, Izmir, Turkey
| | - Evren Ok
- Department of Endodontics, Faculty of Dentistry, Şifa University, Izmir, Turkey
| | - Mustafa Altunsoy
- Department of Pedodontics, Faculty of Dentistry, Şifa University, Izmir, Turkey
| | - Osman Sami Ağlarci
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Şifa University, Izmir, Turkey
| | - Mehmet Çolak
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Dicle University, Diyarbakir, Turkey
| | - Enes Güngör
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Dicle University, Diyarbakir, Turkey
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Çanakçi BC, Er O, Dincer A. Do the Sealer Solvents Used Affect Apically Extruded Debris in Retreatment? J Endod 2015; 41:1507-9. [PMID: 26238529 DOI: 10.1016/j.joen.2015.02.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 02/05/2015] [Accepted: 02/07/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION We evaluated apically extruded debris in the retreatment of root canals filled with different root canal sealers and gutta-percha using different solvents. METHODS Ninety human mandibular central and lateral teeth were prepared using the Reciproc #25 .08 nickel-titanium system (VDW GmbH, Munich, Germany) and were divided randomly into 6 groups. In groups 1, 2, and 3, root canals were filled with epoxy resin-based sealer and gutta-percha, and in groups 4, 5, and 6, root canals were filled with zinc oxide-eugenol-based sealer and gutta-percha. Each tooth was placed in a glass vial experimental apparatus. All root canal fillings were removed with the ProTaper Retreatment nickel-titanium system (Dentsply Maillefer, Ballaigues, Switzerland). During the retreatment procedure, in group 1, Resosolv (Pierre Rolland, Merignac, France) was used; in group 4, Endosolv E (Septodont, Paris, France) was used; and in groups 2 and 5, Guttasolv (Septodont) was used as the solvent. In the control groups (groups 3 and 6), no solvent was used. Reciproc #40 .06 was used for the final preparation. The times required for retreatments were recorded. RESULTS The weight of the extruded debris and the time required for retreatment were decreased significantly in the groups in which a solvent that was intended specifically for the root canal sealer was used (groups 1 and 4). In the Guttasolv groups (groups 2 and 5), the amount of apically extruded debris and the time required decreased for both root canal sealers. CONCLUSIONS The amount of apically extruded debris and the duration of retreatment were reduced by the use of a solvent specific to the sealer compared with a gutta-percha solvent or no solvent.
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Affiliation(s)
- Burhan Can Çanakçi
- Department of Endodontics, Faculty of Dentistry, Erciyes University, Kayseri, Turkey.
| | - Ozgur Er
- Department of Endodontics, Faculty of Dentistry, Trakya University, Edirne, Turkey
| | - Asiye Dincer
- Department of Endodontics, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
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Bourreau MLS, Soares ADJ, Souza-Filho FJD. Evaluation of postoperative pain after endodontic treatment with foraminal enlargement and obturation using two auxiliary chemical protocols. REVISTA DE ODONTOLOGIA DA UNESP 2015. [DOI: 10.1590/1807-2577.0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim This prospective randomized clinical study examined the influence of two different auxiliary chemical substances on postoperative pain in 301 single-visit endodontic treatments, with enlargement of the apical foramen and extrusion of cement into the periapical region. Material and method The two auxiliary chemicals used were 2% chlorhexidine (2% CHX gel; n = 145) and 5.25% sodium hypochlorite (5.25% NaOCl; n = 156). The incidence of postoperative pain and discomfort was assessed at 24 hours and expressed as percentages. The Fisher exact test and the Chi-square test were used to compare variation in postoperative pain. The variables analyzed were previous pain, pulp status, age, and number of root canals. Result In teeth with previous pain instrumented with 2% CHX gel, the incidence of postoperative pain was 22.22% (6/27) versus 11.11% (3/22) in teeth instrumented with 5.25% NaOCl. In teeth without previous pain instrumented with 2% CHX gel, the incidence of postoperative pain was 8.5% (6/118) versus 2.33% (3/129) in teeth instrumented with 5.25% NaOCl, with no statistically significant difference between the groups. Results showed that previous pain had a significant influence on postoperative status (p < 0.001). After 24 hours postoperatively, 93.7% (282/301) of the teeth had no pain and 6.3% (19/301) had some level of pain, and used one or two doses of medication. Conclusion Based on the results, it can be concluded that the auxiliary chemical substances had no influence on postoperative pain.
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Arora M, Sangwan P, Tewari S, Duhan J. Effect of maintaining apical patency on endodontic pain in posterior teeth with pulp necrosis and apical periodontitis: a randomized controlled trial. Int Endod J 2015; 49:317-24. [PMID: 25866134 DOI: 10.1111/iej.12457] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 04/08/2015] [Indexed: 01/09/2023]
Abstract
AIM To evaluate the association between apical patency and post-operative pain in posterior teeth with pulp necrosis and apical periodontitis. METHODOLOGY Sixty-eight patients requiring primary root canal treatment in mandibular first molars with necrotic pulps and apical periodontitis were included. The patients were randomly allocated to one of two groups: patency (n = 34) and nonpatency (n = 34). After administering local anaesthesia, root canal preparation was completed using ProTaper rotary instruments. A size 10 K-file was used as a patency file and carried 1 mm beyond the working length (WL) between each instrument change in the patency group, while it was carried up to WL in the nonpatency group. Patients were asked to record their pain experience on a pain chart daily for 7 days. Three patients (two in the patency group, one in the nonpatency group) did not return with completed pain charts on the subsequent visit, resulting in a total of 65 patients for the final analysis (patency, n = 32; nonpatency, n = 33). Data was analysed using Chi Square test, t-test, Mann-Whitney test and Wilcoxon Signed Ranks test. RESULTS Overall, 43% of the patients experienced post-operative pain. The patency group had less incidence of pain (34%) as compared to the nonpatency group (52%), but the difference was not significant (P = 0.163). CONCLUSION Maintenance of apical patency during chemomechanical preparation had no significant influence on post-operative pain in posterior teeth with necrotic pulps and apical periodontitis.
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Affiliation(s)
- M Arora
- Department of Conservative Dentistry and Endodontics, Post Graduate Institute of Dental Sciences (PGIDS), Rohtak, India
| | - P Sangwan
- Department of Conservative Dentistry and Endodontics, Post Graduate Institute of Dental Sciences (PGIDS), Rohtak, India
| | - S Tewari
- Department of Conservative Dentistry and Endodontics, Post Graduate Institute of Dental Sciences (PGIDS), Rohtak, India
| | - J Duhan
- Department of Conservative Dentistry and Endodontics, Post Graduate Institute of Dental Sciences (PGIDS), Rohtak, India
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Akbar I. Efficacy of Prophylactic use of Antibiotics to Avoid Flare up During Root Canal Treatment of Nonvital Teeth: A Randomized Clinical Trial. J Clin Diagn Res 2015; 9:ZC08-11. [PMID: 25954695 DOI: 10.7860/jcdr/2015/12046.5620] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 01/22/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Flare-up during root canal treatment of non vital teeth is a common clinical incident. The aim of the present study was to assess the effect of prophylactic use of antibiotics to avoid flare up during root canal treatment of the teeth having asymptomatic necrotic pulp. MATERIALS AND METHODS A randomized double blind clinical trial with parallel design was conducted on 100 subjects with asymptomatic non vital teeth. They were randomly divided into two groups. The first group (50 participants) was given two gram amoxicillin one hour before the first visit of root canal treatment; the second group (50 participants) did not receive any treatment (control group). In both groups, root canal treatment was performed in two visits. The flare up was assessed by the pain visual analogue scale and based on the swelling criteria. The data were processed and analyzed using SPSS statistical software 17. A p-value of 0.05 or less was considered statistically significant. RESULTS A total of 80% of participants in the experimental group had flare up while 12% of participants had flare up in the control group. Prophylactic Amoxicillin had no effect on inter-appointment flare up (p > 0.05). There was no relationship between flare up and patient's age, gender and tooth type (p > 0.05). CONCLUSION Prophylactic use of Amoxicillin in asymptomatic non vital teeth before root canal treatment had no effect on the incidence of flare-up.
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Affiliation(s)
- Iftikhar Akbar
- Assistant Professor, Department of Conservative Dentistry, College of Dentistry, Aljouf University , Sakaka, Saudi Arabia
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Archana D, Gopikrishna V, Gutmann JL, Savadamoorthi KS, Kumar ARP, Narayanan LL. Prevalence of periradicular radiolucencies and its association with the quality of root canal procedures and coronal restorations in an adult urban Indian population. J Conserv Dent 2015; 18:34-8. [PMID: 25657524 PMCID: PMC4313476 DOI: 10.4103/0972-0707.148888] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 12/05/2014] [Accepted: 12/18/2014] [Indexed: 11/06/2022] Open
Abstract
Aims: The aim of this cross-sectional study was to determine the prevalence of periradicular radiolucencies (PR) from an urban adult Indian population and to investigate the quality of root canal procedures and coronal restorations and their association with prevalence of PR in root-filled teeth. Settings and Design: Cross-sectional study. Material and Methods: A total of 1,340 subjects (18+ years of age) who reported for non-emergency dental care to 5 different dental care centers had their panoramic radiographs taken during the period from January to December 2013. The periradicular status of 30,098 teeth in these radiographs was evaluated using the Periapical Index Score (PAI). The assessment of the technical quality of the procedure was evaluated based on the criteria of root canal filling length and quality of coronal restoration. Statistical Analysis Used: The data was analyzed statistically by chi-squared test and odds ratio. Results: PR was found in 65% of subjects (n = 865) and 5.8% (n = 1,759) of the 30,098 teeth evaluated (4.30% untreated teeth and 1.53% were root-filled teeth). In all, 4.1% of the teeth (n = 1,234) had some filling material in the root canal(s) and the prevalence of PR in these root-filled teeth was 37.4%, while the remaining 62.6% of root canal-filled teeth showed no evidence of PR. PR occurred significantly more often in teeth where root canal filling was filled more than 2 mm short of radiographic apex or when root filling extruded through the apex. Conclusions: The prevalence of PR in teeth with untreated root canals in India is 4.30%, which is more than twice the weighted world average, while the prevalence of root-filled teeth (4.1%) is lower than the world average (9.6%). The prevalence of PR in root-filled teeth in India is comparable to that in other populations. Inadequate root canal treatment and poor quality of coronal restoration were associated with increased prevalence of PR.
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Affiliation(s)
- Durvasulu Archana
- Department of Conservative Dentistry and Endodontics, Thai Moogambigai Dental College, Dr. MGR Educational and Research Institute University, Chennai, Tamil Nadu, India
| | - Velayutham Gopikrishna
- Department of Conservative Dentistry and Endodontics, Thai Moogambigai Dental College, Dr. MGR Educational and Research Institute University, Chennai, Tamil Nadu, India
| | - James L Gutmann
- Professor Emeritus, Baylor College of Dentistry, Texas A and M Health Science Center, Texas, USA
| | - Kamatchi Subramani Savadamoorthi
- Department of Conservative Dentistry and Endodontics, Thai Moogambigai Dental College, Dr. MGR Educational and Research Institute University, Chennai, Tamil Nadu, India
| | - Angambakkam Rajasekaran Pradeep Kumar
- Department of Conservative Dentistry and Endodontics, Thai Moogambigai Dental College, Dr. MGR Educational and Research Institute University, Chennai, Tamil Nadu, India
| | - L Lakshmi Narayanan
- Department of Conservative Dentistry and Endodontics, Thai Moogambigai Dental College, Dr. MGR Educational and Research Institute University, Chennai, Tamil Nadu, India
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Azim AA, Griggs JA, Huang GTJ. The Tennessee study: factors affecting treatment outcome and healing time following nonsurgical root canal treatment. Int Endod J 2015; 49:6-16. [DOI: 10.1111/iej.12429] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 01/08/2015] [Indexed: 01/10/2023]
Affiliation(s)
- A. A. Azim
- Department of Bioscience Research; College of Dentistry, University of Tennessee Health Science Center; Memphis Tennessee
| | - J. A. Griggs
- Biomedical Materials Science; School of Dentistry; University of Mississippi Medical Center; Jackson MS USA
| | - G. T.-J. Huang
- Department of Bioscience Research; College of Dentistry, University of Tennessee Health Science Center; Memphis Tennessee
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