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Mohamed AF, El-Asfouri HA, Amin SAW. Effect of sublingual fast-dissolving piroxicam premedication on postoperative pain experience in mandibular molars with non-vital pulp: a randomized double-blind controlled trial. Head Face Med 2024; 20:52. [PMID: 39306665 PMCID: PMC11416005 DOI: 10.1186/s13005-024-00453-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Accepted: 08/28/2024] [Indexed: 09/26/2024] Open
Abstract
BACKGROUND The aim of this trial was to evaluate the effect of a preoperative, single dose sublingual fast-dissolving piroxicam (20 mg) compared to placebo on postoperative pain at rest (POP), on biting (POPB) and on percussion (POPer) after single-visit endodontic treatment of asymptomatic mandibular molars with non-vital pulp. METHODS Seventy patients randomly received either piroxicam or placebo 1 h before treatment (n = 35). Patients recorded their pain (POP and POPB) level 6 h, 12 h, 24 h, 48 h, 72 h and 7 days postoperatively using an 11-point numerical rating scale; POPer was assessed after 7 days. Resuce-analgesic intake (RAI) and flare-up incidence (FUI) were recorded. Data were statistically analyzed. RESULTS Both groups had similar baseline characteristics (P > 0.05). Piroxicam showed less POP intensity and incidence than placebo at 6, 12 and 24 h, less POPB intensity and incidence at all timepoints, less POPer intensity and incidence and less RAI (p > 0.05), but similar FUI (P > 0.05). A significant rise in pain compared to baseline occurred with placebo from 6 to 72 h for POP and to 7 days with POPB (p > 0.05); such rise was not detected with piroxicam. POPB showed higher pain intensity than POP at all time points (p < 0.05). No swelling or adverse effects occured. CONCLUSIONS A preoperative single dose of sublingual fast-dissolving piroxicam can be effective in reducing spontaneous pain up to 24 h, stimulated pain up to 7 days, and RAI incidence in asymptomatic mandibular molars with non-vital pulp; it can prevent rise in POP and POPB postoperatively. Stimulated postoperative pain can be more severe and longer lasting than spontaneous pain. TRIAL REGISTRATION Clinicaltrials.gov ID: NCT03998826 (2019).
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Affiliation(s)
- Asmaa Fathelrahman Mohamed
- Department of Endodontics, Faculty of Dentistry, Cairo University, 11 ElSaraya Str, ElManyal, Cairo, 11553, Egypt
| | - Heba Ahmed El-Asfouri
- Department of Endodontics, Faculty of Dentistry, Cairo University, 11 ElSaraya Str, ElManyal, Cairo, 11553, Egypt
| | - Suzan Abdul Wanees Amin
- Department of Endodontics, Faculty of Dentistry, Cairo University, 11 ElSaraya Str, ElManyal, Cairo, 11553, Egypt.
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Kataia MM, Kataia EM, Khalil HF, Seoud MAE. Post-operative pain after root canal preparation with different apical finishing sizes a triple blinded split mouth clinical trial. BMC Oral Health 2024; 24:800. [PMID: 39014316 PMCID: PMC11250953 DOI: 10.1186/s12903-024-04527-9] [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: 02/08/2024] [Accepted: 06/24/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND This is a triple-blinded, prospective split-mouth clinical trial. It is important to shed light on the effect of different apical preparation sizes regarding postoperative pain within the same patient with the same pulpal histological status. The aim is to compare and evaluate the severity of postoperative pain following apical enlargement with two different sizes after the IBF using the visual analogue scale. METHODS Fifty "teeth" in 25 patients were assigned into two equal groups (25 per group) using E3 Azure rotary files; Group A was prepared two sizes greater than the Initial binding file (IBF) (the largest K file to bind at the actual working length) mesial canals, which were enlarged to 35#/0.04 and 40#/0.04 for the distal canals. Group B was prepared in three sizes larger than the IBF: 40#/0.04 for mesial canals and 45#/0.04 for the distal canals. On a modified VAS form, patients were questioned to indicate the degree of their pain and assisted in narrating their pain intensity during the following periods: 12, 24, and 72 h, and after a week. VAS data were non-parametric and analyzed using the signed-rank test for intergroup comparisons, Freidman's test, and the Nemenyi post hoc test for intragroup comparisons. The significance level was set at p < 0.05. RESULTS showed that regardless of measurement time, enlargement of apical preparation was significantly associated with higher pain scores (p < 0.001). Within both groups, there was a significant reduction of measured pain score with time, with values measured after 12 and 24 h being significantly higher than values measured at other intervals (p < 0.001) and with values measured after three days being significantly higher than 1-week value (p < 0.001). CONCLUSION The size of apical preparation had a significant effect on postoperative pain. TRIAL REGISTRATION NUMBER & DATE NCT05847738, 08/05/2023.
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Affiliation(s)
- Mohamed Medhat Kataia
- Department of Endodontics, Faculty of Dentistry, The British University of Egypt, Cairo, Egypt
| | - Engy Medhat Kataia
- Department of Endodontics, Faculty of Dentistry, The British University of Egypt, Cairo, Egypt
- Restorative and Dental Materials Department, National Research Centre, Cairo, Egypt
| | - Hala Fayek Khalil
- Department of Endodontics, Faculty of Dentistry, The British University of Egypt, Cairo, Egypt
| | - Mohammed Abou El Seoud
- Department of Endodontics, Faculty of Dentistry, The British University of Egypt, Cairo, Egypt.
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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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Meyfarth SRS, Tavares JDS, Guimarães LDS, Silva EAB, Gaio DC, Ecker MB, Brancher JA, Küchler EC, Silva-Sousa AC, de Sousa-Neto MD, Antunes LAA, Antunes LS. Association between single-nucleotide polymorphisms in serotonin receptor 2A and melatonin receptor 1A genes and pain after root canal treatment. Int Endod J 2023; 56:1077-1091. [PMID: 37323077 DOI: 10.1111/iej.13946] [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: 02/06/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/17/2023]
Abstract
AIM This study aimed to investigate whether single-nucleotide polymorphisms (SNPs) in the genes encoding 5-HTR2A (5-Hydroxytryptamine (serotonin) receptor 2A) and MTNR1A (melatonin receptor 1A) may contribute to postoperative pain perception after root canal treatment. We hypothesised that SNPs in HTR2A and MTNR1A genes were associated with postoperative pain after root canal treatment. METHODOLOGY This genetic cohort study enrolled patients with single-rooted teeth diagnosed with pulp necrosis and asymptomatic apical periodontitis before root canal treatment. Root canal treatment was performed in one session using a standardized protocol. Postoperative pain and tenderness were assessed using a visual analogue scale (recorded every day for 7 days and on the 14th and 30th days after root canal treatment). Genomic DNA was extracted from saliva and used to genotype the SNPs in HTR2A (rs4941573 and rs6313) and MTNR1A (rs6553010, rs6847693 and rs13140012) using real-time polymerase chain reaction. Genotypes were compared using univariate and multivariate Poisson regression with generalized estimating equations (p < .05). RESULTS In total, 108 patients were enrolled in this study. The SNPs rs6553010 (MTNR1A), rs4941573 and rs6313 (HTR2A) were associated with an increased risk of developing pain after root canal treatment (p < .05). CONCLUSIONS This study suggests that SNPs in HTR2A and MTNR1A influence pain response after root canal treatment.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Alice Corrêa Silva-Sousa
- Restorative Dentistry Department, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Manoel Damião de Sousa-Neto
- Restorative Dentistry Department, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Lívia Azeredo Alves Antunes
- Postgraduate Program, School of Dentistry, Fluminense Federal University, Niterói, Brazil
- Clinical Research Unit, Fluminense Federal University, Rio de Janeiro, Brazil
- Postgraduate Program, School of Dentistry, Fluminense Federal University, Nova Friburgo, Brazil
- Specific Formation Department, School of Dentistry of Nova Friburgo, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Leonardo Santos Antunes
- Postgraduate Program, School of Dentistry, Fluminense Federal University, Niterói, Brazil
- Clinical Research Unit, Fluminense Federal University, Rio de Janeiro, Brazil
- Postgraduate Program, School of Dentistry, Fluminense Federal University, Nova Friburgo, Brazil
- Specific Formation Department, School of Dentistry of Nova Friburgo, Fluminense Federal University, Rio de Janeiro, Brazil
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Versiani MA, Martins J, Ordinola-Zapata R. Anatomical complexities affecting root canal preparation: a narrative review. Aust Dent J 2023; 68 Suppl 1:S5-S23. [PMID: 37984802 DOI: 10.1111/adj.12992] [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] [Accepted: 10/15/2023] [Indexed: 11/22/2023]
Abstract
A fundamental aspect of the Endodontic field is the knowledge of root canal anatomy. Using a variety of techniques, the internal and external anatomy of teeth have been extensively investigated throughout the past century. Recent improvements in three-dimensional computed tomography have enabled more detailed evaluations of root canal morphology in both clinical and laboratory settings. Essentially, researches have unveiled that the root canal constitutes a complex system, comprising not only the main root canal but also lateral components, including isthmuses, fins, accessory canals and apical ramifications. Undoubtedly, this intricate morphology poses a significant challenge when it comes to the process of shaping, cleaning and disinfecting the root canal system. This article aims to explore the anatomical aspects of the root canal system that impact the chemomechanical procedures.
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Affiliation(s)
- M A Versiani
- Dental Specialty Center, Brazilian Military Police, Belo Horizonte, Brazil
| | - Jnr Martins
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Grupo de Investigação em Bioquímica e Biologia Oral, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Centro de Estudo de Medicina Dentária Baseada na Evidência (CEMDBE) - Cochrane Portugal, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
| | - R Ordinola-Zapata
- Endodontic Division, Department of Restorative Sciences, University of Minnesota School of Dentistry, Minneapolis, Minnesota, USA
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Souza MA, Bonacina LV, Trento A, Bonfante FDC, Porsch HF, Ricci R, Lago BLT, Lago CTR, Gabrielli ES, Bervian J, Farina AP, Cecchin D. Influence of the apical limit of instrumentation and photodynamic therapy on the postoperative pain of lower molars with asymptomatic apical periodontitis. Photodiagnosis Photodyn Ther 2021; 36:102489. [PMID: 34416381 DOI: 10.1016/j.pdpdt.2021.102489] [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: 06/27/2021] [Revised: 07/29/2021] [Accepted: 08/16/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The aim of present study was to evaluate the influence of apical limit of instrumentation and PDT on the postoperative pain of lower molars with asymptomatic apical periodontitis. METHODS Forty patients were included in the present study and were divided into 4 groups (n=10), according to apical limit of instrumentation and use of PDT: instrumentation at 0.0 measurement; instrumentation at 0.0 measurement+PDT; instrumentation 1mm beyond 0.0 measurement; instrumentation 1mm beyond 0.0 measurement+PDT. In the PDT, the root canals were filled with 0.01% methylene blue, remaining for 5 min. The low-intensity laser was used with 100 mW, 660-690 nm wavelength), using intra-canal fibre. Root canals were irradiated for 90 s, delivering total dose of 9 J and energy density of 320 J/cm2. After root canal preparation and PDT protocols, root canals were filled with gutta-percha and AH Plus endodontic sealer, being sealed with composite resin.The evaluation of postoperative pain was performed by visual analog scale after 24, 48, 72 hours and 7 days. Data were analysed by specific statistical tests, at level of 5%. RESULTS No statistical significant difference was observed among experimental groups in all evaluation periods, as well as in the intragroup analysis over time, regarding postoperative pain and analgesic medication consumption (p>0.05). CONCLUSIONS Apical limit of instrumentation and PDT have no influence on the postoperative pain of lower molars with asymptomatic apical periodontitis.
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Affiliation(s)
| | | | - Alexia Trento
- School of Dentistry, University of Passo Fundo, Passo Fundo, RS, Brazil
| | | | | | - Rafaela Ricci
- School of Dentistry, University of Passo Fundo, Passo Fundo, RS, Brazil
| | | | | | | | - Juliane Bervian
- School of Dentistry, University of Passo Fundo, Passo Fundo, RS, Brazil
| | - Ana Paula Farina
- School of Dentistry, University of Passo Fundo, Passo Fundo, RS, Brazil
| | - Doglas Cecchin
- School of Dentistry, University of Passo Fundo, Passo Fundo, RS, Brazil
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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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Guimarães LDS, da Silva EAB, Hespanhol FG, Fontes KBFDC, Antunes LAA, Antunes LS. Effect of photobiomodulation on post-operative symptoms in teeth with asymptomatic apical periodontitis treated with foraminal enlargement: A randomized clinical trial. Int Endod J 2021; 54:1708-1719. [PMID: 34173988 DOI: 10.1111/iej.13593] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 11/26/2022]
Abstract
AIM To assess the efficacy of photobiomodulation in reducing post-operative symptoms and use of analgesics in teeth with asymptomatic apical periodontitis treated with foraminal enlargement in a single visit. METHODOLOGY This prospective double-blind, controlled, superiority, randomized clinical trial enrolled 70 patients requiring root canal treatment of one single-rooted tooth with asymptomatic apical periodontitis. The participants were randomized into one of the following two groups: 35 patients in the control group (C.G) - root canal treatment with foraminal enlargement, without any additional treatment and 35 patients in the photobiomodulation group (PBM.G) - root canal treatment with foraminal enlargement associated with photobiomodulation (antimicrobial photodynamic therapy and low-level laser therapy). The outcome variables were post-operative pain, tenderness, oedema and the use of analgesics. Pain intensity was measured using a visual analogue scale (recorded every day for 7 days, then the 14th and 30th days after root canal treatment). Facial oedema was assessed subjectively by two independent evaluators using photographs taken by one of the researchers at 48 h, 72 h and 7 days after the procedures. Data were tabulated and analysed using the Mann-Whitney U, Chi-Square, Fisher`s Exact, Student T and Ordinal Logistic Regression by Generalized Estimating Equations tests in SPSS software. RESULTS There were no significant differences in post-operative pain and tenderness between the groups at any observation period (p > .05). Photobiomodulation (beta = -0.77 / p = .01), time (beta = -0.23 / p < .01), and male gender (beta = -1.20 / p < .01) were associated with decreased post-operative pain. Only time (beta: -0.10; p < .01) and male gender (beta: -1.04; p < .01) were associated with decreased tenderness. For oedema and use of analgesics, there was no difference between the groups (p > .05). CONCLUSIONS Photobiomodulation had no significant effect on post-operative pain, tenderness, oedema and the use of analgesics after root canal treatment with foraminal enlargement, in single-rooted teeth treated in a single visit. Register of Clinical Trials: NCT03704857. Research Ethics Committee: no 2.353.996 / CAAE 74185417.9.0000.5626.
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Affiliation(s)
| | | | | | | | - Livia Azeredo Alves Antunes
- Postgraduate Program, School of Dentistry, Fluminense Federal University, Niterói, Brazil.,Department of Specific Formation, School of Dentistry, Fluminense Federal University, Nova Friburgo, Brazil.,Postgraduate Program in Dentistry of Health Institute of Nova Friburgo, Fluminense Federal University, Nova Friburgo, Brazil
| | - Leonardo Santos Antunes
- Postgraduate Program, School of Dentistry, Fluminense Federal University, Niterói, Brazil.,Department of Specific Formation, School of Dentistry, Fluminense Federal University, Nova Friburgo, Brazil.,Postgraduate Program in Dentistry of Health Institute of Nova Friburgo, Fluminense Federal University, Nova Friburgo, Brazil
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Fatima S, Kumar A, Andrabi SMUN, Mishra SK, Tewari RK. Effect of Apical Third Enlargement to Different Preparation Sizes and Tapers on Postoperative Pain and Outcome of Primary Endodontic Treatment: A Prospective Randomized Clinical Trial. J Endod 2021; 47:1345-1351. [PMID: 34058250 DOI: 10.1016/j.joen.2021.05.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/24/2021] [Accepted: 05/24/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the effect of apical preparation size and taper on postoperative pain and healing after primary endodontic treatment. METHODS One hundred and twenty patients with asymptomatic mandibular first molars with radiographic evidence of periapical pathology and with a periapical index (PAI) score ≥3 were randomly assigned to 2 groups, group 1 and 2, based on apical enlargement to 2 and 3 sizes larger than the initial apical binding file (IABF), respectively. Each group was further divided into subgroups A and B depending on the apical enlargement taper of 4% and 6%, respectively. Endodontic treatment was performed, and the final apical enlargement in all the groups was performed as follows: group 1A, 2 sizes larger than the IABF with a 4% taper; group 1B, 2 sizes larger than the IABF with a 6% taper; group 2A, 3 sizes larger than the IABF with a 4% taper; and group 2B, 3 sizes larger than the IABF with a 6% taper. Postoperative pain was assessed at 6, 12, 24, 48, and 72 hours. Clinical evaluation and the change in the PAI score on radiographs were assessed at the 3-, 6-, and 12-month follow-ups. RESULTS No significant difference in postoperative pain was found. The success rate was lowest (57.1%) in group 1 subgroup A as evidenced by the significant change in the PAI score between group 1 subgroup A and the rest of the groups at the 6- and 12-month follow-ups. CONCLUSIONS Apical preparation to 2 sizes larger than the IABF with a 4% taper is insufficient and results in significantly lower success rates compared with larger preparation sizes and tapers.
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Affiliation(s)
- Shazra Fatima
- Department of Conservative Dentistry and Endodontics, Dr Ziauddin Ahmad Dental College, Aligarh Muslim University, Aligarh, India
| | - Ashok Kumar
- Department of Conservative Dentistry and Endodontics, Dr Ziauddin Ahmad Dental College, Aligarh Muslim University, Aligarh, India
| | - Syed Mukhtar Un Nisar Andrabi
- Department of Conservative Dentistry and Endodontics, Dr Ziauddin Ahmad Dental College, Aligarh Muslim University, Aligarh, India.
| | - Surendra Kumar Mishra
- Department of Conservative Dentistry and Endodontics, Dr Ziauddin Ahmad Dental College, Aligarh Muslim University, Aligarh, India
| | - Rajendra Kumar Tewari
- Department of Conservative Dentistry and Endodontics, Dr Ziauddin Ahmad Dental College, Aligarh Muslim University, Aligarh, India
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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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Morphologic Changes of Apical Foramen and Microcrack Formation after Foraminal Enlargement: A Scanning Electron Microscopic and Micro–computed Tomographic Analysis. J Endod 2020; 46:1726-1732. [DOI: 10.1016/j.joen.2020.07.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/22/2020] [Accepted: 07/13/2020] [Indexed: 12/30/2022]
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12
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Ferreira NDS, Gollo EKF, Boscato N, Arias A, Silva EJNLD. Postoperative pain after root canal filling with different endodontic sealers: a randomized clinical trial. Braz Oral Res 2020; 34:e069. [PMID: 32696911 DOI: 10.1590/1807-3107bor-2020.vol34.0069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/20/2020] [Indexed: 11/22/2022] Open
Abstract
The aim of this randomized clinical trial was to compare the occurrence and intensity of postoperative pain and analgesic intake after root canal treatment, using different root canal sealers. Sixty single-rooted teeth diagnosed with asymptomatic necrosis and apical periodontitis were randomly assigned to 3 experimental groups (n=20), according to the root canal sealer: AH Plus, Endofill or MTA Fillapex. Endodontic treatment was performed in two sessions, and calcium hydroxide was used as the intracanal dressing. Patients were instructed to record pain intensity as none, slight, moderate and severe. Scores from 1 to 4 were attributed to each level of pain after 24 h, 48 h and 7 days. The need for analgesic intake was also recorded. Differences in the incidence of postoperative pain and the need for an analgesic were analyzed using the chi-square test. Differences in pain intensity after treatment were analyzed using the ordinal (linear) chi-square test. No significant differences were detected among the groups in terms of either incidence or intensity of postoperative pain, or need for analgesic intake, at any timepoint (p>0.05). No pain was reported after 7 days. AH Plus, Endofill and MTA Fillapex used for filling root canals resulted in the same rate of postoperative pain and need for analgesic medication.
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Affiliation(s)
- Nadia de Souza Ferreira
- Department of Semiology and Clinics, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | | | - Noeli Boscato
- Department of Restorative Dentsitry, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Ana Arias
- Conservative Dentistry Department, School of Dentistry, Universidad Complutense de Madrid, Madrid, Spain
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Dagher J, El Feghali R, Parker S, Benedicenti S, Zogheib C. Postoperative Quality of Life Following Conventional Endodontic Intracanal Irrigation Compared with Laser-Activated Irrigation: A Randomized Clinical Study. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2020; 37:248-253. [PMID: 31050955 DOI: 10.1089/photob.2018.4558] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objective: The aim of this randomized clinical study was to evaluate the effect of laser-activated irrigation using a photon-induced photoacoustic streaming (PIPS) technique on postoperative pain following completion of root canal obturation. Methods: Fifty-six patients were enrolled in this randomized clinical trial. Fifty-six healthy premolars or molars with asymptomatic irreversible pulpitis, symptomatic irreversible pulpitis, or symptomatic pulpal necrosis, with or without apical periodontitis, were mechanically prepared for endodontic treatment and divided into two groups. Patients were randomly allocated to treatment groups. In the positive control group G1, the final irrigation with 2 cc of 5.25% sodium hypochlorite (NaOCl) was achieved using a 27G needle, introduced into the canal to a distance of 5 mm from the predetermined working length. In the experimental group G2, the root canals were irrigated with 17% ethyldiamine tetric acid (EDTA) and 5.25% NaOCl following the PIPS protocol, using an Er:YAG 2940 nm laser (LightWalker ATS®; Fotona, Slovenia) with a 600 μm diameter tip and operating parameters of 20 mJ per pulse, 15 Hz frequency, 0.3 W average power, and a 50-μs pulse duration. Postoperatively, the patients were advised to take a minor analgesic (ibuprofen 400 mg) in the event of pain perception. Postoperative pain levels were assessed after 24, 48, and 72 h and 7 days through the use of a Visual Analogue Scale questionnaire, completed by each patient. Data were analyzed using Kolmogorov-Smirnov, Fisher Exact, Chi square, Mann-Whitney test, and Friedman's test. The level of significance was set at α = 0.05. Results: There was no significant difference between the laser-irradiated group and the control group (p < 0.5). Laser activation of irrigating solutions did not increase postoperative pain. Conclusions: The outcome of this investigation indicated that PIPS was as effective as conventional irrigation in relation to postoperative pain, making this activation technique interesting to use for supplementary root canal disinfection.
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Affiliation(s)
- Jessica Dagher
- 1 Department of Endodontics, Saint Joseph University, Beirut, Lebanon
| | - Rita El Feghali
- 2 Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Steven Parker
- 2 Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Stefano Benedicenti
- 2 Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Carla Zogheib
- 1 Department of Endodontics, Saint Joseph University, Beirut, Lebanon
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Influence of foraminal enlargement on the healing of periapical lesions in rat molars. Clin Oral Investig 2018; 23:1985-1991. [DOI: 10.1007/s00784-018-2628-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
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15
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Evaluation of Effect of Foraminal Enlargement of Necrotic Teeth on Postoperative Symptoms: A Systematic Review and Meta-analysis. J Endod 2017; 43:1969-1977. [DOI: 10.1016/j.joen.2017.07.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 07/16/2017] [Accepted: 07/18/2017] [Indexed: 11/24/2022]
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16
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Wolgin M, Grundmann MJ, Tchorz JP, Frank W, Kielbassa AM. Ex vivo investigation on the postoperative integrity of the apical constriction after the sole use of electronic working length determination. J Dent 2017. [PMID: 28642058 DOI: 10.1016/j.jdent.2017.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AIM The present study investigated the accuracy of root canal preparation with regard to the integrity of the apical constriction (AC) using two different working length determination approaches: (1) the electronic method of working length determination (EWLD), and (2) the radiologic "gold standard" method (GS). METHODOLOGY Simulation models were constructed by arranging extracted human teeth by means of silicon bolstered gingiva masks, along with a conductive medium (alginate). Electronic working length determination (group 1; EWLD) and radiologic plus initial electronic working length determination for posterior comparability (group 2; GS) preceded manual root canal preparation of teeth in both groups. Master cones were inserted according to working lengths obtained from the group specific method. Subsequently, root apices (n=36) were longitudinally sectioned using a diamond-coated bur. The distance between the achieved apical endpoint of the endodontic preparation and the apical constriction (AC) was measured using digital photography. Then, distances between radiologically identified apical endpoints and AC (GS-AC) were compared with the corresponding distances EWLD-AC. Moreover, the postoperative status of the AC was examined with regard to both preparation approaches. RESULTS Differences between distances GS-AC and EWLD-AC were not statistically significant (p >0.401) (Mann-Whitney-U). Among EWLD samples, 83% of the master cones exhibiting tugback at final insertion terminated close to the apical constriction (±0.5 mm), and no impairment of the minor diameter's integrity was observed. CONCLUSIONS The sole use of EWLD allowed for a high accuracy of measurements and granted precise preparation of the apical regions.
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Affiliation(s)
- Michael Wolgin
- Center for Operative Dentistry, Periodontology, and Endodontology, University of Dental Medicine and Oral Health, Danube Private University (DPU), Steiner Landstraße 124, 3500 Krems, Austria
| | - Markus J Grundmann
- Center for Operative Dentistry, Periodontology, and Endodontology, University of Dental Medicine and Oral Health, Danube Private University (DPU), Steiner Landstraße 124, 3500 Krems, Austria
| | - Jörg P Tchorz
- Center for Operative Dentistry, Periodontology, and Endodontology, University of Dental Medicine and Oral Health, Danube Private University (DPU), Steiner Landstraße 124, 3500 Krems, Austria; Department of Operative Dentistry and Periodontology, Center for Dental Medicine, Medical Center University of Freiburg, Albert-Ludwigs-University, Hugstetterstraße 55, 79106 Freiburg, Germany
| | - Wilhelm Frank
- Center for Preclinical Education, Dept. of Biostatistics, University of Dental Medicine and Oral Health, Danube Private University (DPU), Steiner Landstraße 124, 3500 Krems, Austria
| | - Andrej M Kielbassa
- Center for Operative Dentistry, Periodontology, and Endodontology, University of Dental Medicine and Oral Health, Danube Private University (DPU), Steiner Landstraße 124, 3500 Krems, Austria.
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Predictors, prevention, and management of postoperative pain associated with nonsurgical root canal treatment: A systematic review. J Taibah Univ Med Sci 2017; 12:376-384. [PMID: 31435267 PMCID: PMC6695063 DOI: 10.1016/j.jtumed.2017.03.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/19/2017] [Accepted: 03/27/2017] [Indexed: 01/12/2023] Open
Abstract
Postoperative pain after root canal treatment can be reduced by applying recent advances in endodontic techniques and equipment. This systematic review includes current knowledge about pain after nonsurgical root canal treatment, including predictors, related factors, effects of recent advances, and management. A literature search was performed using the PubMed, ScienceDirect, and Cochrane Library databases for articles published between 1990 and 2016. Search keywords included postoperative pain, nonsurgical treatment, single visit, recent advances in endodontics, and management of postoperative pain with endodontic treatment. Only original research studies were included; editorials, reviews, brief notes, conference proceedings, and letters to the editor were excluded. The initial search yielded 4941 articles, which were assessed and filtered using the selection criteria. Sixty-five studies met the inclusion criteria and were included in the review. The findings showed that pain after nonsurgical root canal treatment occurred in 3–69.3% of patients. Microorganisms were identified as the primary contributors to postoperative pain, and there was no significant difference in postoperative pain between single- and multiple-visit treatments. Postoperative pain after root canal treatment ranges from mild to moderate and occurs even after optimally performed procedures. Furthermore, adequate management of postoperative pain is often considered an indicator of clinical excellence. Application of recently developed endodontic techniques and devices will reduce postoperative pain. Furthermore, a flexible, severity-based drug administration plan can be used to control and manage pain after root canal treatment. Application of the current research findings will reduce pain following root canal treatment and improve patient outcomes.
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18
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The Effect of Foraminal Enlargement of Necrotic Teeth with a Continuous Rotary System on Postoperative Pain: A Randomized Controlled Trial. J Endod 2017; 43:359-363. [DOI: 10.1016/j.joen.2016.11.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 11/02/2016] [Accepted: 11/07/2016] [Indexed: 11/18/2022]
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Yammine S, Jabbour E, Nahas P, Majzoub Z. Foramen Changes following Over Instrumentation of Curved Canals with Three Engine-Driven Instruments: An In Vitro Study. IRANIAN ENDODONTIC JOURNAL 2017; 12:454-461. [PMID: 29225641 PMCID: PMC5722120 DOI: 10.22037/iej.v12i4.16268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 08/06/2017] [Accepted: 08/20/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The present in vitro study aimed to evaluate and compare the changes in shape and surface area of the major foramen following shaping of curved canals with three new generation NiTi engine-driven instruments naming ProTaper Next, BT RaCe and WaveOne Gold- with 3 different levels of protrusion beyond the major apical foramen. METHODS AND MATERIALS A total of 45 extracted human molars with at least one curved canal were distributed in 3 comparable groups of 15 that were instrumented using either ProTaper Next (PTN), BT RaCe (BTR) or WaveOne Gold (WOG). The canals were instrumented to the major foramen and then over instrumented with the final file 0.5 mm, 1 mm and 1.5 mm beyond the foramen. Standardized pre- and post-instrumentation photographs of the foramen were obtained for all groups using a stereomicroscope. Foramen shape and surface area were evaluated using the AmScope software for measurements and compared between groups and levels of instrumentation applying binary conditional logistic regression and repeated measures ANOVA. The level of significance was set at 0.05. RESULTS Foramen shape tended to gradually change from circular to oval as the level of instrumentation increased in all groups. The original foramen shape in WOG group remained better than other groups. Foramen surface areas increased in all groups with Group BTR demonstrating significantly greater values than the other 2 groups. CONCLUSION Over instrumentation resulted in apical enlargement and ovalization in all 3 groups but with different patterns. These differences can be attributed to the final file size, design characteristics and kinematics of the 3 systems.
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Affiliation(s)
- Salwa Yammine
- Department of Endodontics, Lebanese University, Campus Rafic Hariri, Hadath, Beirut, Lebanon;
| | - Edgard Jabbour
- Department of Endodontics, Lebanese University, Campus Rafic Hariri, Hadath, Beirut, Lebanon;
| | - Paul Nahas
- Department of Restorative and Esthetic Dentistry, Lebanese University, Campus Rafic Hariri, Hadath, Beirut, Lebanon;
| | - Zeina Majzoub
- Department of Periodontology, Lebanese University, Campus Rafic Hariri, Hadath, Beirut, Lebanon
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Middha M, Sangwan P, Tewari S, Duhan J. Effect of continuous ultrasonic irrigation on postoperative pain in mandibular molars with nonvital pulps: a randomized clinical trial. Int Endod J 2016; 50:522-530. [DOI: 10.1111/iej.12666] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 05/26/2016] [Indexed: 01/23/2023]
Affiliation(s)
- M. Middha
- Department of Conservative Dentistry and Endodontics; Post Graduate Institute of Dental Sciences (PGIDS); Rohtak India
| | - P. Sangwan
- Department of Conservative Dentistry and Endodontics; Post Graduate Institute of Dental Sciences (PGIDS); Rohtak India
| | - S. Tewari
- Department of Conservative Dentistry and Endodontics; Post Graduate Institute of Dental Sciences (PGIDS); Rohtak India
| | - J. Duhan
- Department of Conservative Dentistry and Endodontics; Post Graduate Institute of Dental Sciences (PGIDS); Rohtak India
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