1
|
Jiménez-Martín C, Martín-González J, Crespo-Gallardo I, Montero-Miralles P, Cabanillas-Balsera D, Segura-Egea JJ. Elective full pulpotomy in mature permanent teeth diagnosed with symptomatic irreversible pulpitis: a two years retrospective study. Clin Oral Investig 2024; 28:421. [PMID: 38976067 PMCID: PMC11231018 DOI: 10.1007/s00784-024-05814-z] [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: 06/03/2024] [Accepted: 06/28/2024] [Indexed: 07/09/2024]
Abstract
AIM To investigate the outcome of elective full pulpotomy, using calcium silicate-based cements (CSBC), after 2 years, in symptomatic mature permanent teeth with carious lesions, diagnosed as irreversible pulpitis, and analyse the capacity of Wolters et al. (2017) classification to predict the likelihood of treatment failure. METHODS The treatment records of 56 patients with symptomatic mature teeth with carious lesions, diagnosed as irreversible pulpitis and treated by elective full pulpotomy, using CSBCs as pulp capping materials, were reviewed. Thirteen teeth were excluded. The remaining 43 teeth were evaluated retrospectively at 24 months. Fisher`s exact test with the Lancaster's mid-P adjustment was used to assess different outcomes amongst the diagnostic categories. RESULTS Four of the cases failed before 24 months and required root canal treatment (RCT). Overall success rate at 2 years was 90.7% (39 of 43). An inverse, but non-significant, correlation was observed between the severity of pulpitis according to the Wolters classification and the treatment success rate (p > 0.05). The type of CSBC used was associated to the success rate (OR = 10.5; 95% C.I. = 0.5 - 207.4; p = 0.027), being 82% with Endosequence and 100% with Biodentine. Postoperative pain associated significantly to lower success rate (66.7%) (Odds ratio = 8.0; 95% C.I. = 0.7 - 95.9; p = 0.047). CONCLUSIONS Elective full pulpotomy using a CSBC was a successful choice for the treatment of mature permanent teeth with symptoms indicative of irreversible pulpitis. There were no significant differences between the success rate of mild, moderate and severe pulpitis. Postoperative pain could be considered a risk marker for failure of full pulpotomy. The term "irreversible pulpitis" should be re-signified to indicate the need for access to the pulp chamber, rather than an indication for extraction or RCT.
Collapse
Affiliation(s)
- Cristina Jiménez-Martín
- Department of Stomatology (Endodontic section), School of Dentistry, University of Sevilla, Sevilla, Spain
| | - Jenifer Martín-González
- Department of Stomatology (Endodontic section), School of Dentistry, University of Sevilla, Sevilla, Spain
| | - Isabel Crespo-Gallardo
- Department of Stomatology (Endodontic section), School of Dentistry, University of Sevilla, Sevilla, Spain
| | - Paloma Montero-Miralles
- Department of Stomatology (Endodontic section), School of Dentistry, University of Sevilla, Sevilla, Spain
| | - Daniel Cabanillas-Balsera
- Department of Stomatology (Endodontic section), School of Dentistry, University of Sevilla, Sevilla, Spain.
- Facultad de Odontología, Universidad de Sevilla, 41009, Sevilla, Spain.
| | - Juan J Segura-Egea
- Department of Stomatology (Endodontic section), School of Dentistry, University of Sevilla, Sevilla, Spain.
- Facultad de Odontología, Universidad de Sevilla, 41009, Sevilla, Spain.
| |
Collapse
|
2
|
Altuhafy M, Ravipati V, Nagi R, Jabr L, Zegar Z, Khan J. Effectiveness of mineral trioxide aggregate on postoperative pain in non-surgical endodontic treatment: a systematic review of randomized controlled trials. Evid Based Dent 2024:10.1038/s41432-024-00996-7. [PMID: 38499698 DOI: 10.1038/s41432-024-00996-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/05/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION Postoperative endodontic pain can negatively influence the quality of life of the patients. Mineral Trioxide Aggregate (MTA) has gained attention as a potential medicament in various endodontic procedures. MTA has been shown to have desirable properties such as biocompatibility, marginal adaptation, and sealing ability compared to other materials. Limited evidence is available about the effectiveness of MTA on the reduction of postoperative pain following endodontic treatment. This article aimed to compare the non-surgical post-endodontic pain-relieving effect of MTA compared with other materials. METHODS Indexed databases (PubMed/Medline, EMBASE, OVID, Scopus, and Cochrane) were independently searched for relevant manuscripts published up to and until June 2023. Randomized controlled trials (RCTs) with a focus on teeth with pulp pathologies, with or without radiolucency, requiring primary endodontic treatment were included. Risk of bias across individual studies was performed using the Cochrane risk of bias tool for interventions. RESULTS Out of the initial 169 articles searched, 9 RCTs met the selection criteria. The protocols were like all the studies, but the pain rating scales, filling material, and restoration materials varied. Out of the 9 included studies, in 4 studies MTA significantly reduced postoperative pain levels, 5 studies showed no difference between MTA and other materials, whereas 1 study reported an adverse effect of grey discoloration after MTA. CONCLUSION The findings of the present review indicate that MTA may reduce postoperative pain following non-surgical endodontic treatment. However, future standardized studies should be conducted to validate the results.
Collapse
Affiliation(s)
- Maryam Altuhafy
- Division of Orofacial Pain and TMJ Disorders, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - Vikranth Ravipati
- Division of Orofacial Pain and TMJ Disorders, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - Ravleen Nagi
- Division of Orofacial Pain and TMJ Disorders, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - Luay Jabr
- Department of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, New York, NY, USA
| | - Zegar Zegar
- Department of Endodontics, School of Dentistry, Loma Linda University, Loma Linda, CA, USA
| | - Junad Khan
- Division of Orofacial Pain and TMJ Disorders, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA.
| |
Collapse
|
3
|
Abbara MT, Akil S, Hamadah O, Achour H, Mahayni G, Alsayed Tolibah Y. Can diode laser 810 nm decrease post endodontic pain in patients with asymptomatic necrotic maxillary incisors? A four-arm randomized controlled trial. BDJ Open 2024; 10:23. [PMID: 38485988 PMCID: PMC10940693 DOI: 10.1038/s41405-024-00203-w] [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] [Received: 12/12/2023] [Revised: 02/05/2024] [Accepted: 02/05/2024] [Indexed: 03/18/2024] Open
Abstract
AIM To find the best method for applying the diode laser 810 nm to relieve post-endodontic pain on necrotic maxillary incisors with periapical lesions within a single-visit treatment. METHODS Eighty patients with a necrotic incisor, diagnosed with asymptomatic apical periodontitis, received standardized cleaning and shaping procedures, then divided randomly with a 1:1:1:1 allocation ratio into four groups: Group 1: control group with no laser application, Group 2: applying the diode laser as an irrigation activation system (IAS), Group 3: applying the diode laser from the buccal and palatal mucosa, Group 4: applying the diode laser as an IAS and from buccal and palatal mucosa. The postoperative pain was assessed using the visual analog scale (VAS) 1, 3, 7, and 14 days after the treatment. The mean values of the VAS score were statistically analyzed used Kruskal-Walis and Mann-Whitney U tests. The level of significance was set at a = 0.05. RESULTS During 14 days after treatment, there was a statistically significant difference between mean values of VAS scores in the four groups (P value < 0.05); Group 1 scored the highest score, whereas Group 4 showed the lowest one. Moreover, Group 4 showed favorable outcomes compared with Group 2 and Group 3 during the first three days after treatment. CONCLUSION Diode laser reduced postoperative pain after necrotic teeth with large-sized apical lesion treatment, whereas using diode laser either as an IAS or LLLT reduced the postoperative pain compared with the control group. Moreover, the usage of a diode laser in both previous techniques represents the best protocol for postoperative pain relief during 14 days of treatment. CLINICAL RELEVANCE The clinical significance of this study is to investigate the best method to reduce postoperative pain using diode lasers 810 nm; where the results of this study indicated that the more diode laser exposer in LLLT and IAS, the less postoperative pain after endodontic procedures.
Collapse
Affiliation(s)
- Mohammad Tamer Abbara
- DDs, MSc,Ph.D student at the department of Endodontics, Faculty of Dentistry, Damascus University, P.O. Box 3062, Damascus, Syria
| | - Samar Akil
- DDS,MSc,Ph.D Associate Professor at the department of Endodontics, Faculty of Dentistry, Damascus University, P.O. Box 3062, Damascus, Syria
| | - Omar Hamadah
- DDS,MSc,Ph.D Associate Professor at the department of Oral Medicine, Faculty of Dentistry, Damascus University, P.O. Box 3062, Damascus, Syria
| | - Hassan Achour
- DDS,MSc,Ph.D Associate Professor at the department of Endodontics, Faculty of Dentistry, Damascus University, P.O. Box 3062, Damascus, Syria
| | - Ghina Mahayni
- DDs, Faculty of Dentistry, Al-Sham Private University, P.O. Box 3062, Damascus, Syria
| | - Yasser Alsayed Tolibah
- DDs, MSc,Ph.D student at the department of Pediatric Dentistry, Faculty of Dentistry, Damascus, University, P.O. Box 3062, Damascus, Syria.
| |
Collapse
|
4
|
Al Attas MH, Maria RD. Assessing the Efficacy of Cold Laser Therapy vs. Traditional Methods in Managing Post-Endodontic Pain: A Randomized Controlled Trial. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S516-S519. [PMID: 38595560 PMCID: PMC11001120 DOI: 10.4103/jpbs.jpbs_839_23] [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: 09/02/2023] [Revised: 09/15/2023] [Accepted: 09/22/2023] [Indexed: 04/11/2024] Open
Abstract
The background of the study highlighted the common occurrence of post-endodontic pain and the need for effective pain management strategies. Materials and Methods Fifty patients were randomly assigned to two groups: the cold laser therapy (CLT) group and the traditional methods group (TMG). The CLT group received laser treatment at the affected area immediately following endodontic treatment, whereas the TMG received standard pain management techniques such as analgesics. Pain levels were assessed using a visual analog scale at baseline and at 6, 12, 24, and 48 hours post treatment. Pain scores were analyzed using appropriate statistical methods, including analysis of variance, and P values were calculated to determine the significance of differences between groups. Results This study found significant differences in post-endodontic pain levels between CLT and standard procedures. At 6 hours post treatment, the CLT group had a mean pain score of 2.1 ± 0.8, whereas the TMG had a mean pain score of 3.8 ± 1.2 (P = 0.012). Pain levels in the CLT group decreased with time, with scores decreasing to 1.5 ± 0.6 at 12 hours, 1.2 ± 0.5 at 24 hours, and 0.9 ± 0.4 at 48 hours post treatment. In contrast, the TMG had greater pain scores at each time point: 3.2 ± 1.0, 2.9 ± 1.1, 2.5 ± 0.9, and 2.1 ± 0.8 at 12, 24, and 48 hours post treatment, respectively. At 12, 24, and 48 hours post treatment, P values of 0.021, 0.036, and 0.004, respectively, indicated significant differences. Conclusion In managing post-endodontic pain, CLT demonstrated superior efficacy compared to traditional methods.
Collapse
Affiliation(s)
- Mustafa Hussein Al Attas
- Department of Conservative Dentistry and Endodontics, College of Dentistry, Qassim University, Buraydah, Saudi Arabia
| | - Rahul D. Maria
- Department of Conservative Dentistry and Endodontics, Bhabha College of Dental Sciences, Bhopal, Madhya Pradesh, India
| |
Collapse
|
5
|
Teja KV, Ramesh S, Janani K, Srivastava KC, Shrivastava D, Natoli V, Di Blasio M, Cicciù M, Minervini G. Clinical correlation of salivary alpha-amylase levels with pain intensity in patients undergoing emergency endodontic treatment. BMC Oral Health 2023; 23:562. [PMID: 37573306 PMCID: PMC10423407 DOI: 10.1186/s12903-023-03195-5] [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: 05/13/2023] [Accepted: 07/01/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Pain is usually subjective and thus it is challenging to describe its characteristics such as nature, intensity, and origin. Non-invasive methods such as assessing salivary alpha-amylase (SAA) may aid the practitioner to evaluate the pain intensity. Hence, the current study aimed to correlate the levels of SAA with the pain intensity in patients presenting with varied endodontic pain levels. METHODS Sixty patients who presented with varied intensities of endodontic pain were selected for the present study out of which seven patients were excluded/dropped, leaving a total sample of fifty-five patients for assessment. Mandibular molar with symptomatic irreversible pulpitis without periapical pathology were included in the study. A 5ml of un-stimulated was obtained from the patients, following which the local anesthesia was administered. Root canal treatment was then performed and the pain scores at pre-operative and post-operative were recorded. Additionally, salivary samples were collected after emergency endodontic treatment and sent for sialochemical analysis. IBM.SPSS statistics software 23.0 was employed to assess the obtained data. RESULTS A statistically significant drop in the pain score (P < 0.001) and SAA levels (P < 0.001) were observed post-operatively in the contract to pre-operative state. A strong positive correlation was reported between SAA levels and pain scores in patients undergoing emergency endodontic treatment at both time intervals namely pre-operative (P < 0.001) and post-operative (P < 0.001). CONCLUSION The results of this preliminary showed a strong association between the pain score and SAA levels in patients undergoing an emergency endodontic treatment.
Collapse
Affiliation(s)
- Kavalipurapu Venkata Teja
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hopitals, Saveetha Institute of Medical and Technical Sciences, Chennai, 600077, Tamil Nadu, India
| | - Sindhu Ramesh
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hopitals, Saveetha Institute of Medical and Technical Sciences, Chennai, 600077, Tamil Nadu, India
| | - Krishnamachari Janani
- Department of Conservative Dentistry and Endodontics, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India
| | - Kumar Chandan Srivastava
- Department of Oral & Maxillofacial Surgery & Diagnostic Sciences, College of Dentistry, Jouf University, Sakaka, 72345, Saudi Arabia.
| | - Deepti Shrivastava
- Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka, 72345, Saudi Arabia.
- Department of Periodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, 602105, Chennai, India.
| | - Valentino Natoli
- Department of Dentistry, School of Biomedical and Health Sciences, European University of Madrid, Madrid, 28670, Spain
- Private Dental Practice, Fasano, 72015, Italy
| | - Marco Di Blasio
- Department of Medicine and Surgery, University Center of Dentistry, University of Parma, Parma, 43126, Italy
| | - Marco Cicciù
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, Catania, 95123, CT, Italy
| | - Giuseppe Minervini
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania, Luigi Vanvitelli, Naples, 80138, Italy
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Ayhan M, Altunbaş D. Efficacy of Potassium Titanyl Phosphate Laser and Sodium Hypochlorite on Postoperative Pain Intensity Following Pulpotomy in Teeth with Symptomatic Irreversible Pulpitis: A Randomized Clinical Trial. Photobiomodul Photomed Laser Surg 2023; 41:225-233. [PMID: 37092958 DOI: 10.1089/photob.2022.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
Introduction: This study evaluated the postoperative pain intensity in permanent teeth with symptomatic irreversible pulpitis treated by pulpotomy using physiological saline, sodium hypochlorite (NaOCl), or the potassium titanyl phosphate (KTP) laser. Materials and methods: Ninety patients diagnosed with symptomatic irreversible pulpitis in permanent molars were randomly divided into three groups according to the pulpotomy procedures. Preoperative pain levels were recorded. Complete hemostasis was achieved with physiological saline (control group), NaOCl, or the KTP laser after initial bleeding control. Patients were asked to mark their pain level on the visual pain scale at 6, 24, 48, and 72 h and 7 and 30 days depending on the severity of pain. The permanent restoration was completed after 7 days. Data were statistically analyzed using Kruskal-Wallis, Mann-Whitney U, Friedman, and Bonferroni tests at a significance level of p < 0.05. Results: According to the present study, the statistical difference between the groups in terms of preoperative pain and percussion pain levels was insignificant (p > 0.05). There was no significant difference between groups in terms of demographic data (p > 0.05). The postoperative pain level of the KTP laser group was significantly lower at 6 h compared with the saline group (p < 0.05). There was no significant difference between groups in terms of the postoperative pain level at other time intervals (p > 0.05). The highest pain scores were observed in all groups at 6 h (p < 0.05). Conclusions: The KTP laser can be preferred primarily for reducing postoperative pain in pulpotomy treatments. The KTP laser or NaOCl-assisted pulpotomy can be an effective treatment for pain reduction in permanent teeth with symptomatic irreversible pulpitis. This report is registered at clinicaltrials.gov (ID: NCT05424796).
Collapse
Affiliation(s)
- Muhammed Ayhan
- Department of Endodontics, Faculty of Dentistry, Sivas Cumhuriyet University, Sivas, Turkey
| | - Demet Altunbaş
- Department of Endodontics, Faculty of Dentistry, Sivas Cumhuriyet University, Sivas, Turkey
| |
Collapse
|
8
|
Gulabivala K, Ng YL. Factors that affect the outcomes of root canal treatment and retreatment-A reframing of the principles. Int Endod J 2023; 56 Suppl 2:82-115. [PMID: 36710532 DOI: 10.1111/iej.13897] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023]
Abstract
This paper undertakes a broad and comprehensive synthesis of relevant clinical, biological, biomechanical, technical and healthcare services data to understand the factors affecting outcomes of periapical healing after root canal (re)treatment. The medical and dental evidence-based era (1980-present) is contextualized with the earlier evidence drive in endodontics (1911-1940) triggered by the focal infection era. The current evidence-based approach has a sharper focus on evidence quality and derivation of practice guidelines. Contrary views question whether guideline-driven, or expertise-development-driven endeavours would best serve outcome improvement in society. The endodontic discipline functions in a broad healthcare framework and sustains industrial, economic and trend pressures that may be deemed to influence outcomes. The nature of root canal treatment and the challenges in determining the factors that affect its outcomes is discussed. The factors potentially affecting periapical healing after root canal treatment are classified into pre-operative, intra-operative and postoperative groups. These categories subsume multiple elements with interactive influences, creating a complex picture, further confounded by some apparently surprising, counter-intuitive and contradictory findings. The technical versus biological conundrum in root canal treatment continues to cause cognitive dissonance. However, due reflection and cross-discipline-synthesis resolve the apparent data conflicts into a very simple, consistent and plausible picture of how root canal treatment works and the key factors that affect periapical healing. Root canal retreatment is considered mainly in the context of its differences from primary treatment as the majority of factors influencing outcomes are common to both. The exceptional difference is that retreatments have a proportionately reduced probability of healing by virtue of compromised apical root canal ramification access or modified host/infection interactions. Root canal (re)treatment outcomes are dominantly influenced by the nature of prior dynamic host/infection interaction (pre-operative patient factors) and how the direction of this dynamic is influenced by two factors: (1) the active efficacy of the operators' root canal treatment protocol to sustain a microbial ecological shift (intra-operative treatment factors) and dampen periapical inflammation; and (2) the passive ability of the functional tooth (and its restoration margin) to maintain its integrity to resist infection reversal (postoperative restorative factors).
Collapse
Affiliation(s)
- Kishor Gulabivala
- Unit of Endodontology, Department of Restorative Dentistry, UCL Eastman Dental Institute, University College London, London, UK
| | - Yuan Ling Ng
- Unit of Endodontology, Department of Restorative Dentistry, UCL Eastman Dental Institute, University College London, London, UK
| |
Collapse
|
9
|
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] [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.
Collapse
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
| |
Collapse
|
10
|
Bassam S, El-Ahmar R, Salloum S, Ayoub S. Endodontic postoperative flare-up: An update. Saudi Dent J 2021; 33:386-394. [PMID: 34803278 PMCID: PMC8589595 DOI: 10.1016/j.sdentj.2021.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/13/2021] [Accepted: 05/20/2021] [Indexed: 02/03/2023] Open
Abstract
Endodontic treatment corresponds to a combined chemical and mechanical approach, followed by a three dimensional hermetic obturation, that eliminate the pulpal and periradiculare disease and boost healing and repair of periradiculare tissue. Despite the advances in the endodontic field, the inter-appointment flare up remains a true nightmare that encounters every dentist. This complication commences a few hours or days after root canal procedures and it is characterized by the development of pain and/or swelling, requiring an unscheduled appointment for emergency treatment. Different studies showed that flare-ups represent a multifactorial phenomenon including mechanical, chemical and microbial factors. In addition, a correlation was found between flare-up and age, gender, tooth type, presence of preoperative pain, tooth condition before treatment, irrigation techniques, number of visits as well as intracanal medication. Moreover, some medicine intake was proved to be efficient in controlling this postoperative pain. However, a clear procedure to avoid its occurrence is yet to be established. In this review, we summarize knowledge about the etiology of flare-up and its related factors. This could be effective in helping dentists to adapt some strategies to prevent it.
Collapse
Affiliation(s)
- Sanaa Bassam
- Department of Endodontics, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
| | - Rima El-Ahmar
- Department of Restorative and Esthetic Dentistry, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
| | - Sara Salloum
- Department of Endodontics, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
| | - Sara Ayoub
- Department of Prosthodontics, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
| |
Collapse
|
11
|
Abstract
Pain associated with infections of the tooth pulp and periapical tissues is intense and often the most common reason for patients seeking emergency dental care. Effective management of acute dental pain requires a deep understanding of pain mechanisms, which enables accurate diagnosis and definitive treatment. While drugs are only used as an adjunct to definitive dental treatment, a thorough understanding of their mechanism of action and effectiveness enables clinicians to effectively control intra-operative and post-operative pain and prevent persistent pain. This review describes how pain is detected, processed, and perceived. It also provides information on evidence-based strategies on the use of different classes of drugs to effectively manage endodontic pain.
Collapse
Affiliation(s)
- Asma A Khan
- Department of Endodontics, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA.
| | - Anibal Diogenes
- Department of Endodontics, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| |
Collapse
|
12
|
VENKATA TEJA K, RAMESH S, RAMESH S. Analgesic Effect of Pre-emptive oral NSAIDs on Post-endodontic Pain levels in Single Visit Endodontics -A Systematic Review. CUMHURIYET DENTAL JOURNAL 2021. [DOI: 10.7126/cumudj.871091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
13
|
Shadmehr E, Sarmast ND, Davoudi A, Chung YJ, Wang HH. The additive effect of clonidine to lidocaine on postoperative pain management after root canal treatment on mandibular molars with symptomatic irreversible pulpitis: A prospective randomised double-blind clinical trial. J Conserv Dent 2021; 24:24-28. [PMID: 34475675 PMCID: PMC8378492 DOI: 10.4103/jcd.jcd_523_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/25/2020] [Accepted: 12/01/2020] [Indexed: 11/21/2022] Open
Abstract
Context: Postoperative pain control has been a common challenge to clinicians in endodontics. Aims: This double-blind randomized clinical trial assessed the efficacy of clonidine added to lidocaine for postoperative pain following endodontic treatment of mandibular molars with symptomatic irreversible pulpitis (SIP). Methods: One hundred participants with lower molars experiencing SIP were recruited and randomly assigned to two groups. 1.8 mL of 2% lidocaine with either epinephrine (1:80,000) or clonidine (15 µg/mL) was administered to each group via an inferior alveolar nerve block. A Heft–Parker Visual Analog Scale was used to rate preoperative pain and at 6, 12, 24, 36, 48, and 72 h following endodontic treatment. Their postoperative analgesic consumption was recorded. Statistical Analysis Used: The analgesic efficacy was analyzed by Chi-square test, paired t-test, and repeated measures ANOVA (P < 0.05). Results: Early postoperative pain was significantly lower in the lidocaine/clonidine group than the lidocaine/epinephrine group (6 h: P = 0.038; 12 h: P = 0.031). The lidocaine/clonidine group consumed a significantly lower amount of analgesics (P = 0.048). Conclusions: The administration of clonidine added to lidocaine may reduce early postoperative pain and consumption of analgesics following endodontic treatment in lower molars with SIP.
Collapse
Affiliation(s)
- Elham Shadmehr
- Department of Preventive and Restorative Dental Science, School of Dentistry, University of California, San Francisco, CA, USA
| | - Nima D Sarmast
- Department of Periodontics and Dental Hygiene, School of Dentistry at Houston, University of Texas, Houston, TX, USA
| | - Amin Davoudi
- Torabinejad Dental Research Center, Isfahan, Iran
| | - Yoo J Chung
- Department of Preventive and Restorative Dental Science, School of Dentistry, University of California, San Francisco, CA, USA
| | - Howard H Wang
- Department of Dental Medicine, New York Medical College, Valhalla, NY, USA
| |
Collapse
|
14
|
Javidi M, Zarei M, Ashrafpour E, Gharechahi M, Bagheri H. Post-treatment Flare-up Incidence after Using Nano Zinc Oxide Eugenol Sealer in Mandibular First Molars with Irreversible Pulpitis. JOURNAL OF DENTISTRY (SHIRAZ, IRAN) 2020; 21:307-313. [PMID: 33344681 PMCID: PMC7737921 DOI: 10.30476/dentjods.2020.83231.1041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Statement of the Problem: Some patients may report moderate-to-severe pain and/or swelling following root canal treatment, which is undesirable for both the patient and dentist and may require an unscheduled emergency visit by patients to relieve their symptoms. Purpose: The aim of this study was to evaluate the post-treatment flare-up incidence following application of nano zinc oxide-eugenol (NZOE) sealer in mandibular first molars with irreversible pulpitis. Materials and Method: This single-blinded study was performed on 60 patients having mandibular first molars with irreversible pulpitis. After signing the written consent form, the patients were randomly divided into two groups considering their age range (20-34 and 35-50 years). Individuals without systemic diseases and with a first mandibular molar diagnosed with irreversible pulpitis due to caries, no sinus track and abscess, normal periapical radiographic appearance, no spontaneous pre-treatment pain, not taken any medication for at least 8 hours before the treatment visit were included in this study. Patients of both sexes with age range of 20 to 50 years were selected. In order to obturate the root canal space, AH26 sealer was used in the one group and the synthesized NZOE was applied in another group. The patients were then given questionnaires to report the severity of pain and presence of swelling during 6, 18, 24, and 48 hours of follow-up. The data was analyzed using SPSS v.19 software applying repeated measures ANOVA. The significance level was set at 0.05. Results: The severity of pain was significantly lower in NZOE group at 24 hours post-treatment (p= 0.003). Patients reported no symptoms of swelling in any group. Conclusion: NZOE sealer manifested satisfactory results and could be regarded as a promising substitute to routine sealers since patients may experience less pain during the first hours after receiving root canal therapy.
Collapse
Affiliation(s)
- Maryam Javidi
- Dept. of Endodontics, Dental Research Center, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mina Zarei
- Dept. of Endodontics, Dental Research Center, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ehsan Ashrafpour
- Postgraduate Dept. of Endodontics, Dental Research Center, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Gharechahi
- Dept. of Endodontics, Dental Research Center, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Bagheri
- Dept. of Dental Material, Dental Research Center, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
15
|
Almuthhin M, Afify M, Alshammari Y, Alkatheeri N, Altuwaijri SM, Alhussain B, Albaij SMA, Alanazi F, Alsheri Y. The Safety and Efficacy of Pre- and Post-Medication for Postoperative Endo- dontic Pain: A Systematic Review and Network Meta-analysis. Open Dent J 2020. [DOI: 10.2174/1874210602014010563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Postoperative Endodontic Pain is a major concern for dentists and their patients, with pain having been reported to occur in 25%–40% of patients treated. Therefore, the aim of this systematic review and Network Meta-analysis (NMA) was to identify the safety and efficacy of pre- and post-medication for reducing postoperative endodontic pain.
Methods:
A literature search was performed in the SCOPUS, MEDLINE, and ScienceDirect, and Cochrane Central databases until December 2019 with no language restriction. Randomized controlled trials evaluating the efficacy of pre- or post-medications compared with other agents, placebo, or no treatment in adult patients who underwent endodontic surgery for postoperative pain were included. The mean difference of postoperative pain was measured using the Standardized Mean Difference (SMD) with its 95% confidence interval (95% CI).
Results:
This Systematic Review included 62 Articles. Of them, 50 studies were included in the NMA. Among all medications, corticosteroids were ranked as the best treatment for the reduction of postoperative pain at 6 and 12 hours with a significant reduction in postoperative pain scores [SMD= -1.18, 95% CI (-1.51: -0.85)] and [SMD= -1.39, 95% CI (-1.77: -1.02)], respectively. Cyclooxygenase-2 (COX-2) inhibitors were ranked as the best treatment for the reduction of postoperative pain at 8 and 24 hours with a significant reduction in postoperative pain scores [SMD= -2.86, 95% CI (-6.05: -1.66)] and [SMD= -1.27, 95% CI (-2.10: -0.43)], respectively. Non-steroidal anti-inflammatory drugs (NSAIDs) significantly reduced the postoperative pain scores in all durations. For postoperative pain at 6 hours, Indomethacin, Novafen, Naproxen, Prednisolone, Ketorolac, Betamethasone, Dexamethasone, Deflazacort, Rofecoxib, Piroxicam, and Ibuprofen significantly reduced the pain score when compared with a placebo. All of these drugs demonstrated a significant reduction at 12 hours except Ketorolac.
Conclusion:
The current evidence suggests that pre- and post-medication can reduce postoperative pain after nonsurgical root canal treatment. Corticosteroids and COX-2 inhibitors showed significant control of the pain up to 12 hours after administration. However, NSAIDs demonstrated a high efficacy from administration and until two days after treatment. Indomethacin, Novafen, prednisolone, and Naproxen were ranked first in most analyzed durations.
Collapse
|
16
|
Shamszadeh S, Asgary S, Shirvani A, Eghbal MJ. Effects of antibiotic administration on post-operative endodontic symptoms in patients with pulpal necrosis: A systematic review and meta-analysis. J Oral Rehabil 2020; 48:332-342. [PMID: 32681652 DOI: 10.1111/joor.13057] [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: 04/29/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The current systematic review and meta-analysis aimed to assess the efficacy of prophylactic oral antibiotics in the management of post-operative endodontic symptoms in adults with necrotic pulp. MATERIALS AND METHODS A systematic search up to April 2020 was performed to find all randomised controlled trials (RTCs) comparing oral antibiotics with placebo to manage post-endodontic symptoms. The outcome measures were post-operative pain, swelling and/or the combined pain and swelling at different follow-ups. Standardised mean differences (SMDs) and 95% confidence intervals (CIs) were estimated using random-effect inverse-variance method. Additional analysis was performed if heterogeneity existed (P < .05). RESULTS For post-endodontic pain, 8 RCTs (n = 690) were included. Antibiotic prescription had no significant effect on endodontic pain at 6 (SMD = -0.008, 95% CI -0.279 - 0.264, P = .95), 12 (SMD = -0.080, 95% CI -1.39 - 1.23, P = .90), 24 (SMD = -0.044, 95% CI -0.29 - 0.20, P = .72), 48 (SMD = 0.18, 95% CI -0.26 - 0.62, P = .42) and 72 h (SMD= -0.050, 95% CI -0.33 - 0.23, P = .723) post-operatively. For post-endodontic swelling, 4 RCTs (n = 149) were included. Antibiotic prescription had no significant effect on endodontic swelling at 24 (SMD = 0.29, 95% CI -0.72 - 1.32, P = .56), 48 (SMD = -0.23, 95% CI -0.98 - 0.51, P = .54) and 72 hours (SMD= -0.03, 95% CI -1.25 - 1.33, P = .96), post-operatively. For combined pain and swelling, no meta-analysis was performed. CONCLUSION The administration of prophylactic antibiotics to prevent post-operative endodontic symptoms is not supported by the current evidence.
Collapse
Affiliation(s)
- Sayna Shamszadeh
- Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Saeed Asgary
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Armin Shirvani
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Mohammad Jafar Eghbal
- Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
| |
Collapse
|
17
|
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.
Collapse
|
18
|
Al-Rawhani AH, Gawdat SI, Wanees Amin SA. Effect of Diclofenac Potassium Premedication on Postendodontic Pain in Mandibular Molars with Symptomatic Irreversible Pulpitis: A Randomized Placebo-Controlled Double-Blind Trial. J Endod 2020; 46:1023-1031. [PMID: 32470370 DOI: 10.1016/j.joen.2020.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 05/16/2020] [Accepted: 05/17/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The aim of this prospective, randomized, double-blind clinical trial was to evaluate the effect of a preoperative, single, oral dose of diclofenac potassium (DFK) on postoperative pain and rescue analgesic intake in patients with symptomatic irreversible pulpitis in mandibular molars treated in 1 visit. METHODS Seventy emergency patients with moderate to severe preoperative pain randomly received either 50 mg DFK or placebo tablets 1 hour before starting endodontic treatment (n = 35 per group). Patients recorded their pain level 6, 12, 24, and 48 hours after treatment on a 170-mm Heft-Parker visual analog scale. The incidence of rescue analgesic intake was also recorded. Outcome data were statistically analyzed using Mann-Whitney U, Friedman, Wilcoxon signed rank, and chi-square tests. Binary logistic regression assessed the association of predisposing factors with postoperative pain. The significance level (α) was set at 0.05. RESULTS Of the 70 patients, 68 were analyzed (n = 34 per group). Both groups had similar baseline characteristics (P > .05). DFK showed significantly less pain incidence and intensity than the placebo at 48 hours only (P < .05). A significant decrease occurred from 24 to 48 hours with DFK (P < .05), which was not recorded with the placebo (P > .05). No difference in the incidence of rescue analgesic intake was reported between groups (P > .05). Food intake timing, sex, and rescue analgesic intake were associated with postoperative pain (P < .05). CONCLUSIONS Premedication by a single, oral dose of 50 mg DFK could be effective in reducing postendodontic pain at 48 hours after 1-visit endodontic treatment in mandibular molars with symptomatic irreversible pulpitis.
Collapse
|
19
|
Stamos A, Drum M, Reader A, Nusstein J, Fowler S, Beck M. An Evaluation of Ibuprofen Versus Ibuprofen/Acetaminophen for Postoperative Endodontic Pain in Patients With Symptomatic Irreversible Pulpitis and Symptomatic Apical Periodontitis. Anesth Prog 2020; 66:192-201. [PMID: 31891295 DOI: 10.2344/anpr-66-03-06] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The purpose of this investigation was to compare ibuprofen versus an ibuprofen/acetaminophen combination for postoperative pain control in a patient model specific to teeth diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis. One hundred and two patients presenting with moderate to severe pain from a maxillary or mandibular posterior tooth diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis were included. Following local anesthetic administration, complete endodontic cleaning and shaping was performed. Patients were randomly assigned to receive identically appearing tablets of ibuprofen 200 mg or a combination of ibuprofen 200 mg/acetaminophen 216.7 mg with instructions to take 3 tablets every 6 hours as needed for pain. Patients were also given a prescription for an escape medication to take if the study medications did not adequately control their pain. A 4-day diary was used to record pain ratings and medication use. Moderate to severe pain was experienced by 59-61% of the patients on postoperative day 1 and 50-57% of the patients on day 2, with the pain ratings decreasing over the next 2 days. There were no statistically significant differences between the 2 groups in postoperative pain, percussion pain, or medication use. There was no difference between ibuprofen and the combination of ibuprofen/acetaminophen in the reduction of postoperative pain following endodontic debridement in patients with symptomatic irreversible pulpitis and symptomatic apical periodontitis.
Collapse
Affiliation(s)
- Alex Stamos
- Former Graduate Student in Endodontics, The Ohio State University
| | - Melissa Drum
- Professor and Graduate Program Director, Division of Endodontics, The Ohio State University
| | - Al Reader
- Emeritus Professor, Division of Endodontics, The Ohio State University
| | - John Nusstein
- Professor and Chair, Division of Endodontics, The Ohio State University
| | - Sara Fowler
- Assistant Professor and Predoctoral Director, Division of Endodontics, The Ohio State University
| | - Mike Beck
- Emeritus Associate Professor, Division of Biosciences, The Ohio State University
| |
Collapse
|
20
|
Effect of Pulpotomy Procedures With Mineral Trioxide Aggregate and Dexamethasone on Post-endodontic Pain in Patients with Irreversible Pulpitis: A Randomized Clinical Trial. Eur Endod J 2020; 4:69-74. [PMID: 32161890 PMCID: PMC7006548 DOI: 10.14744/eej.2019.91885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 04/03/2019] [Indexed: 11/24/2022] Open
Abstract
Objective: Endodontic post-treatment pain continues to be one of the main problems encountered by dental professionals. Therefore, pain control during and after endodontic treatment is one of the most important issues in endodontics. The purpose of this clinical trial was to compare postoperative pain relief achieved with dexamethasone (DEX) and mineral trioxide aggregate (MTA) used as pulp coverage after pulpotomy in human molars with irreversible pulpitis. Methods: This prospective double-blind study was conducted on 54 patients complaining of dental pain due to irreversible pulpitis. The standard pulpotomy procedure was performed by the same dentist in all patients. At the time of the cotton pellet placement, patients were randomly divided into three groups: those in whom a sterile dry cotton (DC) pellet was used, patients treated with a cotton pellet soaked in MTA, and those who were treated with a cotton pellet soaked in DEX. After completion of the treatment, patients received rescue medication every 6 hours for the first day. Postoperative pain was assessed at 6-hour intervals for 24 hours, and then every day until day 7 using a visual analog scale. Results: In general, patients treated with MTA suffered the lowest levels of pain at all time intervals. Post-pulpotomy pain was significantly reduced at 18 and 24 hours and from days 2 to 7 post-treatment in the MTA group. DEX lowered the pain level more than the DC pellet. However, the differences observed in the mean pain scores of the DEX and DC pellet groups at all-time intervals were not statistically significant. Conclusion: Pulpotomy procedures can reduce pain related irreversible pulpitis. Pulpotomy with MTA-soaked cotton pellet significantly reduces pain intensity in patients with irreversible pulpitis.
Collapse
|
21
|
Mostafa MEHAA, El‐Shrief YAI, Anous WIO, Hassan MW, Salamah FTA, El Boghdadi RM, El‐Bayoumi MAA, Seyam RM, Abd‐El‐Kader KG, Amin SAW. Postoperative pain following endodontic irrigation using 1.3% versus 5.25% sodium hypochlorite in mandibular molars with necrotic pulps: a randomized double‐blind clinical trial. Int Endod J 2020; 53:154-166. [DOI: 10.1111/iej.13222] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
| | - Y. A. I. El‐Shrief
- Department of Endodontics Faculty of Dentistry Cairo University Cairo Egypt
| | - W. I. O. Anous
- Department of Endodontics Faculty of Dentistry Cairo University Cairo Egypt
| | - M. W. Hassan
- Department of Endodontics Faculty of Dentistry Cairo University Cairo Egypt
| | - F. T. A. Salamah
- Department of Endodontics Faculty of Dentistry Cairo University Cairo Egypt
| | - R. M. El Boghdadi
- Department of Endodontics Faculty of Dentistry Cairo University Cairo Egypt
| | | | - R. M. Seyam
- Department of Endodontics Faculty of Dentistry Cairo University Cairo Egypt
| | - K. G. Abd‐El‐Kader
- Department of Endodontics Faculty of Dentistry Cairo University Cairo Egypt
| | - S. A. W. Amin
- Department of Endodontics Faculty of Dentistry Cairo University Cairo Egypt
| |
Collapse
|
22
|
Aksoy F, Ege B. The effect of pretreatment submucosal injections of tramadol and dexamethasone on post‐endodontic pain in mandibular molar teeth with symptomatic irreversible pulpitis: a randomized controlled clinical trial. Int Endod J 2019; 53:176-185. [DOI: 10.1111/iej.13246] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 11/06/2019] [Indexed: 11/27/2022]
Affiliation(s)
- F. Aksoy
- Department of EndodonticsFaculty of DentistryAdiyaman University Adiyaman Turkey
| | - B. Ege
- Department of Oral and Maxillofacial Surgery Faculty of Dentistry Adiyaman University Adiyaman Turkey
| |
Collapse
|
23
|
Effects of Ibuprofen Compared to Other Premedication Drugs on the Risk and Intensity of Postendodontic Pain: A Systematic Review. Eur Endod J 2018; 3:123-133. [PMID: 32161868 PMCID: PMC7006579 DOI: 10.14744/eej.2018.83803] [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: 03/21/2018] [Revised: 07/12/2018] [Accepted: 08/10/2018] [Indexed: 11/20/2022] Open
Abstract
Objective This systematic review aims to evaluate the effects of ibuprofen compared to other drugs on the risk and intensity of postoperative pain resulting from endodontic treatment in adult patients. Methods A systematic search was carried out through Medline databases (Pubmed, Scopus, Web of Science, Cochrane, Lilacs, and BBO). There was no restriction on the publication year or idiom. The gray literature was explored. The Periodicos Capes Theses Databases and ProQuest Dissertations were also searched, as well as the unpublished and ongoing trials registry and the IADR abstracts (1990-2016). Solely randomized clinical trials that compared the risk or intensity of pain resulting from endodontic treatment in adult patients were included in this systematic review. The risk of bias of the articles was evaluated using the Cochrane Collaboration's tool. A random-effect meta-analysis was conducted for ibuprofen versus placebo and ibuprofen versus other drugs at 6, 8, and 24 hours. The GRADE approach was used to assess the quality of the evidence. Results A total of 1132 studies were identified, and only seven meet the eligibility criteria. No difference between the groups was detected in any of the meta-analysis. An exception was observed when one study was removed from the meta-analysis of pain intensity at 24 hours for ibuprofen versus placebo, favoring ibuprofen (SMD -0.67; 95% CI -1.05 to -0.17). The quality of evidence in all meta-analyses was graded as low or very low. Conclusion Results of the present systematic review indicate that there is no clear evidence supporting that preoperative ibuprofen is better than other drugs in reducing the risk and intensity of postendodontic pain.
Collapse
|
24
|
Fuller M, Younkin K, Drum M, Reader A, Nusstein J, Fowler S. Postoperative Pain Management with Oral Methylprednisolone in Symptomatic Patients with a Pulpal Diagnosis of Necrosis: A Prospective Randomized, Double-blind Study. J Endod 2018; 44:1457-1461. [DOI: 10.1016/j.joen.2018.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/20/2018] [Accepted: 06/05/2018] [Indexed: 11/27/2022]
|
25
|
Suneelkumar C, Subha A, Gogala D. Effect of Preoperative Corticosteroids in Patients with Symptomatic Pulpitis on Postoperative Pain after Single-visit Root Canal Treatment: A Systematic Review and Meta-analysis. J Endod 2018; 44:1347-1354. [DOI: 10.1016/j.joen.2018.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/24/2018] [Accepted: 05/29/2018] [Indexed: 01/08/2023]
|
26
|
Shamszadeh S, Shirvani A, Eghbal MJ, Asgary S. Efficacy of Corticosteroids on Postoperative Endodontic Pain: A Systematic Review and Meta-analysis. J Endod 2018; 44:1057-1065. [DOI: 10.1016/j.joen.2018.03.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/14/2018] [Accepted: 03/14/2018] [Indexed: 11/17/2022]
|
27
|
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.
Collapse
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
| |
Collapse
|
28
|
Galani M, Tewari S, Sangwan P, Mittal S, Kumar V, Duhan J. Comparative Evaluation of Postoperative Pain and Success Rate after Pulpotomy and Root Canal Treatment in Cariously Exposed Mature Permanent Molars: A Randomized Controlled Trial. J Endod 2017; 43:1953-1962. [DOI: 10.1016/j.joen.2017.08.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/31/2017] [Accepted: 08/02/2017] [Indexed: 11/25/2022]
|
29
|
Tao J, Wang D, Ran J, Jin A, Yu H. Response characteristics of the cat somatosensory cortex following the mechanical stimulation to non-vital and vital canine. Neuroscience 2017; 363:34-42. [PMID: 28757248 DOI: 10.1016/j.neuroscience.2017.07.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/15/2017] [Accepted: 07/18/2017] [Indexed: 11/26/2022]
Abstract
Patients sometimes complain that non-vital teeth after root canal treatment (RCT) are paresthesia compared with vital teeth, and previous psychological studies on the tactile sensibility of non-vital teeth remained controversial. In the present study, intrinsic signal optical imaging, which served as an objective tool, was employed to compare the cortex response characteristics following forces applied to the cat non-vital and vital canines. Based on the evoked cortical responses, the response threshold, signal strength, spatial pattern, temporal dynamics and the preference of force direction, they were not significantly different between vital and non-vital canines. It seemed that the tactile sensibility of vital and non-vital teeth was comparable at the cortical response level, and pulpal receptors were not concerned in tactile function.
Collapse
Affiliation(s)
- Jianxiang Tao
- Department of Prosthodontics, School &Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai 200072, China
| | - Duo Wang
- Vision Research Laboratory, School of Life Sciences, The State Key Laboratory of Medical Neurobiology, Collaborative Innovation Center for Brain Science, Fudan University, Shanghai 200433, China
| | - Jie Ran
- Department of Prosthodontics, School &Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai 200072, China
| | - Anqi Jin
- Vision Research Laboratory, School of Life Sciences, The State Key Laboratory of Medical Neurobiology, Collaborative Innovation Center for Brain Science, Fudan University, Shanghai 200433, China
| | - Hongbo Yu
- Vision Research Laboratory, School of Life Sciences, The State Key Laboratory of Medical Neurobiology, Collaborative Innovation Center for Brain Science, Fudan University, Shanghai 200433, China.
| |
Collapse
|
30
|
Awawdeh L, Hemaidat K, Al-Omari W. Higher Maximal Occlusal Bite Force in Endodontically Treated Teeth Versus Vital Contralateral Counterparts. J Endod 2017; 43:871-875. [DOI: 10.1016/j.joen.2016.12.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 12/25/2016] [Accepted: 12/30/2016] [Indexed: 10/19/2022]
|
31
|
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.
Collapse
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
| |
Collapse
|
32
|
Gyanani H, Chhabra N, Parmar GR. Comparative assessment of efficacy of two different pretreatment single oral doses of betamethasone on inter-appointment and postoperative discomfort: An in vivo clinical evaluation. J Conserv Dent 2016; 19:564-568. [PMID: 27994320 PMCID: PMC5146774 DOI: 10.4103/0972-0707.194022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: Study aimed to evaluate the efficacy of two different pretreatment single oral doses of betamethasone on the incidence of inter-appointment flare up and postoperative discomfort. Materials and Methods: Fifty-four patients aged 18–59 years requiring endodontic treatment were selected and randomly assigned to three groups; single pretreatment oral dose of placebo or betamethasone in two different oral doses of 0.5 mg and 1 mg, respectively. Endodontic therapy was completed in two visits using triple antibiotic paste as intracanal medicament. Patients were given a questionnaire to record their pain at 1, 2, 3, and 7 days after treatment. In the second visit, obturation was done, and the patients were again instructed to record their pain scores after treatment and discharged. The verbal rating scale was used for recording the pain scores. Statistical analysis was done using ANOVA and the Friedman test. Results: 0.5 mg betamethasone group showed least mean pain scores among all experimental groups; however, there was no statistically significant difference between any of the groups (P > 0.05). Conclusion: Pretreatment single oral dose of betamethasone is an effective in managing endodontic flare-ups; however, the results were statistically insignificant.
Collapse
Affiliation(s)
- Hitesh Gyanani
- Department of Conservative Dentistry and Endodontics, K M Shah Dental College and Hospital, Piparia, Vadodara, Gujarat, India
| | - Naveen Chhabra
- Department of Conservative Dentistry and Endodontics, K M Shah Dental College and Hospital, Piparia, Vadodara, Gujarat, India
| | - Ghanshyam R Parmar
- Department of Pharmacy, Sumandeep Vidyapeeth University, Piparia, Vadodara, Gujarat, India
| |
Collapse
|
33
|
Smith EA, Marshall JG, Selph SS, Barker DR, Sedgley CM. Nonsteroidal Anti-inflammatory Drugs for Managing Postoperative Endodontic Pain in Patients Who Present with Preoperative Pain: A Systematic Review and Meta-analysis. J Endod 2016; 43:7-15. [PMID: 27939729 DOI: 10.1016/j.joen.2016.09.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/07/2016] [Accepted: 09/09/2016] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Nonsteroidal anti-inflammatory drugs (NSAIDs) have been commonly used to treat endodontic postoperative pain. The purpose of this study was to address the following Population, Intervention, Comparator, Outcome, Timing, Study design and setting question: in patients with preoperative pain who undergo initial orthograde endodontic treatment, what is the comparative efficacy of NSAIDS compared with non-narcotic analgesics or placebo in reducing postoperative pain and the incidence of adverse events. METHODS Ovid MEDLINE (1946-December 15, 2015), the Cochrane Database of Systematic Reviews (2005-December 15, 2015), and the Cochrane Central Register of Controlled Trials (to December 15, 2015) were searched using included drugs, indications, and study designs as search terms. Hand searches in texts were also conducted. Two independent reviewers assessed eligibility for inclusion, extracted data, and assessed quality using the risk of bias tool. L'Abbe plots were used for qualitative review. Where applicable, meta-analysis was conducted on the pooled effect size (ES). RESULTS Two thousand two hundred eighty-four studies were identified through the database searches; 405 full-text articles were assessed. Fifteen articles met the inclusion criteria; qualitative analysis revealed all studies had a moderate to high risk of bias. Ibuprofen was the most studied NSAID. The L'Abbe plots showed that NSAIDS are effective at relieving postoperative endodontic pain overall. Meta-analysis showed that ibuprofen 600 mg is more effective than placebo at 6 hours postoperatively (ES = 10.50, P = .037), and ibuprofen 600 mg + acetaminophen 1000 mg combination is more effective than placebo (ES = 34.89, P = .000) but not significantly different than ibuprofen (ES = 13.94, P = .317). Five studies reported patients experiencing adverse events such as drowsiness, dizziness, nausea, and emesis; 2 studies reported that patients experienced no adverse events. CONCLUSIONS A combination of ibuprofen 600 mg and acetaminophen 1000 mg is more effective than placebo but not significantly different than ibuprofen 600 mg at 6 hours postoperatively. Ibuprofen 600 mg is more effective than placebo at 6 hours postoperatively; however, there are insufficient data to recommend the most effective NSAID, dose amount, or dose interval for the relief of postoperative endodontic pain of longer duration in patients with preoperative pain.
Collapse
Affiliation(s)
- Elizabeth A Smith
- Department of Endodontology, School of Dentistry, Oregon Health and Science University, Portland, Oregon
| | - J Gordon Marshall
- Department of Endodontology, School of Dentistry, Oregon Health and Science University, Portland, Oregon
| | - Shelley S Selph
- Pacific Northwest Evidence-based Practice Center, Oregon Health and Science University, Portland, Oregon
| | - Dale R Barker
- Department of Endodontology, School of Dentistry, Oregon Health and Science University, Portland, Oregon
| | - Christine M Sedgley
- Department of Endodontology, School of Dentistry, Oregon Health and Science University, Portland, Oregon.
| |
Collapse
|
34
|
Mehrvarzfar P, Esnashari E, Salmanzadeh R, Fazlyab M, Fazlyab M. Effect of Dexamethasone Intraligamentary Injection on Post-Endodontic Pain in Patients with Symptomatic Irreversible Pulpitis: A Randomized Controlled Clinical Trial. IRANIAN ENDODONTIC JOURNAL 2016; 11:261-266. [PMID: 27790253 PMCID: PMC5069900 DOI: 10.22037/iej.2016.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: The aim of this randomized-controlled clinical trial was to assess the effect of intraligamentary (PDL) injection of dexamethasone on onset and severity of post-treatment pain in patients with symptomatic irreversible pulpitis. Methods and Materials: A total number of 60 volunteers were included according to the inclusion criteria and were assigned to three groups (n=20). After administration of local anesthesia and before treatment, group 1 (control) PDL injection was done with syringe containing empty cartridge, while in groups 2 and 3 the PDL injection was done with 0.2 mL of 2% lidocaine or dexamethasone (8 mg/2 mL), respectively. Immediately after endodontic treatment patients were requested to mark their level of pain on a visual analogue scale (VAS) during the next 48 h (on 6, 12, 24 and 48-h intervals). They were also asked to mention whether analgesics were taken and its dosage. Considering the 0-170 markings on the VAS ruler, the level of pain was scored as follows: score 0 (mild pain; 0-56), score 1 (moderate pain; 57-113) and score 3 (severe pain; 114-170). The data were analyzed using the Kruskal-Wallis and the Chi-square tests and the level of significance was set at 0.05. Results: After 6 and 12 h, group 1 and group 3 had the highest and lowest pain values, respectively (P<0.01 and P<0.001 for 6 and 12 h, respectively). However, after 24 and 48 h the difference in the pain was not significant between groups 1 and 2 (P<0.6) but group 3 had lower pain levels (P<0.01 and P<0.8 for 24 and 48 h, respectively). Conclusion: Pretreatment PDL injection of dexamethasone can significantly reduce the post-treatment endodontic pain in patients with symptomatic irreversible pulpitis.
Collapse
Affiliation(s)
- Payman Mehrvarzfar
- Department of Endodontics, Dental Branch, Islamic Azad University of Medical Sciences, Tehran, Iran
| | - Ehsan Esnashari
- Department of Endodontics, Dental Branch, Islamic Azad University of Medical Sciences, Tehran, Iran
| | | | - Mahta Fazlyab
- Department of Endodontics, Dental Branch, Islamic Azad University of Medical Sciences, Tehran, Iran;; Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahyar Fazlyab
- Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia, USA
| |
Collapse
|
35
|
Zand V, Milani AS, Hassani Dehkharghani A, Rahbar M, Tehranchi P. Treatment of Necrotic Teeth Using Two Engine-Driven Systems and Patient's Postoperative Pain: A Double-Blind Clinical Trial. IRANIAN ENDODONTIC JOURNAL 2016; 11:267-272. [PMID: 27790254 PMCID: PMC5069901 DOI: 10.22037/iej.2016.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION One of the most important reasons for postoperative pain is the extrusion of debris from the apical foramen during preparation and shaping of root canals. The aim of this clinical trial was to evaluate the severity of postoperative pain with the use of two different engine-driven NiTi systems. METHODS AND MATERIALS Ninety mandibular molars were randomly divided into two groups (n=45), and root canal cleaning and shaping was done using either RaCe or Reciproc instruments. The severity of postoperative pain was determined with visual analogue scale (VAS) at 4-, 12-, 24-, 48- and 72 h and 1-week intervals and postoperative pain was compared between the two groups. The chi-squared test and repeated-measures analysis were used to compare the data between the two groups. RESULTS Based on the results of the statistical analyses, the two groups were matched regarding the age and gender, with no significant differences. In addition, except for 4- and 24-h and 1-week intervals, postoperative pain was significantly less in the RaCe group compared to the Reciproc group (P<0.001). CONCLUSION Based on the results of the present study, use of RaCe files for cleaning and shaping of root canals in necrotic mandibular molars resulted in less severe postoperative pain compared to Reciproc files.
Collapse
Affiliation(s)
- Vahid Zand
- Department of Endodontics, Dental School, Tabriz University of Medical Science, Tabriz, Iran
| | - Amin Salem Milani
- Department of Endodontics, Dental School, Tabriz University of Medical Science, Tabriz, Iran
| | | | - Mahdi Rahbar
- Department of Operative and Esthetic Dentistry, Dental School, Tabriz University of Medical Science, Tabriz, Iran
| | - Pardis Tehranchi
- Department of Operative and Esthetic Dentistry, Dental School, Tabriz University of Medical Science, Tabriz, Iran
| |
Collapse
|
36
|
Shetkar P, Jadhav GR, Mittal P, Surapaneni S, Kalra D, Sakri M, Basavaprabhu A. Comparative evaluation of effect of preoperative alprazolam and diclofenac potassium on the success of inferior alveolar, Vazirani-Akinosi, and Gow-Gates techniques for teeth with irreversible pulpitis: Randomized controlled trial. J Conserv Dent 2016; 19:390-5. [PMID: 27656053 PMCID: PMC5026094 DOI: 10.4103/0972-0707.190013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: In teeth with irreversible pulpitis, successful local anesthesia is hard to achieve irrespective of the amount of local anesthesia and technique used. Such cases can be managed by concoction of pre-medications like anxiolytics, analgesics and effective local anesthesia. This double-blind, placebo-controlled study was planned to evaluate the effect of oral administration of alprazolam and diclofenac potassium on the success rate of inferior alveolar nerve block (IANB), Gow-Gates (GG) and Vazirani-Akinosi (VA) techniques for the root canal treatment of mandibular molars with irreversible pulpitis. Method: 198 emergency patients with symptomatic irreversible pulpitis were randomly divided into three groups as – A, B and C receiving IANB, GG or V-A respectively using 2% lidocaine with 1: 100,000 epinephrine. These groups were sub-divided into sub-groups I and II as control and pre-medication groups. Patients who did not react to the stimulus made by an explorer between the canine and first premolar and showing subjective lip and tongue numbness were included in the study. Result: All sub-groups showed statistically significant reduction in VAS score. However sub-groups V and VI (that is GG with and without pre-medication respectively) showed best improvement in initial severe pain in mandibular molars with irreversible pulpitis. Moreover, all pre-medication sub-groups showed better pain control compared to respective control groups. Conclusion: It was concluded that use of pre-medications in the form of combination of anxiolytics and analgesics improves the success rate of local anesthesia in teeth with irreversible pulpitis. Use of anxiolytics eases the patient in endodontic emergencies. Also use of GG along with pre-medication is the best method for effective pain management of acute pain in irreversible pulpitis.
Collapse
Affiliation(s)
- Pratibha Shetkar
- Department of Conservative Dentistry and Endodontics, Sinhgad Dental College and Hospital, Pune, Maharashtra, India
| | - Ganesh Ranganath Jadhav
- Department of Conservative Dentistry and Endodontics, Sinhgad Dental College and Hospital, Pune, Maharashtra, India
| | - Priya Mittal
- Department of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, New Delhi, India
| | - Saikalyan Surapaneni
- Department of Conservative Dentistry and Endodontics, Rural Dental College, Pravaranagar, Loni, Maharashtra, India
| | - Dheeraj Kalra
- Department of Public Health Dentistry, Sinhgad Dental College and Hospital, Pune, Maharashtra, India
| | - Mohan Sakri
- Department of Conservative Dentistry and Endodontics, KIMS Dental College and Hospital, Amalapuram, Andhra Pradesh, India
| | - A Basavaprabhu
- Department of Preventive and Pediatric Dentistry, Al-Badar Dental College, Davangere, Karnataka, India
| |
Collapse
|
37
|
Krithikadatta J, Sekar V, Sudharsan P, Velumurugan N. Influence of three Ni-Ti cleaning and shaping files on postinstrumentation endodontic pain: A triple-blinded, randomized, controlled trial. J Conserv Dent 2016; 19:311-6. [PMID: 27563177 PMCID: PMC4979275 DOI: 10.4103/0972-0707.186442] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This randomized, controlled trial evaluated the incidence of postinstrumentation pain on using two different rotary Ni–Ti and one reciprocating Ni–Ti cleaning and shaping systems. Materials and Methods: Asfter sample size estimation, a total of 152 patients were randomized to three groups (Group WO [WaveOne], Group PU [ProTaper Universal], and Group Mt [Mtwo]). Selection of patients was based on root curvature, periapical lesion, vitality, gender, and diagnosis of the patient. A similar clinical protocol was followed and endodontic treatment was performed. Pre- and post-instrumentation pain scores (2, 4, 6, 8, 12, 36, and 48 h) were recorded using visual analog scale score. Kruskal–Wallis test was done for overall comparison of the groups. Bonferroni-corrected Mann–Whitney test was done for pair-wise comparisons and Friedman test was done to compare pain between time points in each file system (P < 0.05). Results: All preinstrumentation pain values were higher than postinstrumentation pain values (P < 0.05). At 48 h, patients in Group WO experienced more pain compared to the other two groups. Pain scores of nonvital teeth were significantly higher when compared to vital teeth. Among nonvital teeth, patients in Group WO had early onset of pain at 6 h and lasted till 48 h, whereas pain started at 12 h and lasted till 36 and 48 h for Group Mt and Group PU, respectively. Conclusion: Patients treated with WaveOne files experienced more pain when compared to the other files. Nonvital teeth experienced more pain compared to vital teeth. Group Mt had the lowest postinstrumentation pain.
Collapse
Affiliation(s)
- Jogikalmat Krithikadatta
- Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospitals, Chennai, Tamil Nadu, India
| | - Vadhana Sekar
- Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospitals, Chennai, Tamil Nadu, India
| | | | - Natanasabapathy Velumurugan
- Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospitals, Chennai, Tamil Nadu, India
| |
Collapse
|
38
|
Joshi N, Mathew S, George JV, Hegde S, Bhandi S, Madhu KS. Comparative evaluation of the efficacy of two modes of delivery of Piroxicam (Dolonex(®)) for the management of postendodontic pain: A randomized control trial. J Conserv Dent 2016; 19:301-5. [PMID: 27563175 PMCID: PMC4979273 DOI: 10.4103/0972-0707.186454] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Alleviating pain is of utmost importance when treating patients with endodontic pain. AIM To compare and evaluate the efficacy of two modes of delivery of pretreatment Piroxicam (Dolonex(®), Pfizer) for the management of postendodontic pain. MATERIALS AND METHODS Sixty-six patients with symptomatic irreversible pulpitis were randomly divided into three groups of 22 subjects Group I - control group, no pharmacological intervention, Group II - patients received pretreatment oral Piroxicam (40 mg), Group III - patients received pretreatment intraligamentary injections totaling 0.4 mL of Piroxicam. Single visit endodontic therapy was performed by a single endodontist. Visual analogue scale was used to record pain before treatment and 4, 8, 12, 24, and 48 h postoperatively. Mann-Whitney U-test and Kruskal-Wallis tests were used to analyze the data. RESULTS The patients in Groups II and III perceived less postendodontic pain as compared to Group I (P < 0.05), at all the time intervals. At 12, 24, and 48 h, pain experience in patients of Group III was significantly less. CONCLUSIONS Intraligamentary mode of delivery of Piroxicam was more efficacious.
Collapse
Affiliation(s)
- Nidhi Joshi
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, M S Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - Sylvia Mathew
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, M S Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - John V George
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, M S Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - Swaroop Hegde
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, M S Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - Shilpa Bhandi
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, M S Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - K S Madhu
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, M S Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| |
Collapse
|
39
|
Elzaki WM, Abubakr NH, Ziada HM, Ibrahim YE. Double-blind Randomized Placebo-controlled Clinical Trial of Efficiency of Nonsteroidal Anti-inflammatory Drugs in the Control of Post-endodontic Pain. J Endod 2016; 42:835-42. [DOI: 10.1016/j.joen.2016.02.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 02/23/2016] [Accepted: 02/26/2016] [Indexed: 12/18/2022]
|
40
|
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]
|
41
|
Metri M, Hegde S, Bhandi S. Effect of pretreatment diclofenac sodium on postendodontic pain: A randomised controlled trial. J Conserv Dent 2016; 19:7-10. [PMID: 26957785 PMCID: PMC4760019 DOI: 10.4103/0972-0707.173183] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Effective management of endodontic pain represents a continuing challenge. Many of the dental professionals are facing significant problems associated with postendodontic pain. Hence, the postendodontic pain has to be prevented at its primary stage without waiting for its occurrence. This trial was carried out to evaluate the use of a preoperative, single oral dose of diclofenac sodium for the prevention and control of postendodontic pain. MATERIALS AND METHODS Fifty patients were randomly assigned to two groups, placebo and diclofenac sodium (100 mg). The medications were administered 30 min before the start of standard endodontic treatment. Postoperative pain was assessed after 6, 12, and 24 h by using a visual analog scale. RESULTS Postendodontic pain showed a statistically significant difference between both groups at 6 and 12 h (P < 0.05) and there was no significant difference at 24 h. CONCLUSION Postendodontic pain was substantially reduced by preoperative administration of single oral dose of diclofenac sodium. It is thus possible to conclude that these favorable results might help to prevent postendodontic pain, especially in patients with a low pain threshold.
Collapse
Affiliation(s)
- Malasiddappa Metri
- Department of Conservative Dentistry and Endodontics, PMNM Dental College and Hospital, Bagalkot, Karnataka, India
| | - Swaroop Hegde
- Department of Conservative Dentistry and Endodontics, M S Ramaiah Dental College and Hospital, Bengaluru, Karnataka, India
| | - Shilpa Bhandi
- Department of Conservative Dentistry and Endodontics, M S Ramaiah Dental College and Hospital, Bengaluru, Karnataka, India
| |
Collapse
|
42
|
Pasqualini D, Corbella S, Alovisi M, Taschieri S, Del Fabbro M, Migliaretti G, Carpegna GC, Scotti N, Berutti E. Postoperative quality of life following single-visit root canal treatment performed by rotary or reciprocating instrumentation: a randomized clinical trial. Int Endod J 2015; 49:1030-1039. [DOI: 10.1111/iej.12563] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 10/12/2015] [Indexed: 12/01/2022]
Affiliation(s)
- D. Pasqualini
- Department of Surgical Sciences; Dental School; University of Turin; Turin Italy
| | - S. Corbella
- Department of Biomedical; Surgical and Dental Sciences; Oral Health Research Centre; Università degli Studi di Milano; Milan Italy
- IRCCS Istituto Ortopedico Galeazzi; Milan Italy
| | - M. Alovisi
- Department of Surgical Sciences; Dental School; University of Turin; Turin Italy
| | - S. Taschieri
- Department of Biomedical; Surgical and Dental Sciences; Oral Health Research Centre; Università degli Studi di Milano; Milan Italy
- IRCCS Istituto Ortopedico Galeazzi; Milan Italy
| | - M. Del Fabbro
- Department of Biomedical; Surgical and Dental Sciences; Oral Health Research Centre; Università degli Studi di Milano; Milan Italy
- IRCCS Istituto Ortopedico Galeazzi; Milan Italy
| | - G. Migliaretti
- Department of Public Health and Microbiology; University of Turin; Turin Italy
| | - G. C. Carpegna
- Department of Surgical Sciences; Dental School; University of Turin; Turin Italy
| | - N. Scotti
- Department of Surgical Sciences; Dental School; University of Turin; Turin Italy
| | - E. Berutti
- Department of Surgical Sciences; Dental School; University of Turin; Turin Italy
| |
Collapse
|
43
|
Zachar JJ. Should retention of a tooth be an important goal of dentistry? How do you decide whether to retain and restore a tooth requiring endodontic treatment or to extract and if possible replace the tooth? AUST ENDOD J 2015; 41:2-6. [PMID: 25850364 DOI: 10.1111/aej.12102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Whether a questionable tooth should be treated endodontically or extracted, is still a dilemma clinicians encounter every day. With advances in technology such as implantology, deciding whether or not to save a tooth is still not clear. Local site-specific factors and patient-related factors that may affect the longevity of a particular tooth should be considered in preparing the treatment plan. Long-term success rates for root canal therapy and implant-supported crowns demonstrate similar outcomes. A choice between these alone is not sufficient in the decision-making process. Only following a systematic evaluation of the reasons for and against tooth retention as directed by each individual case, can the best option be decided.
Collapse
Affiliation(s)
- Jessica J Zachar
- School of Dentistry and Health Sciences, Charles Sturt University, Orange, New South Wales, Australia
| |
Collapse
|
44
|
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.
Collapse
Affiliation(s)
- Iftikhar Akbar
- Assistant Professor, Department of Conservative Dentistry, College of Dentistry, Aljouf University , Sakaka, Saudi Arabia
| |
Collapse
|
45
|
Degree of Patient Pain, Complications, and Satisfaction after Root Canal Treatment or a Single Implant: A Preliminary Prospective Investigation. J Endod 2014; 40:1940-5. [DOI: 10.1016/j.joen.2014.08.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 07/19/2014] [Accepted: 08/26/2014] [Indexed: 11/19/2022]
|
46
|
Ramamoorthi S, Nivedhitha MS, Divyanand MJ. Comparative evaluation of postoperative pain after using endodontic needle and EndoActivator during root canal irrigation: A randomised controlled trial. AUST ENDOD J 2014; 41:78-87. [PMID: 25195661 DOI: 10.1111/aej.12076] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The purpose of this study was to evaluate and compare the postoperative level of pain after activation of irrigants using EndoActivator with conventional needle irrigation during root canal therapy. In this prospective randomised clinical trial, 72 symptomatic irreversible pulpitis patients were selected. Based on block randomisation after routine root canal preparation, patients were assigned to two groups. In group EN, procedures were performed with endodontic irrigating needle (n = 36) while group EA received activation using EndoActivator (n = 36) in the final irrigation protocol. All the participants were called through phone at 8, 24 and 48 h to analyse pain score using visual analogue scale. Those patients who developed pain were prescribed ibuprofen 200 mg. Pain score and frequency of tablet intake were recorded and statistically analysed. Results showed that group EA resulted in significantly less postoperative pain and analgesics intake than group EN. In conclusion, within the limitations of this study, the activation of irrigants using EndoActivator can be considered an effective method for reducing postoperative pain.
Collapse
Affiliation(s)
- Surendar Ramamoorthi
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College, Saveetha University, Chennai, Tamilnadu, India
| | - Malli Sureshbabu Nivedhitha
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College, Saveetha University, Chennai, Tamilnadu, India
| | - Madras Jeyaprakash Divyanand
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College, Saveetha University, Chennai, Tamilnadu, India
| |
Collapse
|
47
|
Arias A, de la Macorra JC, Hidalgo JJ, Azabal M. Predictive models of pain following root canal treatment: a prospective clinical study. Int Endod J 2013; 46:784-93. [DOI: 10.1111/iej.12059] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 12/14/2012] [Indexed: 11/29/2022]
Affiliation(s)
- A. Arias
- Conservative Dentistry Department; School of Dentistry, Complutense University of Madrid; Madrid; Spain
| | - J. C. de la Macorra
- Conservative Dentistry Department; School of Dentistry, Complutense University of Madrid; Madrid; Spain
| | - J. J. Hidalgo
- Conservative Dentistry Department; School of Dentistry, Complutense University of Madrid; Madrid; Spain
| | | |
Collapse
|
48
|
Shantiaee Y, Mahjour F, Dianat O. Efficacy comparison of periapical infiltration injection of dexamethasone, morphine and placebo for postoperative endodontic pain. Int Dent J 2012; 62:74-8. [PMID: 22420475 DOI: 10.1111/j.1875-595x.2011.00092.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of periapical infiltration injection of dexamethasone and morphine in reducing postoperative endodontic pain. METHOD Ninety patients participated in this double-blind randomised controlled clinical trial. They were referred to the dental school of Shahid Beheshti Medical University, Tehran, Iran for conventional endodontic treatment of molar teeth. The canals of each tooth were completely prepared with cleansing and shaping. The patients were randomly divided into three experimental groups to receive dexamethasone, morphine or normal saline (1 mL). Patients were then instructed to complete a pain diary 4, 8, 24 and 48 h after the appointment. Statistical analysis consisted of chi-squared test, analysis of variance and Kruskal-Wallis test. RESULTS There was a statistically significant correlation between dexamethasone or morphine treatment and decreased levels and incidence of endodontic pain at 4, 8 and 24 h, but not at 48 h (P < 0.05). It was also observed that dexamethasone was significantly more effective (56.7% no pain) than morphine (43.3% no pain). CONCLUSION Periapical infiltration of dexamethasone and morphine led to a considerable decrease in postoperative endodontic pain during the first 24 h after operation. Dexamethasone was more effective than morphine in pain reduction.
Collapse
Affiliation(s)
- Yazdan Shantiaee
- Endodontic Department, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | |
Collapse
|
49
|
Efficacy of Ibuprofen and Ibuprofen/Acetaminophen on Postoperative Pain in Symptomatic Patients with a Pulpal Diagnosis of Necrosis. J Endod 2011; 37:1608-12. [DOI: 10.1016/j.joen.2011.08.026] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 06/09/2011] [Accepted: 08/30/2011] [Indexed: 11/17/2022]
|
50
|
Mehrvarzfar P, Abbott PV, Saghiri MA, Delvarani A, Asgar K, Lotfi M, Karamifar K, Kharazifard MJ, Khabazi H. Effects of three oral analgesics on postoperative pain following root canal preparation: a controlled clinical trial. Int Endod J 2011; 45:76-82. [DOI: 10.1111/j.1365-2591.2011.01950.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|