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Nagpal R, Taneja S, Bhalla VK. The effect of bioactive glass-based, bioceramic based and epoxy amine resin based root canal sealers on post-obturation pain: A double blinded randomized controlled trial. JOURNAL OF CONSERVATIVE DENTISTRY AND ENDODONTICS 2024; 27:591-597. [PMID: 38989484 PMCID: PMC11232765 DOI: 10.4103/jcde.jcde_115_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/02/2024] [Accepted: 04/22/2024] [Indexed: 07/12/2024]
Abstract
Aim The aim of this study was to compare the effect of two calcium silicate-based and an epoxy resin-based root canal sealers on postoperative pain and analgesic intake following single-visit root canal treatment. Materials and Method Ninety patients with at least one first or second molar tooth diagnosed as symptomatic irreversible pulpitis and symptomatic apical periodontitis were selected and allocated into three groups (n=30) according to the sealer used. Root canals were prepared using Protaper Gold instruments (Dentsply Sirona) in a crown down technique and irrigated with 2.5% NaOCl (Calyx, India) and saline solution. Root canal filling was then accomplished with a single cone obturation technique and treated in a single visit by the same endodontist. Patients were told to use a Visual Analog Scale (VAS) to rate their postoperative pain severity as none, minimal, moderate, or severe after 6 h, 24 h, 48 h, 5 days and 7 days following obturation using the appropriate sealers. The need for analgesic intake was also recorded. The data were statistically analyzed. Results Results showed a significant difference among the studied groups. Bio-C Sealer Ion+ reported the least pain score followed by Nishika Canal Sealer BG and AH plus sealer at all the time intervals recorded. The intergroup analysis, revealed was a significant difference in postoperative pain at 6 h (p=0.000) and 24 h (p = 0.028), but not at 48 h, 5 day or 7 days (P > 0.05). VAS ratings for all the three groups decreased over time. Also, there were significant differences between the means of analgesic intake among 3 groups (p=0.022). Analgesic intake in group BIO-C Sealer Ion+ is significantly lesser than AH Plus and Nishika Canal Sealer BG group. Conclusion Calcium silicate-based sealer (Nishika Canal Sealer BG and Bio-C Sealer Ion+) resulted in significantly lower levels of pain as compared to epoxy resin-based sealer (AH Plus) at 6h and 24-h interval, there was no significant difference in postoperative pain occurrence at 48-h, 5 day and 7-day period. The analgesic intake in Bio-C Sealer Ion+ group is significantly lesser than Nishika Canal Sealer BG and AH Plus group.
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Affiliation(s)
- Ritesh Nagpal
- Department of Conservative Dentistry and Endodontics, ITS Dental College, Ghaziabad, Uttar Pradesh, India
| | - Sonali Taneja
- Department of Conservative Dentistry and Endodontics, ITS Dental College, Ghaziabad, Uttar Pradesh, India
| | - Vidhi Kiran Bhalla
- Department of Conservative Dentistry and Endodontics, ITS Dental College, Ghaziabad, Uttar Pradesh, India
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Rodrigues GA, Hizatugu R, Bronzato JD, de-Jesus-Soares A, Frozoni M. Effect of preemptive use of a nonsteroidal anti-inflammatory drug and a corticosteroid on the efficacy of inferior alveolar nerve blockade and postoperative pain control in endodontic treatment of molars with symptomatic pulpitis: A randomized double-blind placebo-controlled clinical trial. Int Endod J 2024; 57:520-532. [PMID: 38279778 DOI: 10.1111/iej.14030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 01/28/2024]
Abstract
AIM The anaesthetic success rate of an inferior alveolar nerve block (IANB) in mandibular molars with irreversible symptomatic pulpitis can be low, and postoperative pain control in teeth with this diagnosis can be challenging. This study aimed to evaluate the influence of preemptive use of dexamethasone and oral potassium diclofenac on the success of IANB. The influence of these drugs on the intensity of postoperative pain was assessed as a secondary outcome. METHODOLOGY Eighty-four patients with mandibular molars diagnosed with irreversible symptomatic pulpitis recorded preoperative pain intensity using a cold thermal test and a modified Numerical Rating Scale (mNRS). Sixty minutes before the anaesthetic procedure, patients were randomly assigned to one of three groups based on the medication they received: dexamethasone (4 mg), diclofenac potassium (50 mg), or placebo. All patients received IANB with 4% articaine (1:200 000 epinephrine), and 15 min later, they were evaluated for pain intensity using the cold thermal test. Anaesthetic success was analysed. The pain intensity was then recorded, and endodontic treatment and provisional restoration of the tooth were executed in a single session. Patients were monitored for 6, 12, 24, 48 and 72 h using the mNRS to assess the intensity of postoperative pain. RESULTS There was a statistically significant increase in anaesthetic success when 4 mg dexamethasone (39.3%) or 50 mg diclofenac potassium (21.4%) was used compared to the placebo group (3.6%) (p < .001), with no significant difference between the two drugs. Regarding postoperative pain, dexamethasone was superior to placebo at 6 h (p < .001), with diclofenac having an intermediate behaviour, not differing between dexamethasone and placebo (p > .05). There was no significant difference amongst the groups at 12 h (p > .05). At 24, 48 and 72 h, the effectiveness of dexamethasone and diclofenac were comparable, and both were superior to placebo (p < .001). CONCLUSION The use of dexamethasone or diclofenac potassium was favourable in terms of increasing the success rate of inferior alveolar nerve block in cases of mandibular molars with irreversible symptomatic pulpitis and decreased the occurrence of postoperative pain when compared to the use of a placebo.
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Affiliation(s)
| | - Ruy Hizatugu
- Department of Endodontics, Paulista Association of Dental Surgeons School of Dentistry, São Paulo, SP, Brazil
| | - Juliana Delatorre Bronzato
- Division of Endodontics, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas, Piracicaba, SP, Brazil
| | - Adriana de-Jesus-Soares
- Division of Endodontics, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas, Piracicaba, SP, Brazil
| | - Marcos Frozoni
- Department of Endodontics, São Leopoldo Mandic School of Dentistry, Campinas, SP, Brazil
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Ballal NV, El-Karim I, Duncan HF. Postoperative pain following irrigation. Int Endod J 2024; 57:502-504. [PMID: 38576232 DOI: 10.1111/iej.14048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Affiliation(s)
- Nidambur Vasudev Ballal
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ikhlas El-Karim
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, UK
| | - Henry F Duncan
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College Dublin, University of Dublin, Dublin, Ireland
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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.
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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.
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Danaci Z, Yeter KY. Evaluation of Pain Following the Use of Different Single-file Glide Path Systems: A Randomized Clinical Trial. J Endod 2024; 50:120-128. [PMID: 37924939 DOI: 10.1016/j.joen.2023.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/17/2023] [Accepted: 10/29/2023] [Indexed: 11/06/2023]
Abstract
INTRODUCTION This study aimed to evaluate postoperative pain intensity following glide-path preparation using the ProGlider (PG) and WaveOne Gold Glider (WOGG) systems in asymptomatic teeth with necrotic pulp and periapical lesions. METHODS In this randomized clinical trial (ClinicalTrials.gov ID: NCT05955742) maxillary and mandibular molars with asymptomatic apical periodontitis of 78 patients (age, 18-65 years) were included. The patients were randomly divided into 3 groups: control (n = 26), PG (n = 26), and WOGG (n = 26). All the systems were used according to the manufacturer's instructions, and all the root canal treatments were completed by a single operator within 2 sessions. Postoperative pain was assessed using a numerical rating scale at 6, 12, 18, 24, 48, and 72 hours. Analgesics administered and abscess formation were also recorded. Statistical analyses were performed using the Mann-Whitney U, Bonferroni Dunn, Friedman, Chi-square, and Fisher exact tests. RESULTS The postoperative pain at 12 and 18 hours was lower in the WOGG group than in the other groups (P < .05). The postoperative pain scores at 6 and 24 hours were higher among women than among men (P < .05). The highest postoperative pain scores were observed at 6 hours (P < .05). CONCLUSIONS The WOGG glide-path file system was associated with less postoperative pain than the other systems. Abscess formation and analgesic use were higher in the PG group than in the other groups. Postoperative pain was greater in women than in men.
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Affiliation(s)
- Zeliha Danaci
- Department of Endodontics, Eskisehir Osmangazi University, Faculty of Dentistry, Eskişehir, Turkey
| | - Kübra Yeşildal Yeter
- Department of Endodontics, Eskisehir Osmangazi University, Faculty of Dentistry, Eskişehir, Turkey.
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Sangalli L, Souza LC, Letra A, Shaddox L, Ioannidou E. Sex as a Biological Variable in Oral Diseases: Evidence and Future Prospects. J Dent Res 2023; 102:1395-1416. [PMID: 37967405 DOI: 10.1177/00220345231197143] [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] [Indexed: 11/17/2023] Open
Abstract
The interest of the scientific community on sex and gender differences in health and disease has increased substantially over the past 25 to 30 y as a result of a long process of events and policies in the biomedical field. This is crucial as compelling evidence from human and animal model studies has demonstrated that sex and gender influence health, molecular and cellular processes, and response and predisposition to disease. The present scoping review aims to provide a synthesis of sex differences in oral diseases, ranging from periodontal disease to orofacial pain conditions, from risk of caries development to apical periodontitis. Overall, findings from this review further support a role for sexual dimorphism influencing disease predisposition and/or progression in oral diseases. Of note, this review also highlights the lack of consideration of additional factors such as gender and other psychosocial and external factors potentially influencing oral health and disease. New conceptual frameworks capable of capturing multiple fundamental domains and measurements should be developed in clinical and preclinical studies to inform sex-based individualized preventive and treatment strategies.
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Affiliation(s)
- L Sangalli
- College of Dental Medicine-Illinois, Midwestern University, Downers Grove, IL, USA
| | - L C Souza
- Center for Craniofacial Research, Department of Endodontics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - A Letra
- Departments of Oral and Craniofacial Sciences, Endodontics, and Center for Craniofacial and Dental Genetics, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA
| | - L Shaddox
- Center for Oral Health Research, Division of Periodontology, University of Kentucky, College of Dentistry, Lexington, KY, USA
| | - E Ioannidou
- UCSF, Department of Orofacial Sciences, San Francisco, CA, USA
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Abdelnaby P, Ibrahim M, ElBackly R. In vitro evaluation of filling material removal and apical debris extrusion after retreatment using Reciproc blue, Hyflex EDM and ProTaper retreatment files. BMC Oral Health 2023; 23:902. [PMID: 37990209 PMCID: PMC10664678 DOI: 10.1186/s12903-023-03579-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/25/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVES To evaluate the amount of remaining filing material and apical debris extrusion after retreatment using Reciproc Blue, Hyflex EDM and ProTaper Retreatment Files. MATERIALS AND METHODS Thirty-six extracted permanent mandibular first molars with moderately curved mesial roots were selected. Mesiobuccal canals were prepared using the ProTaper Next system up to size X2 and filled using gutta-percha and Adseal sealer via cold lateral compaction. Teeth were randomly divided into three equal groups (n = 12): Group 1: Reciproc Blue (RB)(VDW, Germany), Group 2: Hyflex EDM (HEDM)(Coltene/Whaledent, Switzerland), Group 3: ProTaper Universal Retreatment file system + ProTaper Next file system (PTUR + PTN)( Dentsply Maillefer, Switzerland). Eppendorf tubes were used to collect the apically extruded debris. Cone-beam computed tomographic scans were taken prior to and after retreatment and the volume of remaining filling material was assessed at the coronal, middle and apical levels. Statistical analysis was performed using the Kruskal-Wallis test, Friedman's test and Wilcoxon Sign Rank test. Significance level was set at p value 0.05. RESULTS There were no statistically significant differences among the three groups in the reduction of the volume of the filling material or in the amount of apically extruded debris. CONCLUSION All the tested filing systems showed similar efficacy in removing the filling material, however, none of them could achieve its complete removal. Apical extrusion of debris occurred with all the systems used with no significant difference between the three groups.
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Affiliation(s)
- Passent Abdelnaby
- Conservative Dentistry Department, MS Student, Endodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Mohamed Ibrahim
- Conservative Dentistry Department, Endodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Rania ElBackly
- Conservative Dentistry Department, Endodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
- Tissue Engineering Laboratories, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
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Alhilou AM, Al-Moraissi EA, Bakhsh A, Christidis N, Näsman P. Pain after emergency treatments of symptomatic irreversible pulpitis and symptomatic apical periodontitis in the permanent dentition: a systematic review of randomized clinical trials. FRONTIERS IN ORAL HEALTH 2023; 4:1147884. [PMID: 37920592 PMCID: PMC10618681 DOI: 10.3389/froh.2023.1147884] [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: 01/19/2023] [Accepted: 09/26/2023] [Indexed: 11/04/2023] Open
Abstract
Background Symptomatic irreversible pulpitis (SIP) or symptomatic apical periodontitis (SAP) are two painful conditions often warranting emergency treatment. The most common emergency treatments supported by evidence are pulpotomy and pulpectomy and are normally performed under time-constrained circumstances. However, there is no strong evidence of which treatment suggested in literature a clinician can use to reduce endodontic pain effectively. Therefore, the aim of this systematic review is to investigate the present knowledge on postoperative pain related to the two types of emergency treatments available for treating SIP and SAP. Methods Randomized controlled trials investigating postoperative pain after emergency treatments (pulpotomy and/or pulpectomy) on permanent dentition with signs and symptoms of SIP and/or SAP were searched in three major databases from 1978 until 2022. Risk of bias was assessed with Cochrane's tool. Results Only five studies fulfilled the inclusion criteria. The included studies indicated that pulpotomy and pulpectomy are both suitable treatment options for SAP and SIP, as they provide sufficient alleviation of pain in permanent dentition. However, inconsistent results were found between the included trials on which emergency treatment is more effective in reducing pain. Cochrane's tool revealed that the studies had a low risk of bias. Limitations found in the design of the included randomized control trials decreased the level of evidence. None of the included studies accounted for essential confounding variables, such as factors affecting pain (including the psychological aspects). Moreover, possible non-odontogenic pain was not assessed, and therefore, it was not excluded; hence, affecting the internal validity of the studies. Conclusion There are controversies within the available randomized control trials on which treatment is most effective in reducing emergency pain. This could be due to some weaknesses in the design of the clinical trials. Thus, further well-designed studies are warranted to draw conclusions on which emergency treatment is more effective in reducing pain. Systematic Review Registration PROSPERO (CRD42023422282).
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Affiliation(s)
- Abdelrahman M. Alhilou
- Department of Restorative Dentistry, College of Dentistry, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Essam Ahmed Al-Moraissi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen
| | - Abdulaziz Bakhsh
- Department of Restorative Dentistry, College of Dentistry, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Nikolaos Christidis
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neurosciences, Huddinge, Sweden
| | - Peggy Näsman
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
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Mokhtari H, Milani AS, Zand V, Shakuie S, Nazari L. The effect of different concentrations and temperatures of sodium hypochlorite irrigation on pain intensity following endodontic treatment of mandibular molars with irreversible pulpitis: A randomized, double-blind clinical trial. Clin Exp Dent Res 2023; 9:859-867. [PMID: 37345724 PMCID: PMC10582240 DOI: 10.1002/cre2.754] [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: 10/06/2022] [Revised: 05/17/2023] [Accepted: 06/09/2023] [Indexed: 06/23/2023] Open
Abstract
OBJECTIVES This study aimed to determine the severity of pain after endodontic treatment of mandibular molars with irreversible pulpitis following the use of sodium hypochlorite (NaOCl) at different temperatures and concentrations. METHODS In this randomized, controlled clinical trial, 72 patients with mandibular molars with irreversible pulpitis were randomly assigned to six groups. The teeth were anesthetized and the root canals were prepared. During the instrumentation, the root canals were irrigated with NaOCl solution at concentrations of 0.5% and 1% and temperatures of 2.5°C, 22°C, and 40°C, 2.5°C were achieved through cryotherapy. Assessment of pain was conducted before, immediately after, and 3, 24, 48, and 72 h after treatment. After obturation, the patients recorded their pain intensity at different time intervals on the visual analog scale (VAS) and reported the number of analgesics tablets they used. The frequency of analgesics tablets and their effect on pain sensation was recorded in the second part of the form. Repeated measures two-way analysis of variance test was used to compare the trend of pain changes over time between two intervals of time in each group. Friedman's nonparametric test was used to compare the intragroup mean score of pain over time and Kruskal-Wallis for comparing the intergroup mean score. RESULTS Changes in VAS pain scores of all the groups were significant over time (p < .001). Pain in all the groups decreased immediately after treatment and increased 3 h after treatment. There were no significant differences in pain ratings and the number of analgesics tablets used in the groups of NaOCl with different concentrations and temperatures over time. CONCLUSIONS Within the study's limitations, we concluded that there was no significant difference between concentrations of 0.5%, and 1% and temperatures of 2.5°C, 22°C, and 40°C in pain intensity following endodontic treatment of mandibular molars with irreversible pulpitis.
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Affiliation(s)
- Hadi Mokhtari
- Department of Endodontic, Faculty of DentistryTabriz University of Medical SciencesTabrizIran
| | - Amin Salem Milani
- Department of Endodontic, Faculty of DentistryTabriz University of Medical SciencesTabrizIran
| | - Vahid Zand
- Department of Endodontic, Faculty of DentistryTabriz University of Medical SciencesTabrizIran
| | - Sahar Shakuie
- Department of Endodontic, Faculty of DentistryTabriz University of Medical SciencesTabrizIran
| | - Leila Nazari
- Department of Endodontic, Faculty of DentistryTabriz University of Medical SciencesTabrizIran
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10
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Bürklein S, Arias A. Effectiveness of root canal instrumentation for the treatment of apical periodontitis: A systematic review and meta-analysis. Int Endod J 2023; 56 Suppl 3:395-421. [PMID: 35670625 DOI: 10.1111/iej.13782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The development of endodontic instruments has rapidly advanced, but their impact on endodontic outcome parameters remains unclear. OBJECTIVES This systematic review aimed to answer the following PICOT questions: In patients with apical periodontitis (P) what is the effectiveness of root canal instrumentation ([Q1] performed with contemporary techniques [I] in comparison with 'traditional' techniques [C]] and ([Q2] performed with contemporary engine-driven NiTi instruments [I] compared with other types of contemporary engine-driven NiTi instruments [with different design and/or technology] [C]) in terms of clinical and patient-related outcomes (O)? METHODS After PROSPERO protocol registration, a literature search was conducted using Clarivate Analytics' Web of Science, Scopus, PubMed and Cochrane Central Register of Controlled Trials. Grey literature and major journal contents were examined. Two independent reviewers performed the study selection, data extraction and appraisal of included studies. A quantitative meta-analysis was considered, and statistical heterogeneity and overall quality of evidence were assessed. RESULTS Nine studies were identified showing substantial methodological differences. Five studies addressed PICOT 1 and three PICOT 2, whereas one study aimed both. A random-effects meta-analysis model was considered for the outcome 'radiographic evidence of normal periodontal ligament space or reduction of apical lesion size' (PICOT 1) based on three studies with 332 evaluable participants and showed that contemporary instrumentation was associated with a more favourable outcome (p = .005) compared with root canal preparation with stainless steel instruments (odds ratio = 2.07 [95%-confidence interval = 1.25-3.44]) with no evidence of statistical heterogeneity (I2 = 0%) but low quality of evidence. DISCUSSION Albeit a few studies fulfilled eligible criteria, no study had a low risk of bias. Compelling evidence indicating significantly different outcome rates using different endodontic instruments when treating teeth with apical periodontitis is lacking. CONCLUSIONS In terms of healing, the results of the meta-analysis determined the higher effectiveness of root canal instrumentation performed with contemporary techniques in comparison with conventional stainless steel instruments in patients with apical periodontitis followed for a minimum of 1 year with low quality of evidence. No differences could be demonstrated between preparations with traditional stainless steel and contemporary NiTi instruments for other clinical and patient-related outcomes. REGISTRATION PROSPERO (CRD42021274642).
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Affiliation(s)
| | - Ana Arias
- School of Dentistry, Complutense University, Madrid, Spain
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11
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Fatima A, Khan UN, Nazir A, Akhtar M, Rana SAA, Kashif M. Frequency and Types of Periapical Radiographic Lesions Associated With Pulpitis in a Tertiary Care Hospital. Cureus 2023; 15:e42529. [PMID: 37637624 PMCID: PMC10458404 DOI: 10.7759/cureus.42529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 08/29/2023] Open
Abstract
Objective This cross-sectional study aimed to determine the frequency and types of periapical radiographic lesions (PARLs) associated with pulpitis in patients visiting a tertiary care hospital. Methodology A sample of patients diagnosed with pulpitis, aged 18 years or older, was recruited following a convenient sampling technique. Clinical examinations were conducted to confirm the diagnosis, and radiographic evaluations, including periapical (PA), occlusal, orthopantomogram (OPG), and cone beam computed tomography (CBCT) radiographs were obtained. The radiographs were evaluated for the presence of PA lesions, and the type, size, and location of the lesions were documented. Data were analyzed using IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp., Armonk, NY, USA). Results A total of 120 patients (equal gender ratio) with a mean age of 32.6 ± 6.39 years participated in the study. PA views were the most frequently performed radiographic view (86.7%), followed by occlusal views (8.3%). The most prevalent radiographic lesion was the widening of the periodontal ligament (PDL) space (34.2%), followed by PA granuloma (17.5%) and PA cyst (10.8%). The most frequently encountered diagnosis was pulpitis (51.7%), followed by irreversible pulpitis with apical periodontitis (25.8%). Education level, swelling, pus discharge, medicine history, and tooth wear showed statistically significant associations (P ≤ 0.05) with the variables under investigation. Conclusions The most common lesions observed were widening of the PDL space, PA granuloma, and PA cyst. The findings contribute to the local epidemiological and clinical data, enriching the existing database. Understanding the prevalence and characteristics of PA lesions associated with pulpitis can aid in accurate diagnosis and treatment planning for patients with pulpal pathologies.
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Affiliation(s)
- Arzoo Fatima
- Operative Dentistry, Bakhtawar Amin Medical and Dental College, Multan, PAK
| | - Ushwa N Khan
- Operative Dentistry, Bakhtawar Amin Medical and Dental College, Multan, PAK
| | - Amara Nazir
- Operative Dentistry, Bakhtawar Amin Medical and Dental College, Multan, PAK
| | - Mobeen Akhtar
- Operative Dentistry, Nishtar Institute of Dentistry (NID), Multan, PAK
| | | | - Muhammad Kashif
- Oral Pathology, Bakhtawar Amin Medical and Dental College, Multan, PAK
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Ismail HH, Obeid M, Hassanien E. Efficiency of diode laser in control of post-endodontic pain: a randomized controlled trial. Clin Oral Investig 2023; 27:2797-2804. [PMID: 36662285 PMCID: PMC10264274 DOI: 10.1007/s00784-023-04864-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/10/2023] [Indexed: 01/21/2023]
Abstract
OBJECTIVES As post-endodontic pain control is one of the main targeted addressed in endodontics, our aim was delignated to compare two different methods for low-level laser application utilizing diode laser: low-level laser therapy (LLLT) and laser-activated irrigation (LAI) in the control of post-endodontic pain. MATERIALS AND SUBJECTS A total of 180 patients received single-visit root canal treatment; they were randomly allocated into 3 equal groups. Group I received LAI, group II received LLLT, and group III served as control with normal root canal treatment and mock laser intervention (ML group). Postoperative pain was recorded using visual analogue scale (VAS) after 24, 48, and 72 h. Data were tabulated and statistically analyzed. RESULTS At 24 h, there was a statistically significant difference between median pain scores in the three groups (P value < 0.001) with ML group scored highest score followed by LAI and then LLLT group. At 48 h, there was a statistically significant difference between the three groups (P value < 0.001), with ML group scoring highest median pain scores while LLLT and LAI showed statistical insignificant scores. At 72 h, there was no statistically significant difference between the 3 groups (P value = 0.179). CONCLUSION LLLT is superior to LAI and ML group in the control of immediate postoperative pain after 24 h while after 48 h both LAI and LLLT were equally effective, but they still showed significant differences when compared to ML group. CLINICAL RELEVANCE Diode laser can be used by clinicians as it decreases the post-endodontic pain in patients with symptomatic apical periodontitis undergoing endodontic treatment.
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Affiliation(s)
- Hend H Ismail
- Dept of Endodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Maram Obeid
- Dept of Endodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt.
| | - Ehab Hassanien
- Dept of Endodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
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Mehra D, Sinha DJ, Singh S, Verma N, Rani P, Parvez B. Comparison of single and multiple file rotary endodontic instruments for debris and irrigant extrusion: An in vitro study. J Conserv Dent 2023; 26:288-291. [PMID: 37398865 PMCID: PMC10309133 DOI: 10.4103/jcd.jcd_62_23] [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: 01/24/2023] [Revised: 02/04/2023] [Accepted: 03/06/2023] [Indexed: 07/04/2023] Open
Abstract
Aim The aim of this study was to assess and compare the quantity of apically debris which was extruded apically by TruNatomy (TN), ProTaper Next (PTN), HyFlex electric discharge machining (EDM), and HyFlex controlled memory (CM), following root canal preparation. Materials and Methods Sixty extracted single-canal mandibular premolars were used. The root canal preparation was done with TN, HyFlex EDM, PTN, or HyFlex CM files. The preweight debris, which was extruded apically, was collected in the Eppendorf tube and later on incubated at 670°C for 3 days and weighed again to record the extruded debris. Results The result showed that there was a significant reduction in debris extrusion by TN system, followed by PTN system, HyFlex EDM, and maximum extrusion in HyFlex CM (P < 0.05). Between the PTN and TN groups as well as between the HyFlex EDM and HyFlex CM groups, statistically significant difference was not observed (P > 0.05). Conclusion Apical debris extrusion is the inherent nature of the all file systems. Nevertheless, the TN file system produced substantially minimum debris extrusion among other systems compared in the study.
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Affiliation(s)
- Deepika Mehra
- Department of Conservative Dentistry and Endodontics, Inderprastha Dental College and Hospital, Ghaziabad, Uttar Pradesh, India
| | - Dakshita Joy Sinha
- Department of Conservative Dentistry and Endodontics, Inderprastha Dental College and Hospital, Ghaziabad, Uttar Pradesh, India
| | - Sarita Singh
- Department of Conservative Dentistry and Endodontics, Inderprastha Dental College and Hospital, Ghaziabad, Uttar Pradesh, India
| | - Neha Verma
- Department of Conservative Dentistry and Endodontics, Inderprastha Dental College and Hospital, Ghaziabad, Uttar Pradesh, India
| | - Priyanka Rani
- Department of Conservative Dentistry and Endodontics, Inderprastha Dental College and Hospital, Ghaziabad, Uttar Pradesh, India
| | - Beenish Parvez
- Department of Conservative Dentistry and Endodontics, Inderprastha Dental College and Hospital, Ghaziabad, Uttar Pradesh, India
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Pereira RP, Bramante CM, Duarte MAH, Alcalde MP, Piai CDGS, Vivan RR. Postoperative pain after using passive ultrasonic irrigation and EasyClean device, irrigation activation techniques: a randomized clinical trial. J Endod 2023:S0099-2399(23)00211-X. [PMID: 37068622 DOI: 10.1016/j.joen.2023.04.002] [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: 02/02/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/19/2023]
Abstract
INTRODUCTION This randomized clinical trial aimed to compare postoperative pain after the use of two different irrigation activation techniques, passive ultrasonic irrigation and the EasyClean device. METHODS Sixty-six single-rooted teeth diagnosed with asymptomatic pulp necrosis and apical periodontitis were randomly assigned to two experimental groups (n=33), which differed in the irrigation activation technique. Postoperative pain levels were assessed after 24, 48, and 72 hours using a verbal rating scale; the ibuprofen intake amount was recorded at the same time intervals. Data were analyzed using Student's t-test, Mann-Whitney U and Fisher's exact tests, with a significance level of 5%. RESULTS Postoperative pain levels and analgesic intake frequency were not significantly different across the two irrigation activation techniques (P > .05). The frequencies obtained in relation to the prevalence of postoperative pain were 3.1-25.8% for all participants of the two studied groups. CONCLUSION The irrigation activation techniques of passive ultrasonic irrigation and the EasyClean device were found to be equivalent in terms of postoperative pain and analgesic intake.
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Affiliation(s)
- Renato Piai Pereira
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil.
| | - Clovis Monteiro Bramante
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Marco Antonio Hungaro Duarte
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Murilo Priori Alcalde
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | | | - Rodrigo Ricci Vivan
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
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İnce-Yusufoğlu S, Keskin NB, Uslu G, Helvacioglu-Yigit D. Effect of EDDY and manual dynamic activation techniques on postoperative pain in non-surgical retreatment: a randomized controlled trial. BMC Oral Health 2023; 23:3. [PMID: 36597145 PMCID: PMC9809104 DOI: 10.1186/s12903-022-02702-4] [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: 10/04/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND During non-surgical retreatment process, the products such as dentin debris, root canal fillings, irrigation solutions, microorganisms and remaining pulp tissues can extrude to the apical area and can cause the postoperative pain and flare-up. Thus, the aim of this study was to evaluatethe effect of EDDY and manual dynamic activation (MDA) techniques on postoperative pain (PP) associated with retreatment. METHODS Ninety patients scheduled for retreatment were treated at a single visit. Non-vital mandibular premolar teeth diagnosed with asymptomatic apical periodontitis were included in this study. The patients were divided into two groups (n = 45) on the basis of the need for additional irrigation activation procedures (EDDY and MDA). The patients' post-treatment pain levels were asked to rate the intensity of their pain on a 10-point numerical rating scale (NRS) at the 12th, 24th, 48th, and 72nd h and 7 days.The data were analyzed using the chi-square and Wilcoxon signed-rank test was used for within-group comparisons and Mann Whitney U test was used to compare the groups by time period. RESULTS The difference in postoperative pain intensity between two groups was statistically significant at 12, 24, 48, and 72 h (p < 0.05). There was no significant difference at 7 days. Moreover, no statistically significant difference was found between the two groups in terms of gender and analgesic medication intake (p > 0.05). Pain intensity after the treatment was lesser in the MDA groupthanin the EDDY group at 12, 24, 48, and 72 h. CONCLUSION This study could lead us to conclude that the two activation systems can be used during endodontic retreatment with no difference at PP 7 days later. However, a comparison of the groups indicated that the EDDY resulted in significantly more PP at 12, 24, 48, and 72 h. Trial registration ClinicalTrials.gov Identifier: NCT04726670.
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Affiliation(s)
- Selen İnce-Yusufoğlu
- grid.449874.20000 0004 0454 9762Department of Endodontics, Faculty of Dentistry, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Neslihan Büşra Keskin
- grid.449874.20000 0004 0454 9762Department of Endodontics, Faculty of Dentistry, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Gülşah Uslu
- Private practice, Idadent Oral and Dental Health Clinic, Canakkale, Turkey
| | - Dilek Helvacioglu-Yigit
- grid.412603.20000 0004 0634 1084College of Dental Medicine, QU Health, Qatar University, P.O. Box: 2713, Doha, Qatar
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16
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Bhardwaj A, Gupta RK, Ates AA, Wahjuningrum DA, Arıcan B, AlOmari T, Luke AM, Pawar AM. Comparison of Postoperative Pain After the Utilization of Different File Systems in Single Visit Endodontics. Patient Prefer Adherence 2023; 17:1025-1034. [PMID: 37090182 PMCID: PMC10115180 DOI: 10.2147/ppa.s405723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/30/2023] [Indexed: 04/25/2023] Open
Abstract
Purpose This prospective single-blind, parallel-group, randomized clinical trial was aimed to compare the effect of three different rotary instrumentation systems ProTaper Next (PTN), Self-Adjusting File (SAF) and XP-endo Shaper (XPS) on postoperative pain and analgesic intakes. Patients and Methods A total of 159 molars diagnosed with symptomatic irreversible pulpitis were randomly divided into three study groups according to the instrumentation techniques: PTN (n = 54), SAF (n = 52), and XPS (n = 53). The preoperative pain scores were taken before the onset of treatment in the groups. After a single appointment for root canal treatment, the patients were asked to rate the level of their pain according to the Visual Analog Scale (VAS) of 100 mm at 6, 24, 48, and 72-hour post-treatment intervals. Ibuprofen was prescribed to be taken while experiencing pain; patients were requested to note the number of pills consumed at intervals after treatment. Results The patients in SAF and XPS groups had lower mean VAS scores than the PTN group at 24-, 48-, and 72-hour intervals (p < 0.05). The most common analgesic intake was optimally seen in the PTN group at a 6-hour interval. All shaping procedures caused postoperative pain, whose intensity decreased with time. Conclusion The SAF and XPS groups had a lesser intensity of pain as well as minimum analgesic intakes as compared to the PTN group. All instrumentation systems moderately caused pain, and the PTN group experienced the highest pain among others.
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Affiliation(s)
- Anuj Bhardwaj
- Department of Conservative Dentistry and Endodontics, College of Dental Science and Hospital, Indore, India
- Department of Conservative Dentistry, Universitas Airlangga, Surabaya, Indonesia
| | - Rudra Kumar Gupta
- Department of Conservative Dentistry and Endodontics, College of Dental Science and Hospital, Indore, India
| | - Ayfer Atav Ates
- Department of Endodontics, Istinye University, Faculty of Dentistry, Istanbul, Turkey
| | - Dian Agustin Wahjuningrum
- Department of Conservative Dentistry, Universitas Airlangga, Surabaya, Indonesia
- Correspondence: Dian Agustin Wahjuningrum, Department of Conservative Dentistry, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, 60132, Indonesia, Email
| | - Burçin Arıcan
- Department of Endodontics, Bahçeşehir University, School of Dental Medicine, Istanbul, Turkey
| | - Taher AlOmari
- Department of Conservative Dentistry, Jordan University of Science and Technology, Al-Ramtha, Jordan
| | - Alexander Maniangat Luke
- Department of Clinical Science, College of Dentistry, Ajman University, Ajman, United Arab Emirates
- Center of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Alexander Maniangat Luke, Department of Clinical Science, College of Dentistry, Ajman University, J1 Building C Block, Al-Jurf 346, Ajman, United Arab Emirates, Email
| | - Ajinkya M Pawar
- Department of Conservative Dentistry, Universitas Airlangga, Surabaya, Indonesia
- Department of Conservative Dentistry and Endodontics, Nair Hospital Dental College, Mumbai, 400008, India
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Al-Saffar FB, Al-Gharrawi HA. A Comparative Evaluation of the Apically Extruded Debris from Root Canals Prepared by R-Motion NiTi File System. Int J Dent 2023; 2023:5731248. [PMID: 37152476 PMCID: PMC10156454 DOI: 10.1155/2023/5731248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/07/2023] [Accepted: 04/07/2023] [Indexed: 05/09/2023] Open
Abstract
Background Apically extruded debris (AED) is an inherent concern during root canal treatment for both endodontists and general practitioners. The present study investigates the AED of the novel R-Motion single-file reciprocating system compared to standard single reciprocating and multifile rotary systems. Materials and Methods Fifty-six moderately curved palatal roots of upper maxillary first molars were selected for the present study. The samples were then divided randomly into four groups (n = 14)- Group I: R-motion (RM), Group II: WaveOne Gold (WOG), Group III: ProTaper Next (PTN), and Group IV: HyFlex EDM (HFEDM). The researcher has modified Myers and Montgomery's method to simulate human body temperature. Vials were used to collect debris and weighted using a 0.00001 sensitive balance before and after instrumentation. The instrumentation of all experimented groups was done at 37°C, terminated at master apical file #25. An auto syringe with a side vented needle was used to deliver 8 ml of deionized water for irrigation of each sample during preparation. Vials were stored in a dry sealed desiccator which contained CaSO4 crystals, for 24 hr before weighing. The weight of the collected debris was obtained by subtracting the preinstrumentation weight from the postinstrumentation weight for each vial. The Kruskal-Wallis and Mann-Whitney U tests were performed to analyse the statistical difference in the amount of debris between the tested groups at a 0.05 significance level. Results The RM system produced less debris extrusion than all tested groups, with a significant difference between the former and the WOG and the PTN systems. However, WOG, PTN, and HFEDM showed no statistically significant difference in the amount of AED. Conclusion All tested groups produced apical debris in different amounts. The RM produced substantially less AED than WOG and PTN. Meanwhile, WOG, PTN, and HFEDM caused a comparable amount of AED.
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Affiliation(s)
- Farah B. Al-Saffar
- Department of Conservative Dentistry, College of Dentistry, Mustansiriyah University, Baghdad 10001, Iraq
| | - Hikmet A. Al-Gharrawi
- Department of Conservative Dentistry, College of Dentistry, Mustansiriyah University, Baghdad 10001, Iraq
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18
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Du M, Haag DG, Lynch JW, Mittinty MN. Application of multilevel models for predicting pain following root canal treatment. Community Dent Oral Epidemiol 2022; 51:418-427. [PMID: 36510289 DOI: 10.1111/cdoe.12807] [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: 11/30/2021] [Revised: 09/17/2022] [Accepted: 10/17/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES This study developed predictive models for one-week acute and six-month persistent pain following root canal treatment (RCT). An additional aim was to study the gain in predictive efficacy of models containing clinical factors only, over models containing sociodemographic characteristics. METHODS A secondary data analysis of 708 patients who received RCTs was conducted. Three sets of predictors were used: (1) combined set, containing all predictors in the data set; (2) clinical set and (3) sociodemographic set. Missing data were handled by multiple imputation using the missing indicator method. The multilevel least absolute selection and shrinkage operator (LASSO) regression was used to select predictors into the final multilevel logistic models. Three measures, the area under the receiver operating characteristic curve (AUROC) and precision-recall curve (AUPRC) and calibration curves, were used to assess the predictive performance of the models. RESULTS The selected-in factors in the final models, using LASSO regression, are related to pre- and intra-treatment clinical symptoms and pain experience. Predictive performance of the models remained the same with the inclusion (exclusion) of the socio-demographic factors. For predicting one-week outcome, the model built with combined set of predictors yielded the highest AUROC and AUPRC of 0.85 and 0.72, followed by the models built with clinical factors (AUROC = 0.82, AUPRC = 0.66). The lowest predictive ability was found in models with only sociodemographic characteristics (AUROC = 0.68, AUPRC = 0.40). Similar patterns were observed in predicting six-month outcome, where the AUROC for models with combined, clinical and sociodemographic sets of predictors were 0.85, 0.89 and 0.66, respectively, and the AUPRC were 0.48, 0.53 and 0.22, respectively. CONCLUSIONS Clinical factors such as the severity and experience of pre-operative and intra-operative pain were discovered important to the subsequent development of pain following RCTs. Adding sociodemographic characteristics to the models with clinical factors did not change the models' predictive performance or the proportion of explained variance.
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Affiliation(s)
- Mi Du
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Shandong Provincial Clinical Research Center for Oral Diseases, Shandong University, Jinan, China.,School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia.,Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Dandara Gabriela Haag
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia.,Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.,Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - John W Lynch
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia.,Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.,Population Health Sciences, University of Bristol, Bristol, UK
| | - Murthy N Mittinty
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia.,Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
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Roshdy NN, Hassan R. Quantitative evaluation of apically extruded debris using TRUShape, TruNatomy, and WaveOne Gold in curved canals. BDJ Open 2022; 8:13. [PMID: 35595771 PMCID: PMC9122899 DOI: 10.1038/s41405-022-00106-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Objective
This study compared the quantity of extruded debris after instrumentation with TRUShape 3D Conforming files, TruNatomy files, and the WaveOne Gold reciprocating system.
Materials and methods
Fifty-one mesiobuccal canals with severe curvatures (25–40°) were assigned to three equal groups according to the rotary system used for preparation, either TRUShape, TruNatomy, or WaveOne Gold files. The extruded debris was collected in pre-weighed glass vials. The data were statistically analyzed using a one-way ANOVA test and Tukey’s post hoc test.
Results
The least extruded debris was obtained with the WaveOne Gold instruments compared to the TRUShape and TruNatomy files (p < 0.001).
Conclusions
Debris extrusion occurs independently of the motion or design of the instrument. The WaveOne Gold system outperformed TRUShape and TruNatomy files in this study.
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de Jesus Oliveira LS, de Figueiredo FED, Correa MB, Faria-e-Silva AL. Supplementary use of the XP-endo Finisher on postoperative pain in posterior teeth with periapical lesions: a randomized clinical trial. Clin Oral Investig 2022:10.1007/s00784-022-04812-3. [DOI: 10.1007/s00784-022-04812-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022]
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Verma J, Verma S, Margasahayam SV. Comparison of pretreatment gabapentin and pregabalin to control postoperative endodontic pain - a double-blind, randomized clinical trial. J Dent Anesth Pain Med 2022; 22:377-385. [PMID: 36246032 PMCID: PMC9536948 DOI: 10.17245/jdapm.2022.22.5.377] [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: 07/14/2022] [Revised: 09/03/2022] [Accepted: 09/18/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Postoperative endodontic pain is an enigma for the dentist. This study aimed to evaluate the analgesic effect of 300 mg gabapentin or 75 mg pregabalin in reducing postoperative endodontic pain compared with a placebo. METHODS Ninety patients who needed root canal treatment with an initial numerical rating scale (NRS) pain score of > 4 (T0) were randomly divided into three groups (n=30). Patients were then administered either 300 mg gabapentin (group A), 75 mg pregabalin (group B), or a placebo (group C) 30 min prior to the start of endodontic treatment. A single operator performed single-visit endodontics, and pain was evaluated immediately after endodontic treatment (T1) and at 4 h (T2), 8 h (T3), 12 h (T4), 24 h (T5), 48 h (T6), and 72 h (T7) using the NRS. Ibuprofen/paracetamol (400 mg/325 mg) was administered as a rescue dose if needed. RESULTS Pregabalin performed significantly better when compared with gabapentin at all time points except at 72 h after treatment (P=0.170). The placebo group showed significantly higher pain scores than the other two groups. The percentage of pain relief was maximum for pregabalin (92.1%), followed by gabapentin (87.6%) and placebo (69.1%) at 72 h after treatment completion. CONCLUSION This study showed that pretreatment with a single dose of pregabalin and gabapentin both had greater analgesic effects than a placebo. They can be effectively used to reduce postoperative endodontic pain.
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Affiliation(s)
- Jayeeta Verma
- Conservative Dentistry and Endodontics, MGM Dental College and Hospital, Navi Mumbai, India
| | - Sidharth Verma
- Anesthesiology, Dr. DY Patil Medical College, Navi Mumbai, India
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Oliveira PS, Ferreira MC, Paula NGN, Loguercio AD, Grazziotin-Soares R, da Silva GR, da Mata HCS, Bauer J, Carvalho CN. Postoperative Pain Following Root Canal Instrumentation Using ProTaper Next or Reciproc in Asymptomatic Molars: A Randomized Controlled Single-Blind Clinical Trial. J Clin Med 2022; 11:jcm11133816. [PMID: 35807101 PMCID: PMC9267392 DOI: 10.3390/jcm11133816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 02/04/2023] Open
Abstract
Aim: The development of postoperative pain following root canal instrumentation may impair patient’s comfort and undermine their trust in the dentist. This study assessed the effect of root canal instrumentation techniques (rotary (PTN; ProTaper Next®) and reciprocating (R; Reciproc®)) on the postoperative pain intensity (primary outcome) and tenderness on biting (secondary outcome) of patients’ asymptomatic molars. Methodology: This study protocol was registered with ReBec-WHO (U1111-1182-2800). From a pool of 112 patients evaluated for eligibility (healthy adults (≤18 years old)), with a single asymptomatic molar (maxillary or mandibular) indicated for root canal treatment, diagnosed with asymptomatic irreversible pulpitis (including chronic hyperplastic pulpitis), 75 were randomly allocated in similar proportions to receive the intervention (two-appointment root canal therapy) in either the PTN or R group. The allocated procedures were performed using standardized protocols. Participants (blinded to the instrumentation technique) rated their pain intensity at 6, 12 and 24 h and from day 2 to day 7 following the root canal instrumentation appointment using a VAS and an NRS; the ibuprofen tablets taken and the presence of tenderness on biting were recorded. The instrumentation time was registered. Univariate and multivariate statistics measured the effect of independent variables on the outcomes. Results: From the 75 patients allocated, 8 patients (4 from each group) were lost; in total, 33 patients were analyzed in the PTN group and 34 in the R group. The frequencies of postoperative pain (p > 0.05) and tenderness on biting (p > 0.05) were similar between groups. The medication intake (mean of 1.31 tablets) and the time of instrumentation (approximately 11 min) were similar between groups. Conclusion: ProTaper Next and Reciproc® caused a slight risk of tenderness on biting and contributed to similar self-reported postoperative pain (low intensity) up to 7 days following root canal shaping.
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Affiliation(s)
- Patrícia Santos Oliveira
- Postgraduate Program of Dentistry, CEUMA University, São Luís 65065-470, Brazil; (P.S.O.); (M.C.F.); (N.G.N.P.)
| | - Meire Coelho Ferreira
- Postgraduate Program of Dentistry, CEUMA University, São Luís 65065-470, Brazil; (P.S.O.); (M.C.F.); (N.G.N.P.)
| | | | - Alessandro Dourado Loguercio
- Department of Restorative Dentistry, School of Dentistry, State University of Ponta Grossa, Ponta Grossa 84010-330, Brazil;
| | | | - Gisele Rodrigues da Silva
- Department of Operative Dentistry, Federal University of Uberlândia (UFU), Uberlândia 38408-100, Brazil;
| | | | - José Bauer
- Dentistry Biomaterials Laboratory (Biomma), School of Dentistry, Federal University of Maranhão, São Luís 65080-805, Brazil;
| | - Ceci Nunes Carvalho
- Postgraduate Program of Dentistry, CEUMA University, São Luís 65065-470, Brazil; (P.S.O.); (M.C.F.); (N.G.N.P.)
- Correspondence: ; Tel.: +55-98-98117-0078
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İnce Yusufoğlu S, Olcay K. Effect of Qmix 2in1, chlorhexidine gluconate, and ethylenediaminetetraacetic acid on postoperative pain after root canal treatment: A double-blind randomized clinical trial. J Dent Res Dent Clin Dent Prospects 2022; 16:70-75. [PMID: 35936934 PMCID: PMC9339748 DOI: 10.34172/joddd.2022.011] [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: 02/23/2021] [Accepted: 07/15/2021] [Indexed: 11/27/2022] Open
Abstract
Background. This study aimed to investigate the effects of different final irrigation solutions on postoperative pain following root canal treatment.
Methods. Eighty-nine nonvital premolar and molar teeth with periapical lesions (PAI: 3‒4) without any clinical symptoms were included. The patients were randomly assigned to three groups according to the final irrigation solutions used: G1: 2 mL of Qmix (n=29), G2: 2 mL of 17% ethylenediaminetetraacetic acid (EDTA) (n=30), and G3: 2 mL of 2% chlorhexidine gluconate (CHX) (n=30). All the patients were prescribed 100 mg of flurbiprofen to use as needed for pain. The patients were asked to rate their pain status according to the verbal rating scale at 12, 24, 48, and 72 hours, and one week. The data were analyzed using Pearson’s chi-squared test, Fisher’s exact test, and chi-squared analysis with Monte Carlo simulation. The significance level was set at P≤0.05.
Results. No significant differences were observed in postoperative pain rates at 12, 48, and 72 hours and one week (P>0.05). However, in the Qmix group, a significantly lower pain level was observed at 24 hours with EDTA and CHX (P=0.019). The rate of mild pain in the EDTA group at 72 hours (18.8%) was significantly higher in premolar teeth than in molar teeth (P=0.012). The moderate pain level in the EDTA group at 12 hours was significantly higher in those>60 years of age (P=0.008). Conclusion. The use of Qmix as an irrigation solution resulted in lower postoperative pain levels at 24 hours compared to other solutions. Therefore, Qmix can be considered a proper final irrigation solution in endodontic treatment regarding postoperative pain.
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Affiliation(s)
- Selen İnce Yusufoğlu
- Department of Endodontics, Faculty of Dentistry, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Keziban Olcay
- Department of Endodontics, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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Elmallawany A, Hussein YF, Ali MM, Montasser K, Aly Y, Sharaf N. Effect of Ultrasonic and Diode Laser Irrigation Activation on Post-operative Pain and Microbial Reduction in Single Visit Endodontic Treatment of Necrotic Mandibular Molars. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: To clinically evaluate the effect of continuous ultrasonic and diode laser 810 wave length irrigation activation techniques on postoperative pain and bacterial reduction in single visit endodontic treatment of mandibular molars.
Material and methods: Forty patients requiring root canal treatment therapy for necrotic mandibular molars teeth were included in this study with age ranges between 20 and 45 years. In all cases, single visit endodontic treatment was carried out using Revo-S rotary file system in crown down sequence. NaOCl 2.5% irrigation solution was used during treatment. Patients were randomly and equally assigned into two groups according to irrigation technique. Group (1): conventional syringe irrigation and group (2): continuous ultrasonic irrigation. Each group was subdivided into two sub groups (n = 10); subgroup 1A (conventional syringe irrigation with no laser), subgroup 1B (conventional syringe irrigation with diode laser), subgroup 2A (continuous ultrasonic irrigation with no laser) and subgroup 2B (continuous ultrasonic irrigation with diode laser).
Postoperative pain evaluation was done using Visual Analogue Scale (VAS) at 6, 12, 24, 36, 48 hours and 7 days postoperatively. Microbiological detection of bacterial reduction was done by taking Samples (S1 and S2) for bacterial cultures. S1 after finishing access cavity and before mechanical preparation and S2 after finishing mechanical preparation and irrigation activation and before obturation. Samples were cultured on blood agar and determined as colony forming units (CFU/mL). Microbiological bacterial reduction was calculated accordingly. Statistical analyses were analyzed using the Mann-Whitney U test. The significance level was set at p < 0.05.
Results: In all sub groups, postoperative pain decreased by time in all time intervals but pain was significantly lower in subgroup (2B) (continuous ultrasonic irrigation with diode laser) than subgroup (1A) (conventional syringe irrigation with no laser) in all time interval. Microbiological results showed the highest bacterial reduction was in subgroup (2B) (continuous ultrasonic irrigation with diode laser) and least bacterial reduction was in subgroup (1A) (conventional syringe irrigation with no laser).
Conclusion: Using diode laser and continuous ultrasonic irrigation activation techniques as adjunctive methods showed improvement in postoperative pain records and enhanced bacterial reduction in root canal therapy.
Keywords: Continuous ultrasonic irrigation, diode laser 810, post-operative pain, bacterial reduction, single visit endodontic treatment.
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Spohr AR, Xavier SR, Malta CP, Pereira-Cenci T, Pappen FG, Morgental RD. Postoperative pain after endodontic reintervention: a randomized clinical trial. Braz Dent J 2022; 33:18-27. [PMID: 35766713 PMCID: PMC9645201 DOI: 10.1590/0103-6440202204785] [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: 11/16/2021] [Accepted: 03/28/2022] [Indexed: 12/01/2022] Open
Abstract
The present randomized clinical trial compared the prevalence and intensity of
postoperative pain in cases of endodontic reintervention using manual or
engine-driven reciprocating instruments. As secondary objectives, the analgesic
intake and time required for the root canal filling removal and
re-instrumentation were also evaluated. Forty-eight individuals with an
endodontically treated single-rooted tooth diagnosed with asymptomatic apical
periodontitis were included in the study. Patients were randomly assigned to two
comparison groups (n=24/group): reintervention with stainless steel manual
instruments or a nickel-titanium reciprocating system (Reciproc; VDW, Munich,
Germany). The endodontic reintervention was performed in two sessions with a
calcium hydroxide-based intracanal medication applied for 14 days before root
canal obturation. Working time for the root canal filling removal and
re-instrumentation was recorded with a digital stopwatch. After each visit,
postoperative pain intensity was assessed at 12, 24, and 48 hours and seven days
using the Numerical Rating Scale (NRS). The patients were also asked about
analgesic intake. Data were analyzed using Pearson chi-square, T and
Mann-Whitney U tests (α=0.05). No significant differences between groups were
found regarding the prevalence and intensity of pain or the need for analgesic
intake at any time point (P > 0.05). Working time was significantly shorter
in the reciprocating group (18 versus 41 minutes). In conclusion, manual and
reciprocating instruments achieved the same results in terms of prevalence and
intensity of postoperative pain and analgesic intake. However, filling material
removal and re-instrumentation of the root canals were more than twice as fast
when using the reciprocating system.
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Affiliation(s)
- Andressa Raquel Spohr
- Graduate Program in Dentistry, Federal University of Pelotas(UFPel), Pelotas, RS, Brazil
| | | | - Cristiana Pereira Malta
- Graduate Program in Dental Sciences, Federal University of Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - Tatiana Pereira-Cenci
- Graduate Program in Dentistry, Federal University of Pelotas(UFPel), Pelotas, RS, Brazil
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26
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Comparative effects of erbium-doped yttrium aluminum garnet laser, the shock wave-enhanced emission photoacoustic streaming, and the conventional needle irrigation on apical extrusion of irrigants. Photodiagnosis Photodyn Ther 2022; 39:102878. [DOI: 10.1016/j.pdpdt.2022.102878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 11/18/2022]
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27
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Erdogan O, Casey SM, Ruparel NB, Sigurdsson A. Bupivacaine for Root Canal Treatment – Practitioner Behaviors and Patient Perspectives: Survey Studies. Local Reg Anesth 2022; 15:11-21. [PMID: 35140517 PMCID: PMC8820451 DOI: 10.2147/lra.s339238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/28/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction and Objectives Local anesthesia is essential in dentistry in providing intraoperative analgesia and anesthesia. However, knowledge related to its use for management of post-operative pain is limited. Perioperative pain management is especially important for root canal treatment (ie, endodontic therapy), performed by endodontists. In this study, we sought to better understand endodontists’ attitudes regarding the use of long-lasting anesthetic, namely 0.5% bupivacaine HCl with 1:200,000 epinephrine, for the management of post-endodontic pain. Additionally, we aimed to understand the perspectives of dental patients about receiving longer lasting anesthesia for endodontic therapy and to determine factors that affect their anesthetic preferences within the orofacial region. Methods An email invitation to participate in an anonymous online survey was sent to members of the American Association of Endodontists. Also, 82 patients attending an in-person visit to an endodontic clinic were recruited to the study. Results Data from 474 endodontic practitioners and 82 patients included in analysis. Among practitioners, the majority reported to either never (33.31%) or rarely (34.84%) using bupivacaine. Most chose “I don’t think I need it” (47%) and “patient discomfort because of longer duration of soft tissue anesthesia” (30.81%) as reasons for not preferring the use of bupivacaine. Of the practitioners who reported at least rare use, most chose bupivacaine for post-operative pain management (78.02%). Conversely, 52% of patients reported that they were likely/most likely to request long-lasting anesthetics for post-operative pain control. Conclusion Bupivacaine is rarely used as a post-operative pain management strategy for endodontic therapy. Specifically, bupivacaine is not preferred not because of adverse events, toxicity, or slow onset concerns, but rather, because of longer duration of soft tissue anesthesia. However, our data suggest that patients may be willing to receive long-lasting anesthesia. Further patient-centered research should investigate the use of long-lasting anesthetic agents for management of post-endodontic pain.
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Affiliation(s)
- Ozge Erdogan
- Department of Endodontics, New York University College of Dentistry, New York, NY, USA
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, MA, USA
- Correspondence: Ozge Erdogan, Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, 188 Longwood Ave, Boston, MA, 02115, USA, Email
| | - Sharon M Casey
- Department of Endodontics, New York University College of Dentistry, New York, NY, USA
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, MA, USA
| | - Nikita B Ruparel
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Asgeir Sigurdsson
- Department of Endodontics, New York University College of Dentistry, New York, NY, USA
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28
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Sng KS, Sin YS, Bhatia S, Kohli S, Lim XY, Ong JY. Acupuncture for the reduction of post-operative pain in a patient with symptomatic irreversible pulpitis: a case report. Acupunct Med 2022; 40:211-212. [PMID: 35018808 DOI: 10.1177/09645284211073336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kim Sia Sng
- Department of Chinese Medicine, Center for Complementary and Alternative Medicine, International Medical University, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
| | - Yen Suan Sin
- Department of Chinese Medicine, Center for Complementary and Alternative Medicine, International Medical University, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
| | - Shekhar Bhatia
- Division of Restorative Dentistry, School of Dentistry, International Medical University, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
| | - Shivani Kohli
- Division of Restorative Dentistry, School of Dentistry, International Medical University, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
| | - Xin Ying Lim
- Department of Chinese Medicine, Center for Complementary and Alternative Medicine, International Medical University, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
| | - Jie Ying Ong
- Department of Chinese Medicine, Center for Complementary and Alternative Medicine, International Medical University, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
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29
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Abdelwahed A, Roshdy NN. Assessment of Post-operative Pain after using EdgeFile X7 and Protaper Next Rotary Systems in Patients with Symptomatic Pulpitis in Mandibular Molars: A Randomized Controlled Clinical Trial. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM: The aim of the study was to evaluate the incidence of post-operative pain and analgesics intake after single-visit endodontic treatment using Edge File X7 and ProTaper Next (PTN) rotary files in mandibular molars having symptomatic pulpitis.
METHODS: The study included 60 patients complaining of symptomatic pulpitis in mandibular molar teeth. After confirming the diagnosis clinically and radiographically, patients were assigned into two equal groups; Group (I): Instrumentation was done with Edge File X7 (EF) rotary files and Group (II): Instrumentation was done with PTN rotary files. The patients underwent standardized single visit endodontic treatment procedures using 2.5% sodium hypochlorite for irrigation. Modified visual analogue scale was used to access pain preoperatively, and then postoperatively after 6, 12, 24, 48, and 72 h. An analgesic (ibuprofen 400 mg) was prescribed to the patient who suffered from persistent pain. The incidence and/or number of analgesic tablets intake were recorded. Data of pain score were compared using Mann–Whitney U test for intergroup comparisons and Freidman’s test followed by Dunn’s post hoc test for intragroup comparisons.
RESULTS: No statistically significant difference was detected between EF and PTN groups regarding the incidence and intensity of pain at different time intervals (p > 0.05). There was a significant reduction in the mean VAS score through the follow-up periods in both groups (p < 0.001). The incidence of analgesic intake was not significant in both groups.
CONCLUSION: The incidence of post-operative pain and the analgesic intake in terms of frequency and quantity were found to be similar with both rotary systems for all the post-operative time points.
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30
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Abbott PV. Present status and future directions - managing endodontic emergencies. Int Endod J 2021; 55 Suppl 3:778-803. [PMID: 34958512 DOI: 10.1111/iej.13678] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/20/2021] [Accepted: 12/26/2021] [Indexed: 11/28/2022]
Abstract
Endodontic emergencies are common in both general dental practices and specialist Endodontic practices. The aim of this review is to provide an overview of endodontic emergencies. Endodontic emergencies can be a result of many different conditions of the pulp, root canal and periradicular tissues. They may occur before endodontic treatment has been started, between appointments when treatment is being performed over multiple visits, or after endodontic treatment has been completed. In the latter situation, the emergency may be very soon after the treatment or it may occur many years later, in which case it is usually a new disease process as a result of the root canal system becoming infected. An emergency can be a stressful situation for both the patient and the dentist (or endodontist) as it is usually an unexpected event. It is incumbent on dental professionals to provide timely assistance to patients who have an emergency, and it is also important to allow sufficient time to manage the situation comprehensively. Management of endodontic emergencies should follow the principles of the 3D's - Diagnosis, Definitive dental treatment and Drugs - and in that sequence. An accurate diagnosis, the first "D", is essential so the appropriate treatment can be provided. Diagnosis requires a thorough understanding of the various conditions that can cause the emergency and this can be helped by having a comprehensive classification of the various conditions. The diagnosis should also direct the clinician to the appropriate definitive dental treatment, the second "D". Root canal treatment will not always be required as some cases can be managed conservatively. Other cases may require root canal re-treatment. The specific details of how the treatment is done can also vary, according to the diagnosis. The final "D" is Drugs - the use of drugs should also be dependent on the diagnosis and the dental treatment. Drugs should only be an adjunct following the treatment. The clinician must also differentiate between inflammation and infection in order to provide the appropriate treatment and to prescribe the appropriate medication for effective pain relief and resolution of other symptoms or signs such as swelling.
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Affiliation(s)
- Paul V Abbott
- UWA Dental School, The University of Western Australia, Western Australia, Australia
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31
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Ali NT, El-Boghdadi RM, Ibrahim AM, Amin SAW. Clinical and microbiological effects of ultrasonically activated irrigation versus syringe irrigation during endodontic treatment: a systematic review and meta-analysis of randomized clinical trials. Odontology 2021; 110:419-433. [PMID: 34729673 DOI: 10.1007/s10266-021-00671-8] [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: 08/11/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022]
Abstract
This study aimed to systematically review clinical and microbiology-related effects of ultrasonically activated irrigation (UAI) compared to syringe irrigation (SI) during endodontic treatment. Electronic databases searching and manual searching were conducted. Only randomized clinical trials (RCTs) were included comparing UAI to SI. The RoB 2.0 Cochrane tool was used for risk-of-bias (RoB) assessment. The main outcomes were postoperative pain, treatment failure, and microbiology-related outcomes. Qualitative and quantitative analyses, wherever applicable, were performed. Risk ratios (RR) and [standardized] mean differences {[S]MD} were calculated for dichotomous and continuous outcomes, respectively. Certainty of evidence (CoE) was assessed using GRADE tool. Ten RCTs were included. UAI reduced pain incidence within the first 24 h (RR 0.50, 95% CI 0.35-0.71, 308 teeth) and microbial counts (SMDpooled - 0.40, 95% CI [- 0.78, - 0.02], I2 = 0%, 126 teeth) than SI in non-vital teeth with apical periodontitis (AP). Both groups, however, had similar effects regarding pain intensity, lipopolysaccharide amounts, and the incidence of rescue-analgesic intake, treatment failure, and microbial presence (p > 0.05). CoE ranged from low to very low. Very limited evidence suggests that UAI could reduce postoperative-pain risk within the first 24 h and microbial counts for non-vital teeth with AP compared to SI. Most meta-analyses, however, are based on very few studies, mostly low-powered, with an overall very-low-to-low CoE. Further well-designed, larger RCTs are, thus, required.
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Affiliation(s)
- Noha Tawfik Ali
- Department of Endodontics, Faculty of Dentistry, Cairo University, 11 ElSaraya Street, ElManyal, Cairo, 11553, Egypt
| | - Randa Mohamed El-Boghdadi
- Department of Endodontics, Faculty of Dentistry, Cairo University, 11 ElSaraya Street, ElManyal, Cairo, 11553, Egypt
| | - Ahmed Mohamed Ibrahim
- Department of Endodontics, Faculty of Dentistry, Cairo University, 11 ElSaraya Street, ElManyal, Cairo, 11553, Egypt
| | - Suzan Abdul Wanees Amin
- Department of Endodontics, Faculty of Dentistry, Cairo University, 11 ElSaraya Street, ElManyal, Cairo, 11553, Egypt.
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Mekhdieva E, Del Fabbro M, Alovisi M, Comba A, Scotti N, Tumedei M, Carossa M, Berutti E, Pasqualini D. Postoperative Pain following Root Canal Filling with Bioceramic vs. Traditional Filling Techniques: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2021; 10:4509. [PMID: 34640531 PMCID: PMC8509229 DOI: 10.3390/jcm10194509] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 12/31/2022] Open
Abstract
This meta-analysis aimed to evaluate postoperative pain (POP) following root canal filling (RCF) with gutta-percha/bioceramic sealer (BCS) vs. gutta-percha/traditional sealer (TS) techniques. Electronic databases were searched for randomized trials. Subgroup analyses were performed for analgesic intake, flare-ups, postoperative time (24/48 h), pulp status, and retreatment. The search yielded 682 records, and nine studies were selected. BCS was associated with significantly lower POP vs. TS at 24 h (P = 0.04) and 48 h (P = 0.0005). In addition, non-significant trends favoring BCS for analgesic intake at 24 h (P = 0.14), flare-ups (P = 0.24) and obturation techniques at 24 h (P = 0.41) and 48 h (P = 0.33), non-significant trends for lower POP with TS vs. BCS 24 h and 48 h in vital teeth (P = 0.50, P = 0.18, respectively), and for lower POP with BCS vs. TS in non-vital teeth at 24 h and 48 h (P = 0.16, P = 0.84, respectively). POP was numerically lower with TS vs. BCS at 24 h (P = 0.65) and 48 h after retreatment (P = 0.59). Moreover, POP did not vary between fillers when the treatment was over single (P = 0.28) or multiple visits (P = 0.50). BCS was associated with significantly lower short-term POP, and with a trend for lower analgesic intake and flare-up incidence, as compared to TS.
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Affiliation(s)
- Elina Mekhdieva
- Endodontics and Restorative Dentistry, CIR Dental School, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (E.M.); (M.A.); (A.C.); (N.S.); (M.C.); (E.B.)
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (M.D.F.); (M.T.)
- IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy
| | - Mario Alovisi
- Endodontics and Restorative Dentistry, CIR Dental School, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (E.M.); (M.A.); (A.C.); (N.S.); (M.C.); (E.B.)
| | - Allegra Comba
- Endodontics and Restorative Dentistry, CIR Dental School, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (E.M.); (M.A.); (A.C.); (N.S.); (M.C.); (E.B.)
| | - Nicola Scotti
- Endodontics and Restorative Dentistry, CIR Dental School, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (E.M.); (M.A.); (A.C.); (N.S.); (M.C.); (E.B.)
| | - Margherita Tumedei
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (M.D.F.); (M.T.)
- Department of Medical, Oral and Biotechnological Sciences, University “G. d′Annunzio” of Chieti-Pescara, 65122 Chieti, Italy
| | - Massimo Carossa
- Endodontics and Restorative Dentistry, CIR Dental School, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (E.M.); (M.A.); (A.C.); (N.S.); (M.C.); (E.B.)
| | - Elio Berutti
- Endodontics and Restorative Dentistry, CIR Dental School, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (E.M.); (M.A.); (A.C.); (N.S.); (M.C.); (E.B.)
| | - Damiano Pasqualini
- Endodontics and Restorative Dentistry, CIR Dental School, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (E.M.); (M.A.); (A.C.); (N.S.); (M.C.); (E.B.)
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Machado R, Comparin D, Ignácio SA, da Silva Neto UX. Postoperative pain after endodontic treatment of necrotic teeth with large intentional foraminal enlargement. Restor Dent Endod 2021; 46:e31. [PMID: 34513637 PMCID: PMC8411006 DOI: 10.5395/rde.2021.46.e31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/17/2020] [Accepted: 12/31/2020] [Indexed: 01/01/2023] Open
Abstract
Objectives To evaluate postoperative pain after endodontic treatment of necrotic teeth using large intentional foraminal enlargement (LIFE). Materials and Methods The sample included 60 asymptomatic necrotic teeth (with or without chronic apical periodontitis), and a periodontal probing depth of 3 mm, previously accessed and referred to perform endodontic treatment. After previous procedures, the position and approximate size of the apical foramen (AF) were determined by using an apex locator and K flexo-files, respectively. The chemomechanical preparation was performed with Profile 04 files 2 mm beyond the AF to achieve the LIFE, using 2.5 mL of 2.5% NaOCl at each file change. The filling was performed by Tagger's hybrid technique and EndoFill sealer. Phone calls were made to all the patients at 24, 48 and 72 hours after treatment, to classify postoperative pain. Statistical analysis was performed by different tests with a significance level of 5%. Results Age, gender, periradicular status and tooth type did not influence postoperative pain (p > 0.05). Only 1 patient (1.66%) reported severe pain after 72 hours. Moderate pain was reported by 7, 4 and 3 patients after 24, 48 and 72 hours, respectively (p = 0.0001). However, paired analyses showed a statistically significant difference only between 24 and 72 hours (p = 0.04). Sealer extrusion did not influence the postoperative pain (p > 0.05). Conclusions Acute or moderate postoperative pain was uncommon after endodontic treatment of necrotic teeth with LIFE. Trial Registration The Brazilian Clinical Trials Registry Identifier: RBR-3r967t
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Affiliation(s)
- Ricardo Machado
- Department of Endodontics, School of Health and Bioscience, Pontifical Catholic University of Paraná - PUC/PR, Curitiba, Paraná, Brazil
| | - Daniel Comparin
- Department of Endodontics, School of Dentistry, Paranaense University - UNIPAR, Francisco Beltrão, Paraná, Brazil
| | - Sérgio Aparecido Ignácio
- Department of Statistics, School of Health and Bioscience, Pontifical Catholic University of Paraná - PUC/PR, Curitiba, Paraná, Brazil
| | - Ulisses Xavier da Silva Neto
- Department of Statistics, School of Health and Bioscience, Pontifical Catholic University of Paraná - PUC/PR, Curitiba, Paraná, Brazil
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Predicting postoperative pain following root canal treatment by using artificial neural network evaluation. Sci Rep 2021; 11:17243. [PMID: 34446767 PMCID: PMC8390654 DOI: 10.1038/s41598-021-96777-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 08/12/2021] [Indexed: 01/17/2023] Open
Abstract
This study aimed to evaluate the accuracy of back propagation (BP) artificial neural network model for predicting postoperative pain following root canal treatment (RCT). The BP neural network model was developed using MATLAB 7.0 neural network toolbox, and the functional projective relationship was established between the 13 parameters (including the personal, inflammatory reaction, operative procedure factors) and postoperative pain of the patient after RCT. This neural network model was trained and tested based on data from 300 patients who underwent RCT. Among these cases, 210, 45 and 45 were allocated as the training, data validation and test samples, respectively, to assess the accuracy of prediction. In this present study, the accuracy of this BP neural network model was 95.60% for the prediction of postoperative pain following RCT. To conclude, the BP network model could be used to predict postoperative pain following RCT and showed clinical feasibility and application value.
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Kandemir Demirci G, Miçooğulları Kurt S, Serefoglu B, Kaval ME, Çalışkan MK. The influence of different NiTi instrumentation techniques on postoperative pain after single-visit root canal treatment. AUST ENDOD J 2021; 47:559-568. [PMID: 34278665 DOI: 10.1111/aej.12547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/27/2021] [Accepted: 07/04/2021] [Indexed: 11/30/2022]
Abstract
This study aimed to evaluate the effect of multi-file rotary (Protaper Universal) and reciprocating single-file (Reciproc Blue) root canal preparation techniques on the occurrence of postoperative pain in asymptomatic mandibular molar teeth with large periapical lesions in single-visit root canal treatment (RCT). A hundred and twenty teeth were randomly assigned to two groups: Protaper Universal (PTU) or Reciproc Blue (RB) instruments. Postoperative pain at 6, 12, 24, 48, 72 h and 7 days after obturation was measured. Mann-Whitney U-test was performed to compare the pain scores between the groups and to assess the relation of pain with patients' age and gender. Spearman's rank correlation was utilized to correlate the pain intensity and analgesic intake at different time points. There was no significant difference between the instrumentation techniques regarding postoperative pain at any time points evaluated (P > 0.05). There was a correlation between analgesic intake and intensity of pain (P < 0.05). No statistically significant difference was found among the groups assessed in the study in terms of analgesic intake (P > 0.05).
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Affiliation(s)
| | | | - Burcu Serefoglu
- Department of Endodontology, School of Dentistry, Ege University, Izmir, Turkey
| | - Mehmet E Kaval
- Department of Endodontology, School of Dentistry, Ege University, Izmir, Turkey
| | - Mehmet K Çalışkan
- Department of Endodontology, School of Dentistry, Ege University, Izmir, Turkey
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Influence of occlusal reduction on pain after endodontic treatment: a systematic review and meta-analysis. Sci Rep 2021; 11:14019. [PMID: 34234168 PMCID: PMC8263790 DOI: 10.1038/s41598-021-93119-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 06/14/2021] [Indexed: 12/03/2022] Open
Abstract
The purpose of this systematic review was to analyze the influence of occlusal reduction on the postoperative pain levels after endodontic treatment (instrumentation and obturation of the root canal system). This review followed the PRISMA statement and was registered at PROSPERO (CRD42018107918). Two independent reviewers searched the Lilacs, Cochrane Library, PubMed (Medline), Web of Science, Scopus, Scielo, and ScienceDirect for articles published until April 2021. The research question was, "Does occlusal reduction decrease postoperative pain in endodontically treated teeth?". Only randomized clinical trials were included. The RevMan 5 program was used for meta-analysis, calculating the relative risk (RR) and 95% confidence interval (CI) of the dichotomous outcome (presence or absence of pain). The search strategies retrieved 4114 studies. Twelve studies were included for qualitative analysis and nine for quantitative analysis. The meta-analysis results did not reveal a significant difference in the reduction of postoperative pain levels for endodontic instrumentation at 6, 12, 24, 48 h and for endodontic obturation at 6 or 12 h after occlusal reduction. According to the GRADE tool, the analyzed outcome was classified as having a moderate level of certainty. It is concluded that occlusal reduction does not interfere with postoperative pain levels after endodontic treatment.
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de Freitas Portela FSM, De Martin AS, Pelegrine RA, Gutmann JL, Kato AS, Bueno CEDS. Effect of Foraminal Enlargement on Postoperative Pain in Necrotic Single-Rooted Teeth: A Randomized Clinical Trial. J Endod 2021; 47:1046-1051. [DOI: 10.1016/j.joen.2021.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
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Shubham S, Nepal M, Mishra R, Dutta K. Influence of maintaining apical patency in post-endodontic pain. BMC Oral Health 2021; 21:284. [PMID: 34078331 PMCID: PMC8173919 DOI: 10.1186/s12903-021-01632-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 05/12/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The concept of instrumentation beyond the apical foramen by small flexible file to prevent apical blockage is apical patency. However, this procedure might endow postoperative pain, thus to maintain apical patency or not is the matter of dilemma. Hence, the primary objective of this study was to compare postoperative pain between apical patency and non-patency groups and secondary objective was to evaluate the influence of number of visits, vitality of teeth, group of teeth and preoperative pain on post-operative pain. METHODS Preselected (n = 178) patients based on group of teeth and status of pulp were randomly divided into 2 groups, apical patency and non-patency which was further treated in either single or multiple visits. After exclusion, 160 patients were included. Each group (n = 80) was subdivided in single visit (n = 40) and multiple visits (n = 40), including vital (n = 20) and non-vital teeth (n = 20) and single-rooted (n = 10) and multiple-rooted teeth (n = 10). Apical patency was maintained with a size 10 K-file during conventional hand filing step-back shaping procedure. Intensity of pain was recorded before treatment and on days 1, 2, and 7 after treatment using Numerical Rating Scale (NRS-11). Statistical analysis was done using Mann-Whitney U test, Spearman correlation and Multiple linear regression analysis. RESULTS The primary outcome of this study showed statistically significant difference (p < 0.05) in postoperative pain scores between patency and non-patency groups with higher pain scores in patency group on 1st, 2nd and 7th day follow up. The secondary outcome showed postoperative pain in patency-maintained group was influenced by status of the pulp and preoperative pain only. Vital teeth of patency-maintained group treated in multiple visits showed statistically significant (p = 0.02) post-operative pain in day 1 follow up. Pre-operative pain showed positive correlation with postoperative pain with statistically significant difference. CONCLUSIONS Our study concluded that maintenance of apical patency increased postoperative pain. Evaluation of influence of number of visits, status of pulp, group of tooth and preoperative pain revealed status of pulp and preoperative pain as influencing factors for postoperative pain in patency group.
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Affiliation(s)
- Snigdha Shubham
- Department of Conservative Dentistry and Endodontics, Universal College of Medical Sciences, Ranigaon, Bhairahawa, Nepal
| | - Manisha Nepal
- Department of Conservative Dentistry and Endodontics, Universal College of Medical Sciences, Ranigaon, Bhairahawa, Nepal
| | - Ravish Mishra
- Department of Oral and Maxillofacial Surgery, Universal College of Medical Sciences, Ranigaon, Bhairahawa, Nepal
| | - Kishor Dutta
- Department of Orthodontics and Dentofacial Orthopaedics, Universal College of Medical Sciences, Ranigaon, Bhairahawa, Nepal
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Vilas-Boas L, Cozer V, Tawil PZ, Coelho MS. Effect of Photodynamic Therapy on Postoperative Pain in Posterior Teeth with Symptomatic Apical Periodontitis. Photodiagnosis Photodyn Ther 2021; 35:102348. [PMID: 34033935 DOI: 10.1016/j.pdpdt.2021.102348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/07/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
This study aimed to evaluate the impact of photodynamic therapy (PDT) after root canal preparation on pain relief in posterior teeth presenting with symptomatic apical periodontitis (SAP). A visual analog scale (VAS) was completed by the patients which registered their pain perception as none (0), mild (1-3), moderate (4-7), or severe (8-10). Only patients who registered moderate or severe pain were included. Seventy patients were allocated to two groups (n=35): a control group (CG) without the PDT application and an intervention group with PDT application (PG). The same chemo-mechanical preparation was achieved in both groups. In the PG, 150 µM methylene blue (MB)Please remove the underline was placed inside the canal for 2 minutes and a 660 nm wavelength laser was applied through a fiber for 3 minutes (100 mW, 600 J/cm², total 18J). The patients were asked to register their pain perception in the VAS document after 24-h, 72-h, and 1-week intervals. The number of tablets taken for pain relief was also recorded. The Mann-Whitney, Students T-test and Fisher´s exact tests were used for statistical analysis (P < .05). After 1 week, 32 patients in the CG and 33 in the PG returned their VAS cards. The PG resulted in lower pain levels after the 24-hour interval (median 0) than the CG (median 2); there was no difference between both groups at 72-h and 1-week intervals. The decrease in pain was higher in the PG at all time-intervals when compared to the CG. There was no difference in the mean number of tablets taken for pain relief (P > .05). Within the limitations of this study, it can be concluded that PDT was efficient in decreasing pain in teeth presenting with SAP. There was no difference observed after 72 hours and there was no impact on the intake of pain relief medication.
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Affiliation(s)
- Larissa Vilas-Boas
- São Leopoldo Mandic School of Dentistry, Rua Emilio Ribas 776 sala 13, Campinas, SP, 13025-141, Brazil
| | - Viviany Cozer
- Universidade Federal Fluminense - UFF, School of Dentistry, Department of Endodontics, Niterói, RJ , Brazil
| | | | - Marcelo Santos Coelho
- São Leopoldo Mandic School of Dentistry, Rua Emilio Ribas 776 sala 13, Campinas, SP, 13025-141, Brazil.
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Mustafa R, Al Omari T, Al-Nasrawi S, Al Fodeh R, Dkmak A, Haider J. Evaluating In Vitro Performance of Novel Nickel-Titanium Rotary System (TruNatomy) Based on Debris Extrusion and Preparation Time from Severely Curved Canals. J Endod 2021; 47:976-981. [PMID: 33737004 DOI: 10.1016/j.joen.2021.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/28/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION This laboratory-based study aimed to investigate the quantitative amount of apically extruded debris from severely curved root canals and the preparation time for the novel rotary system TruNatomy (TN; Dentsply Sirona, Charlotte, NC) compared with Reciproc Blue (RCB; VDW Dental, Munich, Germany), HyFlex (HyFlex Controlled Memory [HCM; Coltene/Whaledent, Altstatten, Switzerland] and HyFlex EDM [HEDM, Coltene/Whaledent]), and ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland) rotary systems. METHODS One hundred mandibular molar human teeth with severe curvature of the mesiobuccal canal (25°-45°) were included in the present study. The specimens were randomly distributed into 5 balanced groups (n = 20): TN, RCB, HCM, PTN, and HEDM. The amount of extruded debris for each group during instrumentation at body temperature was collected in an Eppendorf tube. After desiccation, the mean debris weights for each group were calculated. The total preparation time for each group was also recorded. Data were statistically analyzed using the Kruskal-Wallis test at a significance level of P < .05. RESULTS The HCM and HEDM groups extruded a significantly higher amount of debris than the other tested groups (P < .001). TN extruded the least amount of debris, but it was not significantly different compared with the RCB and PTN groups (P > .05). In terms of preparation time, the TN group did not show any significant difference compared with the other groups. CONCLUSIONS All instrumentation systems extruded debris. TN was among the groups that produced the lowest amount of apically extruded debris that is clinically acceptable. The amount of apically extruded debris using the TN system was equal to 2 popular systems and statistically significantly less than 2 other popular systems studied.
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Affiliation(s)
- Ruba Mustafa
- Department of Conservative Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan.
| | - Taher Al Omari
- Department of Conservative Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Suhad Al-Nasrawi
- Department of Conservative Dentistry, Faculty of Dentistry, University of Kufa, Najaf, Iraq
| | - Rami Al Fodeh
- Department of Prosthetic Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Alaa Dkmak
- Department of Conservative Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Julfikar Haider
- Department of Engineering, Manchester Metropolitan University, Manchester, United Kingdom
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Liapis D, De Bruyne MAA, De Moor RJG, Meire MA. Postoperative pain after ultrasonically and laser-activated irrigation during root canal treatment: a randomized clinical trial. Int Endod J 2021; 54:1037-1050. [PMID: 33595920 DOI: 10.1111/iej.13500] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 12/18/2022]
Abstract
AIM To compare the intensity of postoperative pain after primary root canal treatment of asymptomatic teeth when using ultrasonically (UAI) or laser-activated irrigation (LAI). METHODOLOGY In this superiority randomized clinical trial (ClinicalTrials.gov ID: NCT03981237) with parallel design, fifty-six patients with an asymptomatic tooth in need of primary root canal treatment were enrolled. After chemo-mechanical canal preparation using rotary instruments and NaOCl irrigation, teeth were randomly assigned to two groups and patients were blinded to the final irrigation protocol. In the UAI group (n = 28), 60s activation with an Irrisafe tip was done per canal. In the LAI group (n = 28), NaOCl was activated with a pulsed Er:YAG (2940 nm) laser, equipped with a conical tip, with settings of 50 µs, 20 mJ at 15 Hz for 60 s. Patients recorded their pain intensity 6, 24, 48 and 72 h after treatment on a 100 mm visual analogue scale (VAS), as well as their analgesic consumption. Pain levels and incidence were compared across groups using the Mann-Whitney U-test and chi-square test. RESULTS Overall, mean postoperative pain intensity was low, with the majority of patients having no or minimal pain 24 h postoperatively. At 6 h postoperatively, pain intensity and incidence were significantly higher in the UAI group compared to the LAI group (P < 0.05). For the other time intervals, no significant differences in postoperative pain incidence or intensity were found. The frequency of analgesic intake did not differ significantly between the two groups. Neither of the activation methods resulted in any adverse effects. CONCLUSIONS Ultrasonically and laser-activated irrigation resulted in low and comparable levels of postoperative pain in asymptomatic patients receiving primary root canal treatment.
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Affiliation(s)
- D Liapis
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
| | - M A A De Bruyne
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
| | - R J G De Moor
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
| | - M A Meire
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
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Karataş E, Kahraman ÇY, Akbıyık N. Association between polymorphisms in catechol-O-methyl transferase, opioid receptor Mu 1 and serotonin receptor genes with postoperative pain following root canal treatment. Int Endod J 2021; 54:1016-1025. [PMID: 33559241 DOI: 10.1111/iej.13493] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the effect of single nucleotide polymorphisms in the COMT, OPRM1, 5HT1A, 5HT2A and 5HTR3B genes on the intensity of postoperative pain following root canal treatment. METHODOLOGY Ninety-five patients with mandibular and maxillary molar teeth diagnosed with symptomatic apical periodontitis and a level of preoperative pain greater than 50 on a 100 mm visual analogue scale (VAS) were included. Salivary DNA was collected from the participants and stored in Eppendorf tubes at -80 °C. Preoperative percussion pain values were recorded before the root canal treatment procedures. After completion of root canal treatment, the participants were given instructions to record their postoperative pain intensity levels at 24, 48 and 72 h, 5 days and 1 week after treatment, using the VAS. A second visit for the patients after seven days was planned to record their intensity levels of percussion pain on VAS. The percussion test was performed by tapping on the occlusal surface of the tooth with a blunt instrument. A QIAamp DNA Mini Kit was used to isolate DNA from saliva, and SNP Genotyping Analysis software version 1 was used to analyse the genotypes by calculating FAM and HEX signals. The Kruskal-Wallis and Mann-Whitney U-tests were used to evaluate pain intensity values amongst the genotypes, alleles, haplotypes and allele combinations. Nominal data (gender, intake and tooth number) were analysed using a Chi-square test. Bonferroni correction was performed. Thus, the significance level was set at 1.6% (P = 0.016), 2.5% (P = 0.025) and 1.25% (P = 0.0125) for genotype, allele and haplotype comparisons, respectively. RESULTS There was no significant difference amongst the genotypes and alleles in terms of pre- and postoperative pain intensity. There was no significant difference amongst the haplotypes formed for the COMT gene in terms of pain intensity. Additionally, there was no significant association between the allelic combination formed for 5HT1A + 5HT2A genes and the intensity of postoperative pain. CONCLUSION The findings indicate that none of the evaluated SNPs for COMT, OPRM1, 5HT1A, 5HT2A and 5HTR3B genes were associated with the intensity of postoperative pain.
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Affiliation(s)
- E Karataş
- Department of Endodontics, Faculty of Dentistry, Atatürk University, Erzurum, Turkey
| | - Ç Y Kahraman
- Department of Medical Genetics, Medical Faculty, Atatürk University, Erzurum, Turkey
| | - N Akbıyık
- Department of Endodontics, Faculty of Dentistry, Atatürk University, Erzurum, Turkey
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Postoperative Pain after Endodontic Treatment under Irrigation with 8.25% Sodium Hypochlorite and Other Solutions: A Randomized Clinical Trial. J Endod 2021; 47:696-704. [PMID: 33607121 DOI: 10.1016/j.joen.2021.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/22/2021] [Accepted: 02/07/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the postoperative pain in patients after endodontic treatment using 8.25% sodium hypochlorite (NaOCl) compared with other concentrations and 2% chlorhexidine (CHX). METHODS In this double-blind randomized trial, 180 patients were evaluated who underwent a single session of endodontic treatment under irrigation with 2.5%, 5.25%, or 8.25% NaOCl or 2% CHX solutions. The presence of postoperative pain was assessed 24, 48, and 72 hours after treatment and recorded using the visual analog scale (VAS). A descriptive analysis, logistic regression, and Wald test were performed. RESULTS Altogether 169 patients participated, of whom 107 were women, and the mean age was 38.1 ± 14.4 years. No significant differences occurred between the irrigants and the pain outcomes, not even for the use of postoperative pain medication and responses to VAS (P > .05). In the multivariate model including irrigants, after 24 hours or at any time, a significant difference (P < .05) remained in preparation time ≥10 minutes and the presence of overfilling. Also, in relation to the VAS, the overfilling presented significantly different results (P < .05). CONCLUSIONS There was no significant difference in the presence of postoperative pain between the 8.25% NaOCl and the other irrigation solutions. However, the extended preparation time and the overfilling material were responsible for the increase of postoperative pain.
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Jang YE, Kim Y, Kim BS. Influence of Preoperative Mechanical Allodynia on Predicting Postoperative Pain after Root Canal Treatment: A Prospective Clinical Study. J Endod 2021; 47:770-778.e1. [PMID: 33516824 DOI: 10.1016/j.joen.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/04/2021] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Odontogenic pain can manifest as pulpal pain, periapical pain (mechanical allodynia), or both. This study aimed to assess the changes in the intensity of mechanical allodynia (MA) and to identify predictors of postoperative pain after root canal treatment (RCT). METHODS In total, 579 consecutive patients who required RCT were enrolled; we included patients with asymptomatic pulpal diagnoses to avoid any effects of preoperative spontaneous pain on postoperative pain and to evaluate MA independently. Using a visual analog scale (VAS), patients separately indicated the intensity of spontaneous pain, tenderness to percussion, and pain on biting; these measurements were performed before treatment (preoperative pain), at the beginning of each visit (postpreparation pain), and daily for 1 week after RCT (postobturation pain). For analytical purposes, patients were subdivided into 2 groups based on the intensity of preoperative MA (none to mild [VAS <4] or moderate to severe [VAS ≥4]) to evaluate changes in MA and predictive factors of moderate to severe postoperative pain. A generalized estimating equation, repeated-measures analysis of variance, and logistic regression analysis were used. RESULTS Although the intensity of MA was significantly higher in the moderate to severe group after the initiation of RCT (P < .05), 93% of them experienced alleviation in MA, and 30% of patients in the none to mild group experienced an increase in MA. After adjusting for clinical variables, moderate to severe preoperative MA and the presence of necrotic pulp were significantly correlated with moderate to severe postoperative pain with an odds ratio of 4.107 and 0.286, respectively. CONCLUSIONS Moderate to severe preoperative MA was a predictive factor of postoperative pain in patients undergoing RCT.
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Affiliation(s)
- Young-Eun Jang
- Department of Conservative Dentistry, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Yemi Kim
- Department of Conservative Dentistry, College of Medicine, Ewha Womans University, Seoul, Korea.
| | - Bom Sahn Kim
- Department of Nuclear Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
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Karataş E, Kirici DÖ, Arslan H. Postoperative Pain After the use of Sodium Hypochlorite gel and Solution Forms: A Randomized Clinical Study. Eur Endod J 2021; 6. [PMID: 33531449 PMCID: PMC8056817 DOI: 10.14744/eej.2020.08370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 11/08/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The present study aimed to compare the effect of sodium hypochlorite (NaOCl) gel and solution forms on postoperative pain level. METHODS Fifty-two patients were divided into two groups according to the root canal irrigation solution. In the NaOCl solution group, the root canals were irrigated with 2 mL of 5.25% NaOCl between each pecking motion. In the NaOCl gel group, 5.25% NaOCl gel was used according to the manufacturer's instructions. The root canal treatments were completed and the participants were given instructions to record postoperative pain levels on 24, 48, and 72 hours and 1 week after treatment using VAS. RESULTS Intergroup analyses revealed that the NaOCl gel group resulted in significantly less postoperative pain than the NaOCl solution group on day 1. CONCLUSION It can be concluded that using NaOCl gel during root canal preparation results in less postoperative on day 1 when compared with the NaOCl solution.
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Affiliation(s)
- Ertuğrul Karataş
- From the Department of Endodontics, Faculty of Dentistry, Atatürk University, Erzurum, Turkey
| | - Damla Özsu Kirici
- Department of Endodontics, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
| | - Hakan Arslan
- From the Department of Endodontics, Faculty of Dentistry, Atatürk University, Erzurum, Turkey
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Postoperative pain in endodontic retreatment of one visit versus multiple visits: a systematic review and meta-analysis of randomized controlled trials. Clin Oral Investig 2021; 25:455-468. [PMID: 33399930 DOI: 10.1007/s00784-020-03767-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The aim of this systematic review and meta-analysis (SRM) was to assess the postoperative pain (PP) after non-surgical endodontic retreatment (NSER) in a one visit compared to multiple visits. The PICO question used was "Does NSER in patients with unsatisfactory endodontic treatment in a one-visit visit have a similar PP to that of NSER in multiple visits?" MATERIALS AND METHODS This systematic review followed PRISMA and was registered in PROSPERO (CRD42019136700). Searches were performed in the PubMed/MEDLINE, Scopus, and the Cochrane Library databases for articles published until September 2020. The eligible criteria were randomized clinical trials (RCTs). The meta-analysis was based on the Mantel-Haenszel. The PP after the retreatment was analyzed using a dichotomous outcome, measured according to risk ratio (RR) when p < 0.05. The Cochrane scale was used to assess risk of bias, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence. RESULTS Four studies were included. In general analysis without considering intensity, one-visit NSER presented lower PP than the multiple visits only for 1 and 30 days [(RR = 0.67; CI: 0.48 to 0.93; p = 0.02), and (RR = 0.09; CI: 0.01 to 0.66; p = 0.02)], respectively. Regarding sub-analysis considering the intensity, one visit present lower mild PP when compared with multiple visits [(RR = 0.54; CI: 0.30, 0.96; p = 0.04); (RR = 0.33; CI: 0.12, 0.88; p = 0.03); and (RR = 0.12; CI: 0.02, 0.86; p = 0.03)], respectively. However, sub-analysis for moderate and severe PP showed no significant difference, independently of period evaluated (p > 0.05). Regarding the risk of bias analysis, a low risk was observed for most domains, except allocation that was considered unclear, while the certainty of evidence for each analysis was considered low. CONCLUSION Within the limitations of study, the one and multiple visit can be considered adequate, because both present a similar occurrence of PP, except for mild pain. However, due to the low number of studies, further well conducted and standardized RCTs are needed to reassess these results. CLINICAL RELEVANCE Both therapies of endodontic retreatment can be considered in clinical practice. Therefore, the endodontist must consider the patient's individual characteristics and experience to consider the best treatment approach.
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Mantri S, Gupta N, Paul B, Dube K, Ghosh S. Incidence of postoperative pain after single-visit and multiple-visit root canal therapy: A randomized controlled trial. J Conserv Dent 2021; 24:348-353. [PMID: 35282580 PMCID: PMC8896126 DOI: 10.4103/jcd.jcd_216_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 11/04/2022] Open
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Khoo ST, Ode W, Lopez V, Yu VSH, Lai C, Lui JN. Factors Influencing Quality of Life after Surgical and Nonsurgical Interventions of Persistent Endodontic Disease. J Endod 2020; 46:1832-1840. [DOI: 10.1016/j.joen.2020.08.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/27/2020] [Accepted: 08/26/2020] [Indexed: 12/19/2022]
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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.
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Effect of Bioactive Glass-Based Root Canal Sealer on the Incidence of Postoperative Pain after Root Canal Obturation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238857. [PMID: 33260512 PMCID: PMC7730492 DOI: 10.3390/ijerph17238857] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 12/22/2022]
Abstract
The purpose of this study is to evaluate the effect of a bioactive glass-based root canal sealer, Nishika Canal Sealer BG (CS-BG), on the incidence of postoperative pain (PP) after root canal obturation (RCO). Eleven dentists performed pulpectomy or infected root canal treatments for 555 teeth. During RCO, CS-BG was used. After RCO, the rate of PP and the factors affecting PP (pain during RCO and pain immediately after RCO) were analyzed. PP was observed in eight teeth (1.5%), and within 7 days after RCO, there were no teeth with pain. In these teeth with PP, there was a significant difference in the occurrence of pain during RCO, but not in the occurrence of pain immediately after RCO, when compared with pulpectomy and infected root canal treatment. These clinical results show that CS-BG has an excellent biocompatibility, and can suppress the distress of patients during RCO.
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