Incidence of postoperative pain after use of calcium hydroxide mixed with normal saline or 0.2% chlorhexidine digluconate as intracanal medicament in the treatment of apical periodontitis

Impact of Cryotreated and Warm Sodium Hypochlorite on Post-Operative Pain in Teeth with Symptomatic Irreversible Pulpitis: A Randomized Controlled Trial

INTRODUCTION

The purpose of this study was to evaluate effect of cryotreated and warm sodium hypochlorite (NaOCl) on post-operative pain in patients with symptomatic irreversible pulpitis and symptomatic apical periodontitis.

METHODS

Sixty-six individuals with pre-operative pain scores of ≥ 54mm on the Heft Parker Visual Analogue Pain Scale (HP-VAS) diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis as per the AAE guidelines in mandibular molars were included. The preparation of the access, and the root canals were instrumented and irrigated in accordance with a standard protocol. Based on the temperature of the final irrigant, the root canals were then randomly assigned to three groups and 3% NaOCl was irrigated: Control (at 25°C), cold NaOCl (2°C) and warm NaOCl (60°C) (n = 22/group). Root canal treatment was completed at the same visit. Pre- and post-operative pain assessment at 6, 24, 48, and 72 hours was conducted using HP-VAS, and analgesic consumption was noted. Suitable statistical tests were used to analyze the data.

RESULTS

In comparison to the other two groups, cold NaOCl group had a lower HP-VAS score at all follow-up intervals. Between groups, there was a statistically significant difference in post-operative pain scores at 6 and 72 hours (p < 0.05). None of the subjects experienced any postoperative discomfort at 72 hours in the control and cold NaOCl group.

CONCLUSION

Patients treated with cold NaOCl as the final irrigant experienced significantly lesser post-operative pain at 6 hours when compared to room temperature and warm NaOCl.

Niosomal Doxycycline and Triamcinolone: A Novel Approach to Minimize Cytotoxicity in Endodontic Medicaments

Introduction

Mechanical root canal preparations and irrigation solutions are essential for reducing microbial counts in the root canal system. However, these methods do not completely eliminate microorganisms. Intracanal medicaments are used to further decrease microbial counts. This study aims to assess the cytotoxicity of various intracanal medicaments.

Materials and methods

In this in vitro study, murine fibroblast cell lines (L929) were cultured in a controlled environment. The MTT assay was employed to evaluate the cytotoxicity of different medicament combinations, including calcium hydroxide and triamcinolone (D1), niosomal doxycycline and triamcinolone (D2), calcium hydroxide (D3), and a combination of doxycycline and triamcinolone (D4). Statistical analysis was performed using ANOVA and Dunnett's test.

Results

The results indicated that D1 and D2 had lower cytotoxicity, while D4 exhibited the highest cytotoxicity. D1 was found to be non-cytotoxic up to a concentration of 500 µg/mL over a period of 72 hours. D2 and D3 showed similar effects up to concentrations of 250 µg/mL and 100 µg/mL, respectively, for 72 hours. In contrast, D4 exhibited cytotoxicity at concentrations above 75 µg/mL at 72 hours.

Conclusion

This study suggests that encapsulating doxycycline in niosomal structures (D2) reduces cytotoxicity in murine fibroblast cell lines (L929) for at least 24 and 48 hours. These findings offer promising implications for the development of endodontic medicaments with improved biocompatibility.

Comparative evaluation of the effectiveness of intracanal and intraoral cryotherapy on postendodontic pain in patients with symptomatic apical periodontitis: A randomized clinical trial

Introduction

There is a rising need for controlling postendodontic pain (PEP) without using analgesics and other conventional methods.

Aims

The aim of the study is to compare the effectiveness of various cryotherapy applications on controlling PEP in patients with symptomatic apical periodontitis.

Methods

One hundred and eight patients were selected and preoperative pain and pain on percussion scores were recorded using Numeric Rating Scale (NRS) and Visual Analog Scale (VAS), respectively. After obtaining consent, the access cavity was prepared under local anesthesia. After cleaning and shaping, the patients were randomized into the following groups: Group A: Canals were given final irrigation with 20 mL room temperature saline solution for 5 min, Group B: Canals were given final irrigation with 20 mL cold (2°C-4°C) saline solution for 5 min, and Group C: After obturation and restoration procedures, small ice packs of size 2 cm × 2 cm × 2.5 cm (wrapped in sterile gauze) were placed intraorally on the vestibular surface of the treated tooth. At 6 h, postoperative pain was measured using NRS and at 24 h, pain and pain on percussion were measured using NRS and VAS, respectively.

Results

Data were analyzed using SPSS software. There was a significant reduction in postoperative pain in the intracanal and intraoral groups at 6 and 24 h when compared with the control group individually. There was no significant difference in postendodontic between intracanal and intraoral cryotherapy groups at 6 and 24 h.

Conclusions

Both intracanal and intraoral cryotherapy applications are effective in reducing PEP in patients with symptomatic apical periodontitis.

Comparative evaluation of calcium hydroxide and other intracanal medicaments on postoperative pain in patients undergoing endodontic treatment: A systematic review and meta-analysis

Aim

The aim of this study was to evaluate the effect upon postoperative pain in teeth of patients suffering from apical periodontitis or necrotic pulp when treated with calcium hydroxide and compare it with other intracanal medicaments.

Materials and Methods

MEDLINE database, PubMed and Google Scholar databases were searched based on the filters and inclusion and exclusion criteria. The screening was done to finally acquire 9 articles from the mass of searched articles. The data extraction followed the screening process, and qualitative and quantitative data were recorded. The risk of bias was conducted with the Cochrane Collaboration tool, and meta-analysis was done using Review Manager version 5.3.

Results

A total of 9 studies over the past five decades met the inclusion criteria for full-text reading, and all 9 of them were included for further analysis. When we assessed for pain outcome, in comparison with CHX and Ca(OH), the cumulative mean difference was -4.57 (confidence interval: -16.25, 7.11). The heterogeneity was significant I2 = 95%, hence we applied the random effects model. The mean difference showed that the mean pain outcome was more in the control (Ca(OH)) group, as compared to the intervention group.

Conclusion

Calcium hydroxide is effective in reducing posttreatment pain when it is used alone, but its effectiveness can be increased when used in combination with other medicaments such as chlorhexidine.

Present status and future directions of intracanal medicaments

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.

Prevalence of endodontic flare-up following intracanal medicament placement in permanent teeth undergoing endodontic treatment – A systematic review

Background:

Endodontic flare-up can occur in teeth undergoing root canal treatment. Intracanal medicaments are most commonly used in between appointments to eliminate microbial flora in the canal. However, extrusion of medicaments in the periapical region can cause an inflammatory reaction leading to postoperative pain.

Aim:

The aim of this study was to evaluate the prevalence of endodontic flare-up following intracanal medicament placement in permanent teeth undergoing endodontic treatment.

Study Design:

A comprehensive search was done in MEDLINE through PubMed, Cochrane, EBSCOhost, and Google Scholar from July 31, 1999 to July 31, 2019 to identify randomized trials involving the use of intracanal medicaments in teeth undergoing root canal treatment.

Methods:

The titles and abstracts of all retrieved articles were screened by two independent reviewers, and irrelevant studies were excluded. Full texts of the eligible studies were obtained and thoroughly assessed. Seventeen randomized control trials comprising 2665 subjects were included.

Statistical Analysis:

Narrative synthesis was provided for the findings obtained from the studies, mainly focusing on the intervention details. Heterogeneity of the previously mentioned characteristics was assessed using the Chi-square test and I² statistics.

Results:

Placement of intracanal medicament was not associated with the occurrence of pain.

Conclusion:

The present review suggests that intracanal medicament do not cause endodontic flare-up rather reduces inter-appointment pain during endodontic treatment.

Is Intracanal Cryotherapy Effective in Reducing Postoperative Endodontic Pain? An Updated Systematic Review and Meta-Analysis of Randomized Clinical Trials

This research aimed to assess the potency of intracanal cold therapy in diminishing postoperative endodontic pain. PubMed, Scopus, the Cochrane Library, EMBASE, the Web of Science, grey literature, and endodontic journals were used to identify randomized controlled clinical trials evaluating postoperative pain after a final irrigation with a cold irrigant (as an experimental group) and a room temperature irrigant (as a control group). The risk of bias was rated according to the Cochrane Collaboration's tool and the Grading Recommendation Assessment, Development, and Evaluation (GRADE) system was used to estimate the evidence quality. For the meta-analysis, a random effects model was utilized. The qualitative analysis contained 16 studies and the quantitative analysis contained 9 studies. The experimental groups showed a reduction in postoperative pain at 6 h (mean difference (MD) = -1.11; p = 0.0004; I2 = 72%; low quality evidence), 24 h (MD = -1.08; p = 0.003; I2 = 92%; low quality evidence), 48 h (MD = -0.38; p = 0.04; I2 = 81%; low quality evidence), and 72 h (MD = -0.69; p = 0.04; I2 = 90%; low quality evidence). A higher quality of evidence from more clinical trials is needed.

Effectiveness of Intracanal Cryotherapy in Root Canal Therapy: A Systematic Review and Meta-analysis of Randomized Clinical Trials

INTRODUCTION

The effectiveness of intracanal cryotherapy for reducing postoperative pain is unclear. The objective of this systematic review was to evaluate the effect of intracanal cryotherapy on postoperative pain after root canal therapy in patients with pulpal or periradicular pathosis.

METHODS

We searched PubMed, Embase, Scopus, and the Cochrane Library as well as the top 3 endodontic journals for relevant articles. We included randomized controlled trials that included adults. Our main outcome was postoperative pain intensity measured with a validated scale. We assessed the risk of bias using the Cochrane criteria and the quality of the included studies using Grading of Recommendation Assessment, Development, and Evaluation. We used a random-effects model for meta-analysis.

RESULTS

Eight studies involving 810 patients were included. The overall risk of bias was moderate. Seven of 8 studies used a visual analog scale to measure pain intensity. Compared with controls, intracanal cryotherapy significantly reduced postoperative pain at 6 (mean difference = -1.37; 95% confidence interval [CI], -0.61 to -2.14; P < .05; I2 = 76%; moderate-quality evidence) and 24 hours after the procedure (mean difference = -1.43; 95% confidence interval, -0.70 to -2.15; P < .05; I2 = 89%; moderate-quality evidence). There was no significant effect on pain at 48 and 72 hours and 7 days after the procedure.

CONCLUSIONS

Moderate-quality evidence suggests that intracanal cryotherapy (ie, using cold saline irrigation as a final irrigant) significantly reduces the intensity of pain at 6 and 24 hours after root canal therapy. Future clinical trials assessing the effectiveness of intracanal cryotherapy are advocated.

The Effect of Different Combinations of Calcium Hydroxide as Intra-Canal Medicament on Endodontic Pain: A Randomized Clinical Trial Study

Introduction

After treating the tooth root canal, pain is one of the problems that many patients are facing. In order to reduce pain, and regarding the advice of treating necrotic teeth during several sessions, intra-canal medicaments can be used between sessions. The purpose of this study is to compare pain relieving effect of calcium hydroxide combined with three solutions of normal saline, chlorhexidine 2% and dexamethasone.

Materials and methods

This triple blind randomized clinical trial was performed on 90 necrotic molars and premolars. The patients were classified in three medicaments' groups including mixture of calcium hydroxide and normal saline (G1), chlorhexidine 2% (G2) or dexamethasone (G3) that were placed in the canal during the first treatment session. The patients were provided with a Heft-Parker Visual Analog Scale form to record their pain in different intervals of 4, 24, 48, 72 and 96 h after cleaning and shaping the root canal. Data analysis was carried out using the Chi-Square, one-way ANOVA and Repeated Measure tests.

Results

No significant difference was observed in the mean pain of the groups after 4 h (P>0.05). However, a significant difference was found between G1 and G3 in the mean pain from day 1 to 72 h after treatment. The mean pain was less in dexamethasone (G3) group (P<0.05), but the difference was not statistically significant at 96 h after treatment (P>0.05). No significant difference was found between "G2-G1" and "G2-G3" groups at different time intervals (P>0.05).

Conclusion

The mixture of calcium hydroxide and dexamethasone compared to calcium hydroxide and normal saline in short and medium time had a significant effect on reducing pain after cleaning and shaping the root canal. It seems that the mixture of calcium hydroxide and dexamethasone can be considered as an effective medicament on reducing pain during root canal treatment sessions.

TREATMENT OUTCOME OF MANUAL VERSUS ROTARY TECHNIQUES IN SINGLE-VISIT ENDODONTICS FOR PATIENTS IN A NIGERIAN TEACHING HOSPITAL: A RANDOMIZED CLINICAL TRIAL

BACKGROUND

Adequate canal preparation is essential in achieving successful outcome sequel to root canal treatment. Nickel-Titanium (NiTi) rotary instruments has steadily gained grounds in endodontics for root canals preparation, however, it is yet to be widely practiced among dental practitioners in Nigeria.

AIM AND OBJECTIVES

To compare the treatment outcomes of single visit root canal treatment when either rotary or manual step-back preparation technique is used in shaping the canal, employing clinical and radiographic criteria.

DESIGN OF THE STUDY

A randomized controlled trial.

SETTING

Conservation Unit of Restorative Dentistry Clinics, Lagos University Teaching Hospital (LUTH), Lagos, Nigeria.

MATERIALS AND METHODS

120 consecutive consenting subjects were included in the study. The inclusion criteria were: medically fit individuals with restorable anterior, premolar or first molar tooth diagnosed with irreversible pulpitis, pulp necrosis or apical periodontitis; they had no to moderate pain, with periodontally sound and not excessively curved tooth. Randomization was performed by balloting using sealed envelopes and subjects were assigned in equal numbers to one of two groups, rotary and manual. Subjects were monitored following treatment for clinical and radiographic parameters at 1 day, 1 week, 1 month, 3 months and 6 months. Data analysis was done using SPSS-version 20.0, and differences were considered significant if p < 0.05.

RESULTS

Twenty-seven (45%) and 23(38.3%) teeth in manual and rotary group respectively had pain at 1-day review. Significant difference in occurrence of pain in relation to both gender (p=0.001) and tooth-type (p=0.026) was noted between the groups at 1-day review. By the final review, there was no reported post-operative pain. There was no significant difference between the two groups in relation to the other clinical parameters at the different review periods. Twenty-four (40%) and 16 (26.7%) teeth had pre-existing periapical radiolucency in manual and rotary groups respectively; by final review, periapical radiolucency had reduced to 16.9% and 3.4% respectively, with the rotary group having significantly less radiolucency. Favourable outcome at 6-month review was significantly higher in the rotary group (96.6%), compared to the manual group (83.1%) in (p=0.033); the difference in outcome was due to significantly better outcomes with the molar tooth category in the rotary group.

CONCLUSION

There was a significantly more favourable treatment outcome in the rotary compared to the step-back technique in canal preparation, employing clinical and radiographic criteria.

Predictors, prevention, and management of postoperative pain associated with nonsurgical root canal treatment: A systematic review

Postoperative pain after root canal treatment can be reduced by applying recent advances in endodontic techniques and equipment. This systematic review includes current knowledge about pain after nonsurgical root canal treatment, including predictors, related factors, effects of recent advances, and management. A literature search was performed using the PubMed, ScienceDirect, and Cochrane Library databases for articles published between 1990 and 2016. Search keywords included postoperative pain, nonsurgical treatment, single visit, recent advances in endodontics, and management of postoperative pain with endodontic treatment. Only original research studies were included; editorials, reviews, brief notes, conference proceedings, and letters to the editor were excluded. The initial search yielded 4941 articles, which were assessed and filtered using the selection criteria. Sixty-five studies met the inclusion criteria and were included in the review. The findings showed that pain after nonsurgical root canal treatment occurred in 3–69.3% of patients. Microorganisms were identified as the primary contributors to postoperative pain, and there was no significant difference in postoperative pain between single- and multiple-visit treatments. Postoperative pain after root canal treatment ranges from mild to moderate and occurs even after optimally performed procedures. Furthermore, adequate management of postoperative pain is often considered an indicator of clinical excellence. Application of recently developed endodontic techniques and devices will reduce postoperative pain. Furthermore, a flexible, severity-based drug administration plan can be used to control and manage pain after root canal treatment. Application of the current research findings will reduce pain following root canal treatment and improve patient outcomes.

Effect of Corticosteroids on Pain Relief Following Root Canal Treatment: A Systematic Review

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.