Comparison of post-obturation pain experience following one-visit and two-visit root canal treatment on teeth with vital pulps: a randomized controlled trial

Postoperative pain in primary root canal treatments after Er: YAG laser-activated irrigation: a systematic review and meta-analysis

This systematic review aimed to compare postoperative pain in endodontic treatments using PIPS Er: YAG laser-activated irrigation (LAI) versus conventional needle irrigation. An electronic search was conducted to identify randomized clinical trials (RCT) investigating postoperative pain in patients who underwent root canal treatments in permanent teeth using PIPS Er: YAG laser-activated irrigation or conventional needle irrigation. Two reviewers performed study selection, data extraction, risk of bias assessment (RoB 2.0 tool), and the certainty of evidence (GRADE). The meta-analyses were conducted using Review Manager software (p ≤ 0.05). The mean difference (MD) was chosen as the effect measure, and a random-effect model was employed, along with a 95% confidence interval (CI). The search identified 2864 records, and after selecting, three RCTs were included in the quantitative analysis. The meta-analysis showed a difference in postoperative pain according to the evaluation time. The subgroup meta-analysis revealed that the PIPS Er:YAG showed a significant reduction in the postoperative pain in the 48 hours (MD = -0.78; 95% CI [-1.39, -0.17]; p = 0.01; I² = 69%) compared to the control group. However, no statiscally significant results were found when assessing postoperative pain after 1, 3 and 7 days (95% CI; p > 0.05). The PIPS Er: YAG laser-activated irrigation reduced postoperative pain at 2 days following primary endodontic treatment. However, the certainty of the evidence is low and further RCTs are needed to confirm these results and avoid bias and confounding factors. Registration: PROSPERO registration number: CRD42023432499.

Influence of number of visits on the outcome of endodontic treatment

The success of endodontic treatment (ET) is largely dependent on the application of a strict protocol for disinfecting the root canal system and may be influenced by the number of visits but remains controversial in the literature. This review provides an overview of published studies comparing ET in single and multiple visits. A search was performed in the electronic databases such as PubMed, Cochrane Library, Science Direct, and Google Scholar from 2017 to 2022. Eligibility criteria were randomized clinical trials, reviews, and studies focusing on single- or multivisit techniques. Twenty-four articles were included. The main characteristics, including healing rates, success, and postoperative pain after ET, were extracted from the studies. The results of the studies included in this review showed that single- and multisession ET are similar in terms of healing rates and long-term complications, although both treatment approaches may be associated with short-term postoperative pain.

Post-operative pain in non-surgical root canal treatment after sealer-based obturation versus warm vertical compaction: A randomized clinical trial

AIM

Post-operative pain may occur after non-surgical root canal treatment (NSRCT). The root filling technique and choice of sealer may be contributing factors. This randomized controlled clinical trial compared post-operative pain and analgesics intake after NSRCT using a sealer-based obturation technique (SBO) with single-cone gutta-percha and calcium silicate sealer (CSS) versus a warm-vertical compaction (WVC) technique with gutta-percha and a resin-based sealer (RBS).

METHODOLOGY

This study was designed as a parallel-two arm, double-blind, randomized superiority clinical trial registered at www.

CLINICALTRIALS

gov (NCT04753138). Patients referred for NSRCT fulfilling the inclusion criteria participated in this study. Pre-operative periapical radiographs and CBCT scans were taken and numerical rating scale (NRS) pain scores were recorded. Upon completion of canal instrumentation, participants were randomly allocated to either Group SBO: SBO with CSS or Group WVC: Warm-vertical compaction with RBS. Post-operative pain and analgesics intake were recorded at 1, 3 and 7 days after endodontic treatment completion. Non-parametric Mann-Whitney U and Friedman tests and a generalized estimating equation were used to assess differences in pain scores between the groups, within each treatment group at different time points and for correlations, respectively.

RESULTS

The study included 195 participants (212 teeth). One participant declined to submit the NRS form. Therefore, 194 participants (211 teeth) were included in the final analysis (99.5% response rate). No statistically significant differences in post-operative pain or analgesic intake existed between the two groups at any time point (p > .05). Age, pre-operative pain, apical diagnosis and post-operative analgesic intake were significantly related to post-operative pain (p < .05).

CONCLUSIONS

Sealer-based obturation technique with CSS was associated with similar post-operative pain levels and analgesics intake as WVC with RBS. Regarding post-operative pain, SBO with CSSs may be a suitable clinical alternative.

Post-operative pain after root canal preparation with different apical finishing sizes a triple blinded split mouth clinical trial

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.

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

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.

A systematic review and meta-analysis on the effects of phototherapy on postoperative pain in conventional endodontic reintervention

OBJECTIVES

This systematic review and meta-analysis (SRM) aimed to evaluate the efficacy of laser phototherapy (LPT) on the reduction in postoperative pain (PP) of endodontic origin after conventional/non-surgical reintervention of root canals.

METHODS

This SRM was registered with PROSPERO (CRD42021243500) and followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Meta-analysis was conducted using R software with the "META" package, the mean difference (MD) measure of effect was calculated, and the fixed effect model was applied with a 95% confidence interval (CI). The Cochrane collaboration scale was used to assess the risk of bias and the GRADE tool to assess the quality of evidence.

RESULTS

Initially, 1028 articles were found, and five articles were included. Most studies were classified as "low" risk of bias. Of the five clinical studies, four showed a significant decrease in PP after endodontic reintervention in the LPT groups compared to the control group, especially in the first four days after the intervention. In symptomatic teeth with multiple roots, LPT led to less PP at 24 h (MD -0.52 [-1.03; -0.02] p = .04). However, no significant difference between the groups was found at 48 and 72 h (p > .05). The certainty of the evidence was classified as low.

CONCLUSION

Despite the limitations of this SRM, LPT was shown to be a promising alternative for reducing and controlling PP in conventional endodontic reintervention.

CLINICAL SIGNIFICANCE

The use of LPT in endodontic reintervention may be a safe and promising alternative to clinically efficacious agent for use in the management of PP in this procedure.

Postoperative pain after single-visit root canal treatment or vital pulp therapy: A systematic review and meta-analysis

BACKGROUND

This systematic review aimed to investigate whether vital pulp therapy and root canal treatment (RCT) promote different postoperative pain.

STUDIES REVIEWED

The authors searched PubMed, Cochrane Library, Embase, and Latin American and Caribbean Health Sciences Literature databases for studies published through June 30, 2022. The authors included randomized clinical trials if they reported on the assessment of postoperative pain after direct pulp capping, partial pulpotomy, pulpotomy, or single-visit RCT. The authors assessed the frequency of no, mild, moderate, and severe postoperative pain. They conducted meta-analyses to compare postoperative pain after full pulpotomy (PULP) and RCT.

RESULTS

The qualitative synthesis included 57 studies, and the authors conducted meta-analysis of 3. PULP leads to more asymptomatic cases (relative risk [RR], 1.06; 95% CI, 1.01 to 1.11; P < .01; I2 = 67%) and to a lower occurrence of mild (RR, 0.89; 95% CI, 0.79 to 0.99; P < .04; I2 = 37%) and moderate (RR, 0.70; 95% CI, 0.51 to 0.95; P < .02; I2 = 57%) postoperative pain than RCT. The frequency of severe pain was very low for both vital pulp therapy and RCT. Moderate to severe postoperative pain was more common at 48 hours through 72 hours after RCT and up to 36 hours after PULP. Pain intensity after PULP was higher using calcium-enriched material compared with using mineral trioxide aggregate at 12, 18, and 36 hours (P < .001).

PRACTICAL IMPLICATIONS

PULP showed a significantly higher incidence of no pain and a lower incidence of mild and moderate pain than single-visit RCT. Clinical decisions for RCT or PULP should not be based on differences in postoperative pain. When analgesia is indicated, it probably should be limited to a short time after PULP.

The effect of the irrigant activation protocol on postoperative pain in maxillary incisors with asymptomatic apical periodontitis: A three-arm randomized clinical trial

OBJECTIVES

This study aimed to compare the effects of three irrigation activation systems (IAS) on postoperative pain (PP) in activating three final irrigants: sodium hypochlorite 5.25%, ethylenediaminetetraacetic acid 17%, and chlorhexidine 2%.

MATERIALS AND METHODS

This parallel randomized clinical trial included referred patients with asymptomatic large-sized apical lesion incisors. A standard method was followed in the canal cleaning and shaping for all included patients in the study. Then, the patients were randomly assigned (1:1 allocation) into three groups: G1 (n = 20) with passive ultrasonic irrigation activation; G2 (n = 20) with XP-Endo Finisher file activation; and G3 (n = 20) with diode laser (810 nm) activation. PP was estimated in all groups using a visual analog scale after 1, 3, 7, and 14 days of treatment. Comparisons between the groups were made using the Kruskal-Wallis test, whereas the Mann-Whitney U test was used in the pairwise comparisons.

RESULTS

Sixty patients were followed-up in this trial. There were significant differences between the groups in terms of PP After 1, 3, and 7 days of treatment (p = 0.002, p = 0.017, and p = 0.006, respectively). On the first day of treatment, G3 showed the lowest PP compared with G1 and G2 (p = 0.007 and p = 0.001, respectively). On the third day of treatment, G3 showed less PP compared with G2 (p = 0.005). On the seventh day of treatment, G2 showed the highest PP compared with G1 and G3 (p = 0.012 and p = 0.003, respectively).

CONCLUSIONS

The XP-Endo Finisher file caused the highest PP level especially in the next day and 3 days of the treatment, whereas the diode laser had the lowest PP level during the first week of treatment. It is noteworthy that PP disappeared completely after 2 weeks of treatment with all three IASs.

TRIAL REGISTRATION

The trial was registered in the ISRCTN registry (Trial ID: SRCTN99457940).

The effect of two different root canal sealers on treatment outcome and post-obturation pain in single-visit root canal treatment: A prospective randomized clinical trial

AIM

This randomized clinical trial aimed to evaluate and compare the effect of mineral trioxide aggregate (MTA)-based bioceramic- and resin-based sealers on the incidence and intensity of post-obturation pain and treatment outcome in asymptomatic vital molar teeth in single-visit root canal treatment.

METHODOLOGY

One hundred asymptomatic mandibular molar teeth with vital pulp were randomly assigned into two groups according to the sealer used: MTA Fillapex or AH Plus sealer. WaveOne Gold instruments were used for root canal preparations. Root canals were obturated with WaveOne Gold gutta-percha cones corresponding in size and taper to the last instrument used. MTA Fillapex was used in the first group and AH Plus was used in the second group as the root canal sealer. The effects of age, gender, tooth types and the level of root canal filling on the treatment outcome were evaluated after 1 and 2 years. Postoperative pain at 6, 12, 24, 48, 72 h, 4, 5, 6, 7 and 30 days after root canal treatment was measured with the Numerical Rating Scale. Chi-square test was used for the treatment outcome and Mann-Whitney U, chi-Square and Spearman correlation analyses were used for postoperative pain. α = .05 was the level of significance.

RESULTS

Twelve patients did not complete the 2-year follow-up and the study finished with 88 patients. In the MTA Fillapex group 41 correct, one short, two extruded, and in the AH Plus group 40 correct, one short and three extruded root canal fillings were detected. No significant differences were observed between the first- and second-year treatment outcomes between the groups (p > .05).There was no association between age, gender, tooth number, root canal filling length and the treatment success in all evaluated teeth (p > .05). The differences between the groups in terms of postoperative pain incidence and intensity at all time-points were not significant (p > .05). There was no correlation between the age and postoperative pain (p > .05), but pain was statistically higher in women (p < .05).

CONCLUSIONS

Mineral trioxide aggregate Fillapex showed similar success rate and post-obturation pain incidence and intensity as AH Plus sealer and can be used as a root canal sealer in asymptomatic mandibular molars with irreversible pulpitis.

Single versus multiple visits for endodontic treatment of permanent teeth

BACKGROUND

Root canal treatment (RoCT), or endodontic treatment, is a common procedure in dentistry. The main indications for RoCT are irreversible pulpitis and necrosis of the dental pulp caused by carious processes, coronal crack or fracture, or dental trauma. Successful RoCT is characterised by an absence of symptoms (i.e. pain) and clinical signs (i.e. swelling and sinus tract) in teeth without radiographic evidence of periodontal involvement (i.e. normal periodontal ligament). The success of RoCT depends on a number of variables related to the preoperative condition of the tooth, as well as the endodontic procedures. RoCT can be carried out with a single-visit approach, which involves root canal system obturation (filling and sealing) directly after instrumentation and irrigation, or with a multiple-visits approach, in which the treatment is completed in two or more sessions and obturation is performed in the last session. This review updates the previous versions published in 2007 and 2016.

OBJECTIVES

To evaluate the benefits and harms of completion of root canal treatment (RoCT) in a single visit compared to RoCT over two or more visits, with or without medication, in people aged over 10 years.

SEARCH METHODS

We used standard, extensive Cochrane search methods. The latest search date was 25 April 2022.

SELECTION CRITERIA

We included randomised controlled trials and quasi-randomised controlled trials in people needing RoCT comparing completion of RoCT in a single visit compared to RoCT over two or more visits.  DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were 1. tooth extraction and 2. radiological failure after at least one year (i.e. periapical radiolucency). Our secondary outcomes were 3. postoperative and postobturation pain; 4. swelling or flare-up; 5. analgesic use and 6. presence of sinus track or fistula after at least one month. We used GRADE to assess certainty of evidence for each outcome. We excluded five studies that were included in the previous version of the review because they did not meet the current standard of care (i.e. rubber dam isolation and irrigation with sodium hypochlorite).

MAIN RESULTS

We included 47 studies with 5805 participants and 5693 teeth analysed. We judged 10 studies at low risk of bias, 17 at high risk of bias and 20 at unclear risk of bias. Only two studies reported data on tooth extraction. We found no evidence of a difference between treatment in one visit or treatment over multiple visits, but we had very low certainty about the findings (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.09 to 2.50; I2 = 0%; 2 studies, 402 teeth). We found no evidence of a difference between single-visit and multiple-visit treatment in terms of radiological failure (RR 0.93, 95% CI 0.81 to 1.07; I2 = 0%; 13 studies, 1505 teeth; moderate-certainty evidence). We found evidence of a higher proportion of participants reporting pain within one week in single-visit groups compared to multiple visit groups (RR 1.55, 95% CI 1.14 to 2.09; I2 = 18%; 5 studies, 638 teeth; moderate-certainty evidence).  We found no evidence of a difference in the proportion of participants reporting pain until 72 hours postobturation (RR 0.97, 95% CI 0.81 to 1.16; I2 = 70%; 12 studies, 1329 teeth; low-certainty evidence), pain intensity until 72 hours postobturation (mean difference (MD) 0.26, 95% CI -4.76 to 5.29; I2 = 98%; 12 studies, 1258 teeth; low-certainty evidence) or pain at one week postobturation (RR 1.05, 95% CI 0.67 to 1.67; I2 = 61%; 9 studies, 1139 teeth; very low-certainty evidence). We found no evidence of a difference in swelling or flare-up incidence (RR 0.56 95% CI 0.16 to 1.92; I2 = 0%; 6 studies; 605 teeth; very low-certainty evidence), analgesic use (RR 1.25 95% CI 0.75 to 2.09; I2 = 36%; 6 studies, 540 teeth; very low-certainty evidence) or sinus tract or fistula presence (RR 1.00, 95% CI 0.24 to 4.28; I2 = 0%; 5 studies, 650 teeth; very low-certainty evidence). Subgroup analysis found no differences between single-visit and multiple-visit RoCT for considered outcomes other than proportion of participants reporting post-treatment pain within one week, which was higher in the single-visit groups for vital teeth (RR 2.16, 95% CI 1.39 to 3.36; I2 = 0%; 2 studies, 316 teeth), and when instrumentation was mechanical (RR 1.80, 95% CI 1.10 to 2.92; I2 = 56%; 2 studies, 278 teeth).

AUTHORS' CONCLUSIONS

As in the previous two versions of the review, there is currently no evidence to suggest that one treatment regimen (single-visit or multiple-visit RoCT) is more effective than the other. Neither regimen can prevent pain and other complications in the 12-month postoperative period. There was moderate-certainty evidence of higher proportion of participants reporting pain within one week in single-visit groups compared to multiple-visit groups. In contrast to the results of the last version of the review, there was no difference in analgesic use.

Incidence and risk factor analysis for swelling after apical microsurgery

BACKGROUND

Swelling after apical microsurgery is a postoperative reaction and may reduce quality of life during healing.

AIM

To evaluate periapical swelling after apical microsurgery and determine potential risk factors.

METHODS

Ninety-eight apical microsurgery patients were selected for this study. Before surgery, bone shadow volume and density of pathological tissue were measured by cone beam computed tomography. The other variables (age, gender, operative teeth number, fistula, preoperative swelling, drug use and preoperative root canal treatments) were assessed during examination. Swelling degree was confirmed by questionnaires for patients on postoperative days 1, 7, 14 and 21. Statistical analyses were performed to identify predictors for swelling.

RESULTS

Majority of patients reported moderate (45.9%) or severe (34.7%) swelling on day 1, and moderate (44.9%) or mild (45.9%) on postoperative day 7. Ninety-nine percent of patients had no or mild swelling on postoperative day 14. The average swelling level peaked on day 1 postoperatively and gradually decreased. Of statistical significance, age, bone shadow volume and density of pathological tissue acted as predictors of swelling (P < 0.05). However, there was no significant difference in gender, tooth number, fistula, preoperative swelling, drug use, or preoperative root canal treatments (P > 0.05).

CONCLUSION

Younger patients with larger shadow volume and density were significantly more likely to develop swelling after apical microsurgery.

A randomized controlled trial to evaluate the incidence of postoperative pain and flare-ups in single and multiple visits root canal treatment

Background

Irreversible pulpitis is a painful and debilitating condition. Root canal treatment (RCT) provides prompt relief and salvages the affected tooth/teeth. It has classically been performed as a multivisit procedure. A relatively newer approach constitutes performing all the steps in one single visit. This study was designed to explore if single-visit RCT could be confidently used as an effective and preferred treatment modality for irreversible pulpitis in the Indian Armed forces.

Methods

The study compared the incidence of postoperative pain, tenderness on percussion (TOP), flare-ups, and the analgesic drug use in 60 cases of acute irreversible pulpitis who were treated by either single or multiple visit root canal therapy. Each treatment group included 30 patients who were evaluated preoperatively and postoperatively at 24 h, one week and one month.

Results

The study found statistically higher incidence of postoperative pain (mild variant) and TOP in single visit therapy, 24 h after the obturation while the difference was insignificant at one week and one month after therapy. Analgesic use was significantly higher after the single visit therapy in the first 24 h. No flare-ups were recorded in either group. Significant pain and tenderness was observed after chemo-mechanical preparation (appointment 2) in multivisit regimen.

Conclusion

Single visit therapy is a safe, practical, and effective approach. The treatment results are similar to the multivisit regimen. It should therefore be considered for wider adoption and application.

Postoperative pain intensity and incidence following single visit root canal treatment with different obturation techniques: a randomized clinical trial

Background

There are few studies in the literature about the effect of obturation techniques on postoperative pain. Besides, GuttaFlow2 was used for the first time in this study regarding postoperative pain. This study aimed to compare the postoperative pain levels and incidence following single-visit root canal treatment with different canal filling techniques; cold lateral compaction (CLC), thermoplasticised solid-core carrier (GuttaCore) based filling and cold free-flow compaction (GuttaFlow2) technique.

Methods

The patients (n = 93) having single-rooted teeth with a single canal diagnosed with asymptomatic irreversible pulpitis or single-rooted vital teeth with a single canal requiring endodontic treatment because of prosthetic reasons were enrolled in this study. Patients were randomized into three groups (n = 31) according to the obturation technique. A single operator performed all the treatments in a single visit. Data on obturation levels, postoperative pain and analgesic intake frequency were recorded at postoperative 6, 12 and 24 h and daily afterward until the 7^th day. Postoperative pain was measured by visual analogue scale (VAS). The date were statistically analyzed with chi-squared tests (for the analyses of the categorical data), the nonparametric Kruskal-Wallis test (for the comparisons of VAS score) and with the Friedman test (for the assessments of the changes in VAS scores over time).

Results

The GuttaCore group recorded the higher pain levels, except first 12 h, on the other hand, the GuttaFlow2 group recorded the lower pain levels at all time periods. Significant differences occurred among the groups during the first 4 days (p < 0.05), except at 12 h (p = 0.054). The patients in the CLC and GuttaFlow2 groups did not need to use the prescribed analgesic; however, one patient in the GuttaCore group used it once.

Conclusions

Postoperative pain levels following root canal therapy were affected by the obturation technique especially first 4 days following obturation.

Evaluation of Postoperative Pain Following Single-Visit Root Canal Treatment with Rotary and Reciprocal Ni–Ti File Systems in Children

Background and Objectives: Postoperative pain is a common symptom of a flare-up after root canal treatments (RCTs). Insufficient instrumentation, extrusion of irrigation solutions and debris, and the existence of a periapical lesion are the factors affecting postoperative pain after root canal treatments. The aim of this study was to evaluate the postoperative pain and instrumentation time of the single-file reciprocating system and multiple-file Ni–Ti rotary system in children ages 9–12 years old. Materials and Methods: Our study was conducted on 51 permanent mandibular molars with the diagnosis of irreversible pulpitis. Patients were randomly assigned into two groups, and RCTs were completed with either the Reciproc Blue or Protaper NEXT file systems. Instrumentation time for each system was noted, and patients were given a pain scale that included a visual analog scale for 6, 24, 48, and 72 h after treatment. Postoperative pain scores and instrumentation times were analyzed statistically with a chi-square test and Student’s t-test. Results: There was no statistically significant difference in postoperative pain between the Reciproc Blue and Protaper NEXT systems at all time intervals. Instrumentation time was significantly shorter in the Reciproc Blue group in comparison with the Protaper NEXT group. Conclusions: Postoperative pain findings following RCT using single-file reciprocating systems were similar to the rotary system group. However, chair time in the reciprocating system group was significantly lower. This provided a comfortable and patient-friendly treatment approach for children, and could enhance their cooperation.

Assessment of Antimicrobial Efficacy of Nano Chitosan, Chlorhexidine, Chlorhexidine/Nano Chitosan Combination versus Sodium Hypochlorite Irrigation in Patients with Necrotic Mandibular Premolars: A Randomized Clinical Trial

AIM: The study was done to assess the antimicrobial effectiveness of Chitosan Nanoparticles (CNPs), Chlorhexidine (CHX), and their combination (CHX/CNPs) versus that of Sodium hypochlorite (NaOCl) in patients with mandibular necrotic premolars and to evaluate their effects on post-operative pain after single-visit endodontic treatment. MATERIALS AND METHODS: Sixty patients with necrotic mandibular premolars were divided randomly to four groups (n = 15) according to the used irrigating solution. Instrumentation was done using rotary ProTaper files. During instrumentation, irrigation was done using 2.5% NaOCl; afterward, canals were flushed with sterile saline. A final flush with the study irrigants was done as follows: 3% CNPs for Group A, 2% CHX for Group B, CHX/CNPs for Group C, and 5.25% NaOCl for Group D. Samples were collected from root canals before and after canal preparation then cultured to assess the number of colony-forming units/ml. All patients were instructed to record their pre- and post-operative pain levels on a numerical rating scale. RESULTS: CNPs and CHX/CNPs were significantly more effective than either CHX or NaOCl; however, there was no significant difference between them against anaerobic bacteria. All tested irrigants were similarly effective against aerobic bacteria. CNPs and CHX/CNPs were associated with significantly lower post-operative pain levels in the first 24 h after treatment. CONCLUSIONS: CNPs and its combination with CHX are significantly more effective than both CHX and NaOCl against anaerobic bacteria isolated from necrotic mandibular premolars. Post-operative pain intensity was significantly lower with CNPs and CNPs/CHX combination than with either NaOCl or CHX.

Postoperative Pain following Root Canal Filling with Bioceramic vs. Traditional Filling Techniques: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

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.

Evaluation of Ozone Therapy in Endodontic Treatment of Teeth with Necrotic Pulp and Apical Periodontitis: A Randomized Clinical Trial

INTRODUCTION

The aim of this study was to compare the effect of different application techniques of ozone on the prevalence of postendodontic pain in patients undergoing single-visit root canal treatment.

METHODS

hundred eight patients with necrotic pulp in single-rooted teeth and apical periodontitis participated in the trial. A standard single-visit endodontics protocol was followed with 5.25% sodium hypochlorite and rotary nickel-titanium files. After shaping and cleaning, patients were randomly allocated into the following groups: group 1 (n = 21), ozone treatment with no activation (NA); group 2 (n = 22), ozone treatment with manual dynamic activation (MDA); group 3, (n = 21), ozone treatment with passive ultrasonic activation (PUA); group 4 (n = 23), ozone treatment with sonic activation (SA); and group 5 (n = 21), no ozone treatment (the control group). Patient levels of discomfort were recorded at 6 different time intervals using the visual analog scale (VAS). Comparison of the mean difference between the groups and time intervals was performed using 2-way analysis of variance followed by a post hoc Bonferroni test. The level of significance was set at 5%.

RESULTS

VAS scores were highest for the control > NA > MDA > SA > PUA groups. A statistically significant reduction in VAS scores was observed in the PUA and SA groups in comparison with the NA, control, and MDA groups. Timewise comparison showed a highly significant decline in VAS scores at all time intervals (P < .001).

CONCLUSIONS

Ultrasonic and sonic activation of ozone resulted in less pain in patients undergoing single-visit endodontics compared with no ozone treatment.

Comparative Evaluation of Hand K-flex Files, Pediatric Rotary Files, and Reciprocating Files on Instrumentation Time, Postoperative Pain, and Child's Behavior in 4-8-year-old Children

Background

A pulpectomy is regarded as the choice modality of treatment for necrotic teeth. The use of hand files, though popular traditionally as a gold standard, may be challenging due to increased chairside time. Postoperative pain is one of the most common complications of pulpectomy and may be unpleasant for a child/pedodontist. Rotary files were found to reduce instrumentation time, reduce apical extrusion, and in turn reduce pain but there is a lack of studies in primary teeth particularly for pediatric and reciprocating file systems. The increased number of options available today makes it a dilemma for the operator to choose a suitable file system.

Aim and objective

The study aimed to evaluate and compare the instrumentation time, postoperative pain, and effect on child's behavior among three groups, i.e., hand K-flex files (group I), pediatric rotary files (group II), and reciprocating files (group III).

Materials and methods

A total of 75 primary molar teeth after meeting inclusion criteria were randomly allocated into three groups. During the procedure, step-wise instrumentation time was recorded using a stopwatch. The child's behavior pre- and postoperatively was assessed by an evaluator. The postoperative pain (up to 1 week) was assessed by a questionnaire.

Results

The mean age of children taken for the study was 6.03 ± 1.2 years with 46 males and 29 females. The mean biomechanical preparation time was observed to be significantly shorter in the pediatric rotary and reciprocating file groups vs hand K-flex files (p < 0.001**). The postoperative pain after 6 hours had a mean value of 0.88 + 0.9 for the hand K-flex file group which was significantly higher than both rotary file groups (p < 0.05*). The pre- and postoperative behavior revealed no significant difference.

Conclusion

The clinical performance of pediatric and reciprocating files was superior, but the choice of file system did not significantly alter behavior.

How to cite this article

Tyagi R, Khatri A, Kalra N, et al. Comparative Evaluation of Hand K-flex Files, Pediatric Rotary Files, and Reciprocating Files on Instrumentation Time, Postoperative Pain, and Child's Behavior in 4–8-year-old Children. Int J Clin Pediatr Dent 2021;14(2):201–206.

The effect of solution and gel forms of sodium hypochlorite on postoperative pain: a randomized clinical trial

Objectives

The aim of this study is to evaluate the effect of using gel and solution forms of NaOCI during the chemomechanical preparation of the root canals on postoperative pain at different time intervals.

Methodology

114 patients with mandibular molar teeth and symptomatic irreversible pulpitis were included in the study. All patients were divided into two groups based on the irrigant used during root canal preparation (n=57): Group 1, 5.25% NaOCI, Group 2, 5.25% NaOCI gel. All groups were filled with gutta-percha and AH Plus root canal sealer using single-cone technique. VAS scale (1-10) was used for postoperative pain assessment. After endodontic treatment, all patients were asked to record their postoperative pain levels at the 6th, 24th, 48th, 72nd hours, and 1 week later. The data were analyzed using Chi-Squared, Independent Samples T, Cochran Q and Friedman tests.

Results

Statistically significant difference was not found between the distributions of pain levels at different times according to the groups (p>0.050). A statistically significant difference was observed between the distributions of pain levels measured at different times in the solution group (p<0.001). A statistically significant difference was found between the distributions of pain levels measured at different times in the gel group (p<0.001). In both groups, highest postoperative pain levels occurred in the first 6 hours. Pain levels of the gel group as 38,5% mild, 17.3% moderate, 5.8% severe and pain levels of the solution group were obtained as 46.2% mild, 26.9% moderate, 9.6% severe at the 6th hour.

Conclusions

The use of the gel form of NaOCI during the chemomechanical preparation of the root canals showed similar postoperative pain when compared to the solution form.

The effect of two rotary and two reciprocating NiTi systems on postoperative pain after root canal retreatment on single-rooted incisor teeth: A randomized controlled trial

AIM

This randomized clinical trial aimed to assess the effect of two rotary (ProTaper Retreatment + ProTaper Gold and Hyflex EDM) and two reciprocating (Reciproc Blue and WaveOne Gold) NiTi systems on postoperative pain after root canal retreatment on single-rooted incisor teeth.

METHODOLOGY

One hundred and eighty patients scheduled for root canal retreatment were randomly assigned to one of the four groups according to the NiTi system (ProTaper Retreatment + ProTaper Gold, Hyflex EDM, Reciproc Blue or WaveOne Gold) used for the removal of root canal fillings and further canal preparation. The working length was determined to be 1 mm shorter than the '0.0' mark of the apex locator. Root canals were filled with gutta-percha and an epoxy resin-based root canal sealer using a lateral compaction technique. The teeth were restored using a resin composite material. A single operator performed the retreatments in a single visit. The incidence and intensity of postoperative pain were rated on a numeric rating scale by patients 24, 48 and 72 h after retreatment. The number of analgesic tablets (400 mg Ibuprofen) taken by patients was also recorded. Data were analysed using the Mann-Whitney U, Wilcoxon and chi-square tests.

RESULTS

For the intensity of postoperative pain, the difference between the four groups was not significantly different (p > .05). No significant difference was found between the groups in terms of analgesic medication intake (p > .05).

CONCLUSIONS

The rotary and reciprocating NiTi systems tested in this study were associated with similar intensity of postoperative pain and intake of analgesics following root canal retreatment on single-rooted incisor teeth completed in one visit.

Factors Associated with Incomplete Endodontic Care

INTRODUCTION

Incomplete endodontic treatment has been associated with detrimental health outcomes.

METHODS

This retrospective study reviewed charts of patients receiving endodontic care over a 1-year period at the Postgraduate Endodontic Clinic at Rutgers School of Dental Medicine, Newark, NJ, to assess whether factors such as receipt of palliative endodontic care and demographic factors were associated with completion, or noncompletion, of initial nonsurgical root canal therapy (RCT).

RESULTS

A total of 1806 patient charts met the study inclusion criteria. With descriptive statistics and bivariate analysis, the variables of palliative care, Medicaid recipient, age group, and distance from the clinic were significantly associated with RCT completion (P < .05). In the binary logistic regression with all independent variables, palliative care and age group variables were the significant factors (P < .05). Patients who had no palliative care had 8.5 times the odds of completing RCT than patients who had received palliative care. The age group of 18-35 years had 0.59 times the odds of complete RCT than the age group <18 years.

CONCLUSIONS

Incomplete nonsurgical endodontic treatment is highly associated with the receipt of prior palliative care. Further research is indicated to investigate additional factors that may influence patient completion of endodontic care and opportunities to improve public health care program design to obtain optimal patient-centered outcomes.

The Comparison of Short-Term Postoperative Pain in Single- versus Multiple-Visit Root Canal Treatment: A Systematic Review and Meta-Analysis Study

Postoperative pain after root canal therapy (RoCT) is an unpleasant experience for patients, and it could be affected by different factors. The times of visits could be one of these factors that were evaluated in various studies. However, there is inconsistent evidence on the relation between postoperative pain and the times of visits. Therefore, the current systematic review aimed to summarize the results of these studies and meta-analyze them. For this purpose, a comprehensive search was conducted in four main databases (Cochrane Database of Systematic Reviews, Web of Science, PubMed, and Scopus databases) for related English articles from 1978 to August 2020. The quality of studies was evaluated using the Delphi checklist. The heterogeneity of studies was determined by I2 statistic, and publication bias was assessed using the funnel plot and the Begg test. The results were presented by using relative ratio (RR) estimates and standard mean difference (SMD) with its 95% confidence intervals (CI) using a random-effects model. Initial searches from mentioned databases identified 1480 papers; of which only 27 of them met the inclusion criteria. In quality assessment, thirteen studies had quality scores of more than 7, two studies had 4 scores, and the rest had 5 scores. Overall, based on the available evidence, the meta-analysis showed that the risk of postoperative pain in single-visit was 1.02 times (CI 95% (0.99, 1.19), I2 = 60.7%, $p=0.001$ ) higher than that of the multiple-visit treatment. The mean difference of postoperative pain in single-visit was −0.30 (CI 95% (−0.36, −0.25), I2 = 0.94.4, $p=0.001$ ) compared with the multiple-visit treatment. Based on the results of this meta-analysis, the risk of postoperative pain in single-visit RoCT was higher than that in multiple-visit RoCT with acceptable statistical heterogeneity and moderate quality of the studies.

Evaluation of postoperative pain/discomfort after intracanal use of Nd:YAG and diode lasers in patients with symptomatic irreversible pulpitis and asymptomatic necrotic pulps: a randomized control trial

OBJECTIVES

This study aimed to investigate the ability of the diode and Nd:YAG lasers to decrease postoperative pain/discomfort after intracanal application in vital and devital endodontic cases.

MATERIAL AND METHODS

One hundred two patients with symptomatic irreversible pulpitis and asymptomatic necrotic pulps were selected and randomly divided into three groups. After chemomechanical preparation, Nd:YAG and diode laser was applied to first and second groups for final treatment of the root canals. In the control group, no further disinfection protocol was performed upon traditional procedures. Then all the teeth were obturated in the same appointment. Pre- and postoperative pain were recorded using the VAS at 0, 12th, 24th, 48th, and 72nd hours following the treatment Kruskal-Wallis and Dunn test.

RESULTS

VAS scores were significantly the most at 12-h period compared with other time periods after treatment for all groups. There was no significant difference among Nd:YAG laser, diode laser, and control groups in non-vital cases (p > 0.05). In vital cases, Nd:YAG laser group represented significantly fewer scores compared with diode laser and control groups at 48-h period (p < 0.05).

CONCLUSIONS

The processes involving the use of Nd:YAG and diode lasers after chemomechanical preparation was found to be equivalent in terms of postoperative pain intensity after completion of treatment in one session both in vital or non-vital cases except in vital cases in Nd:YAG group at 48 h.

CLINICAL RELEVANCE

Adjunct clinical use of Nd:YAG or diode lasers to traditional chemomechanical preparation did not cause any improvement or deterioration on postoperative discomfort and pain in patients with symptomatic irreversible pulpitis and asymptomatic necrotic pulps.

The effect of sonic activation of irrigant on postoperative pain after root canal treatment in primary molar teeth: a randomized, clinical study

PURPOSE

Postoperative pain following root canal treatment is a concern for pediatric patients and pediatric dentists. The purpose of this study was to evaluate the effect of using sonic activation (SA) on postoperative pain levels after root canal therapy of primary molars.

METHODS

A total of 110 patients aged 5-9 years with symptomatic irreversible pulpitis involving primary molars were included in the study and were randomly divided into two groups according to agitation methods: SA and no sonic activation (NSA). Root canal treatments were completed, and the teeth were restored permanently. Postoperative pain levels were evaluated using the five-face scale at 8, 24, 48, and 72 h and 1 week after treatment. Pain levels and frequency of analgesic intake were recorded and analyzed.

RESULTS

Postoperative pain values were lower in the SA group than in the NSA group at 8, 24, and 48 h after treatment (p < 0.05). No significant difference was observed between the groups in terms of postoperative pain values at 72 h and 1 week after treatment (p > 0.05).

CONCLUSIONS

It was determined that the use of SA reduces postoperative pain level significantly after root canal treatment in primary molar teeth.

CLINICAL RELEVANCE

The use of SA can be recommended to clinicians since it is effective in the successful management of postoperative pain of root canal treatment in primary molar teeth.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT04197531.

The effect of two calcium silicate-based and one epoxy resin-based root canal sealer on postoperative pain: a randomized controlled trial

AIM

To compare the effect of two calcium silicate-based (Endoseal MTA and EndoSequence BC Sealer) and an epoxy resin-based (AH Plus) root canal sealer on postoperative pain following single-visit root canal treatment on molar teeth.

METHODOLOGY

Patients (n = 90) having one first or second molar tooth diagnosed with asymptomatic irreversible pulpitis were randomly divided into three groups according to the sealer used (n = 30) and were treated by two endodontists having at least 10 years of experience. All patients received a single-visit root canal treatment. After the treatments, postoperative pain scores and analgesic intake were recorded at 6, 12, 24 and 48 h, and 3, 4, 5, 6 and 7 days. The data were analysed statistically using non-parametric Kruskal-Wallis tests (for the comparisons of the age and VAS scores), Friedman tests (for the assessments of the changes in pain scores over time), chi-squared tests (for the comparisons of categorical variables) and Spearman's correlation test (for the correlation assessments of the age and gender factors with postoperative pain; α = 0.05).

RESULTS

There were no significant differences amongst the groups in terms of postoperative pain at any time-points assessed (P > 0.05) nor for analgesic intake of patients amongst the groups (P > 0.05). Analgesic intake decreased significantly after 12 h in all groups (P < 0.05).

CONCLUSIONS

The sealers tested in this study were associated with similar levels of postoperative pain and were associated with a similar intake of analgesics.

Sodium Hypochlorite Reduces Postoperative Discomfort and Painful Early Failure after Carious Exposure and Direct Pulp Capping-Initial Findings of a Randomized Controlled Trial

In this randomized controlled single-center clinical trial on 96 adult patients with parallel experimental groups (n = 48), the effects of washing a dentin/pulp wound in non-symptomatic teeth with extremely deep caries and pulpal exposure were compared between a 2.5% sodium hypochlorite (NaOCl) solution and a chemically-inert physiological saline control solution. After the allocated wound lavage, the pulps were capped with a mineral trioxide aggregate, covered by a glass-ionomer/resin liner, and the teeth were immediately restored with a resin-bonded-composite. In this first report, the early events were analyzed: postoperative discomfort (on an NRS-11 scale) at day-3 and -7 after intervention, and the occurrence of unbearable pain causing patients to contact the principal investigator to perform a root canal treatment (pulpectomy) during the first three months. The NaOCl solution caused a highly significant reduction in post-operative discomfort (p = 0.0010 day 3; p = 0.0007 day 7) and early painful failures (p = 0.0008) compared with the control. These novel findings highlight the importance of infection control in teeth with extremely deep carious lesions. Based on these observations, the use of an NaOCl solution to wash the exposed dentin/pulp wound in the vital pulp treatment is highly recommended in order to reduce pain and early failure.

Influence of Tooth Factors and Procedural Errors on the Incidence and Severity of Post-Endodontic Pain: A Prospective Clinical Study

The objective of this prospective study was to assess tooth-related factors that play a role in the incidence of postoperative pain (PP) and determining if procedural errors influence PP occurrence. A total of 442 patients referred for root canal treatment met the inclusion criteria and were included in this prospective study. The same protocol was used in all root canal treatments. Patient, tooth, treatment related factors and the occurrence of procedural errors were registered. Incidence and intensity of PP was assessed at 24 and 48 h by telephonic interview and in person seven and 15 days after treatment. A logistic and ordinal regression analysis was used to assess the role of patient, tooth and treatment related factors in the incidence and intensity of PP, respectively. Preoperative and intraoperative factors differently affected the incidence of PP at the different time intervals. The presence of procedural errors did not significantly influence PP occurrence. The presence of preoperative pain and the need of additional anesthesia during treatment were associated with higher incidence of PP 24 and 48 h after treatment; the extent of apical enlargement played a significant role in the presence of PP after seven days of treatment; and the excessive occlusal load induced by the absence of a contralateral tooth was the only factor related to the maintenance of PP up to 15 days. In conclusion, the presence of preoperative pain, the need of additional anesthesia during treatment, the extent of apical enlargement and the excessive occlusal load induced by the absence of a contralateral tooth were related to a higher incidence of PP.

Incidence of postoperative flare-ups after single-visit and multiple-visit endodontic therapy in permanent teeth

AIM

Single- and multiple-visit root canal treatment has been the subject of long-standing debate in the endodontic community, so the purpose of this study was to determine the incidence of postoperative flare-up after single- and multiple-visit endodontic therapy in permanent teeth.

MATERIALS AND METHODS

A total of 65 children aged >10 years who underwent root canal treatment were randomly categorized equally into two treatment groups: the first group underwent single-visit treatment, and the other group underwent multiple-visit therapy. The visual analog scale was employed to evaluate pain preoperatively and postoperatively after obturation. Recall visits were carried out after 1 week, 1 and 3, 6 and 9 months. The Statistical Package for the Social Sciences version 15.0 was employed for statistical analysis.

RESULTS

Except at the baseline, at all the other time intervals, the mean pain score in the multiple-visit group was higher as compared to that of the single-visit group; statistically no significant difference was found.

CONCLUSION

The mean pain score in the single-visit group was lower as compared to that of the multiple-visit group; however, the difference between the two groups was statistically significant (P > 0.05).

Photobiomodulation in Endodontic, Restorative, and Prosthetic Dentistry: A Review of the Literature

Objective: To provide a review of the literature about the photobiomodulation therapy (PBMT) dental treatment protocols in endodontic, restorative, and prosthetic dentistry based on validated clinical studies published so far. More specifically, this study was carried out to carefully review therapeutic protocol of PBMT in clinical studies and their conclusions. Background data: The importance of using low-power lasers and photobiomodulation (PBM) is increasing in dentistry mainly due to their painless and noninvasive function. However, lack of sufficient clinical studies has led to unclear results regarding PBMT in dentistry, and also lack of an available precise protocol for clinicians. Moreover, scarcity of clinical studies in this area has made conduction of a precise systematic review study difficult. Methods: In our study, published clinical studies up to April 2019 were reviewed from library sources, Google Scholar, PubMed and Medline, Elsevier, Embase, Cochrane, Scopus, and Web of science (ISI). Inclusion criteria included those presented in clinical trials and case report/case series, language (English), and studies available in full text. Exclusion criterion was in vitro studies. Results: In general, findings of clinical studies have shown that PBMT can have a significant role in reducing postoperative dental pain, increasing depth of anesthesia, improving tooth hypersensitivity, reducing inflammation of the tissue, and helping wound healing. Conclusions: A review of clinical studies showed that the use of alternative or adjunctive PBMT is of great importance in controlling postoperative pain after endodontic treatments. In addition, evidence suggests that different parameters of light can be efficient in the treatment of tooth hypersensitivity. Nevertheless, lack of sufficient clinical studies and reliable results do not allow introducing a precise treatment protocol.

Comparison of post-operative pain after root canal instrumentation with hand K-files, H-files and rotary Kedo-S files in primary teeth: a randomised clinical trial

PURPOSE

To compare the post-operative pain after root canal instrumentation with hand K-files, H-files and rotary Kedo-S in primary teeth.

METHOD

All 4-6-year-old children were invited and 69 agreed to participate. The participants were randomly divided and distributed for instrumentation with K-file (Group 1), H-file (Group 2) and rotary Kedo-S files (Group 3). After completion of root canal procedure, the post-operative pain was evaluated at intervals of 6, 12, 24, 48, and 72 h using modified Wong-Baker pain scale and compared between the groups.

RESULTS

Post-operative pain between three groups at 6, 12, 24, 48 and 72 h was compared using Chi square test. There was decreased post-operative pain with Kedo-S rotary files as compared to other two groups (P value < 0.001). The post-operative pain decreased after 12 h for all the groups with no pain at 24, 48 and 72 h intervals.

CONCLUSION

Paediatric rotary files Kedo-S showed significantly less post-operative pain as compared to K-file and H-file at 6 h and 12 h intervals. However, follow-up interval of 24, 48 and 72 h showed no significant difference between the rotary and hand file groups.

The effect of preoperative oral administration of prednisolone on postoperative pain in patients with symptomatic irreversible pulpitis: a single-centre randomized controlled trial

AIM

This single-centre randomized, double-blind, placebo-controlled clinical trial assessed the effect of a preoperative, single, oral dose of prednisolone on postoperative pain and postoperative analgesic intake in patients with symptomatic, irreversible pulpitis in mandibular molars.

METHODOLOGY

Four hundred participants, randomly assigned to two equal groups, received either 40 mg prednisolone or placebo tablets 30 min before single-visit root canal treatment. Patients recorded their pain level 6, 12 and 24 h after treatment on a 100-mm visual analogue scale. All patients received a sham capsule to take if needed as a postoperative analgesic, and, if the pain persisted, an analgesic was prescribed. The relative risk reduction and 95% confidence intervals (CI) were estimated for binary data. Mann-Whitney U-test was used to compare postoperative pain intensity between groups.

RESULTS

The relative risk reduction in pain incidence was 20.31% (95% CI: 12.03%, 27.82%) at 6 h, 23.39% (95% CI: 14.75%, 31.16%) at 12 h and 28.85% (95% CI: 18.08%, 38.20%) at 24 h. Prednisolone had significantly less post-obturation pain intensity compared to placebo at 6, 12 and 24 h (P < 0.001). The relative risk reduction in sham-capsule intake was 54% (95% CI: 38%, 66%) and of analgesic intake was 55% (95% CI: 3%, 79%). No adverse effects were recorded.

CONCLUSION

Preoperative oral administration of a single dose of 40 mg prednisolone was beneficial to control short-term post-obturation pain after single-visit root canal treatment in patients with symptomatic irreversible pulpitis reducing pain incidence after 24 h by approximately 30% and postoperative analgesic intake by approximately 55%.

Management of Post Endodontic Retreatment Pain With Low Level Laser Therapy

Introduction: Pharmacotherapy with analgesics and non-steroidal anti-inflammatory drugs has been traditionally used to relief post-operative pain of endodontic treatments. However, due to the side effects reported for these drugs, some efforts have been made to decrease the post-operative pain of the endodontic treatments through laser irradiation. The present study aimed to evaluate the effects of low level laser therapy (LLLT) on the reduction of pain after root canal retreatment. Methods: In this clinical trial, 61 patients requiring endodontic retreatments in posterior teeth were selected. A single visit endodontic retreatment was performed. After biomechanical preparation, low level laser was irradiated to the buccal and lingual mucosa overlying the apices of the target tooth in the experimental group. In the control group patients received placebo laser to eliminate the probable psychological effects of laser. Laser irradiation was done with a single dose of 808 nm wavelength (Whitening Lase II- Laser DMC, Samsung, Korea) with 100 mW power, and dose of 70 J/cm2 for 80 seconds. Pain severity was recorded before, immediately after and 4, 8, 12, 24 and 48 hours after the treatment by visual analogue scale (VAS). The pain scores were statistically analyzed by chi-square test between 2 groups. The effects of different variables on the post-operative pain experience were also studied by means of Logistic regression. Results: Pain scores decreased significantly through time until 48 hours after treatment. No significant differences were observed between the 2 modalities regarding pain scores at any time. According to regression analysis, pain severity scores were lower in the laser-irradiated specimens than control groups (OR = 5.69); however, this difference was not statistically significant. Consumption of analgesics after the treatment had significant effect in decreasing post-operative pain experience (OR = 56) while factors of age, gender, laser irradiation, pre-treatment pain scores and education level did not. Conclusion: Low level laser irradiation had limited effects to decrease pain associated with the endodontic retreatments in the first and second molars; however, more studies are required to assess the effects of different parameters of low level laser in this regard.

Post endodontic pain following single-visit root canal preparation with rotary vs reciprocating instruments: a meta-analysis of randomized clinical trials

Background

In endodontic therapy, continuous rotary instrumentation reduced debris compared to reciprocal instrumentation, which might affect the incidence of post-endodontic pain (PP). The aim of our study was to assess whether PP incidence and levels were influenced by the choice of rotary or reciprocal instruments.

Methods

In this meta-analysis the Pubmed and EM databases were searched for prospective clinical randomized trials published before April 20, 2016, using combinations of the keywords: root canal preparation/instrumentation/treatment/therapy; post-operative/endodontic pain; reciprocal and rotary instruments.

Results

Three studies were included, involving a total of 1,317 patients, 659 treated with reciprocating instruments and 658 treated with rotary instruments. PP was reported in 139 patients in the reciprocating group and 172 in the rotary group. The PP incidence odds ratio was 1.27 with 95% confidence interval (CI) (0.25, 6.52) favoring rotary instruments. The mild, moderate and severe PP levels odds ratios were 0.31 (0.11, 0.84), 2.24 (0.66, 7.59) and 11.71 (0.63, 218.15), respectively. No evidence of publication bias was found.

Conclusions

Rotary instrument choice in endodontic therapy is associated with a lower incidence of PP than reciprocating instruments, while reciprocating instruments are associated with less mild PP incidence.

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

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

Postoperative pain after the removal of root canal filling material using different techniques in teeth with failed root canal therapy: a randomized clinical trial

OBJECTIVES

This study evaluated the intensity and duration of postoperative pain after the removal of root canal filling material in retreatment procedures of upper incisor teeth with chronic apical periodontitis, using different techniques.

MATERIALS AND METHODS

One hundred and thirty-five patients requiring retreatment of upper incisor teeth with chronic apical periodontitis were included in the study. The patients were assigned to three groups of 45 patients, according to the method used to remove old canal filling material. In group 1, canal filling material was removed using hand files. In group 2, the canal filling material was removed with ProTaper universal retreatment (PTUR) instruments. In group 3, Reciproc instruments were used to remove canal filling material. Teeth were then medicated with calcium hydroxide and sealed using temporary filling material. The presence of postoperative pain was assessed after 6, 12, 24, 48 and 72 h, 7 days, and finally after 10 days.

RESULTS

In all time intervals, except for 72 h, 7 days and 10 days, group 1 participants reported more intense postoperative pain than those in groups 2 and 3 (p = 0.02). In all time intervals, there was no difference in the pain scores between groups 2 and 3 (p = 0.08). In all groups, the intensity of postoperative pain decreased over time. The required time to remove canal filling material was less for the Reciproc group compared to the hand and ProTaper retreatment groups (p = 0.032).

CONCLUSIONS

Hand files caused greater postoperative pain after non-surgical endodontic retreatment (NSER) of upper incisor teeth with chronic apical periodontitis compared to the ProTaper retreatment and Reciproc files.

Postoperative pain intensity after using different instrumentation techniques: a randomized clinical study

Postoperative pain is a frequent complication associated with root canal treatment, especially during apical instrumentation of tooth with preexisting periradicular inflammation

Postoperative Pain and Flare-Ups: Comparison of Incidence Between Single and Multiple Visit Pulpectomy in Primary Molars

INTRODUCTION

Endodontic treatment performed in either single- or multiple visit can be followed by numerous short- and long term complications. One of the short term complications include postoperative pain and flare-ups. The ability to predict its prevalence and forewarn the patient may go some way towards enabling coping strategies and help dentist in pain management treatment decisions.

AIM

To compare the incidence and intensity of postoperative pain and flare-ups between single- and multiple visit pulpectomy in primary molars. Also, to correlate the preoperative status of the pulp to postoperative pain and flare-ups.

MATERIALS AND METHODS

Eighty primary molars indicated for pulpectomy were included in the study and divided into two groups. Tooth treated and preoperative status of the pulp vitality was recorded. All the conventional steps in pulpectomy were followed. Teeth in Group 1 (single visit pulpectomy) were obturated on the same visit. Teeth in Group 2 (multiple visit pulpectomy) were obturated in the subsequent appointment. The recording of postoperative pain, flare-ups, use of medication were done after 24 hours, seven days and one month.

RESULTS

Four cases in both the groups reported postoperative pain (10%) at 24 hour recall, p=0.74. One flare-up (2.5%) was recorded in each group p=0.67. None of the patients reported pain at seventh day and one month recall. Postoperative pain was recorded in five non-vital teeth (13.5%) and three vital teeth (6.9%). However, it was statistically not significant p=0.53.

CONCLUSION

From the perspective of our study there was a low incidence of postoperative pain. The majority of patients in both groups reported no pain or only minimal pain within 24 hours of treatment. There were no differences between single- and multi visit treatment protocols with respect to the incidence of postoperative pain. No significant correlation could be found between pulp vitality and the incidence of postoperative pain.

Single-visit or multiple-visit root canal treatment: systematic review, meta-analysis and trial sequential analysis

OBJECTIVES

Single-visit root canal treatment has some advantages over conventional multivisit treatment, but might increase the risk of complications. We systematically evaluated the risk of complications after single-visit or multiple-visit root canal treatment using meta-analysis and trial-sequential analysis.

DATA

Controlled trials comparing single-visit versus multiple-visit root canal treatment of permanent teeth were included. Trials needed to assess the risk of long-term complications (pain, infection, new/persisting/increasing periapical lesions ≥1 year after treatment), short-term pain or flare-up (acute exacerbation of initiation or continuation of root canal treatment).

SOURCES

Electronic databases (PubMed, EMBASE, Cochrane Central) were screened, random-effects meta-analyses performed and trial-sequential analysis used to control for risk of random errors. Evidence was graded according to GRADE.

STUDY SELECTION

29 trials (4341 patients) were included, all but 6 showing high risk of bias. Based on 10 trials (1257 teeth), risk of complications was not significantly different in single-visit versus multiple-visit treatment (risk ratio (RR) 1.00 (95% CI 0.75 to 1.35); weak evidence). Based on 20 studies (3008 teeth), risk of pain did not significantly differ between treatments (RR 0.99 (95% CI 0.76 to 1.30); moderate evidence). Risk of flare-up was recorded by 8 studies (1110 teeth) and was significantly higher after single-visit versus multiple-visit treatment (RR 2.13 (95% CI 1.16 to 3.89); very weak evidence). Trial-sequential analysis revealed that firm evidence for benefit, harm or futility was not reached for any of the outcomes.

CONCLUSIONS

There is insufficient evidence to rule out whether important differences between both strategies exist.

CLINICAL SIGNIFICANCE

Dentists can provide root canal treatment in 1 or multiple visits. Given the possibly increased risk of flare-ups, multiple-visit treatment might be preferred for certain teeth (eg, those with periapical lesions).

Single versus multiple visits for endodontic treatment of permanent teeth

BACKGROUND

Root canal treatment (RoCT), or endodontic treatment, is a common procedure in dentistry. The main indications for RoCT are irreversible pulpitis and necrosis of the dental pulp caused by carious processes, tooth cracks or chips, or dental trauma. Successful RoCT is characterised by an absence of symptoms (i.e. pain) and clinical signs (i.e. swelling and sinus tract) in teeth without radiographic evidence of periodontal involvement (i.e. normal periodontal ligament). The success of RoCT depends on a number of variables related to the preoperative condition of the tooth, as well as the endodontic procedures. This review updates the previous version published in 2007.

OBJECTIVES

To determine whether completion of root canal treatment (RoCT) in a single visit or over two or more visits, with or without medication, makes any difference in term of effectiveness or complications.

SEARCH METHODS

We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 14 June 2016), Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 5), MEDLINE Ovid (1946 to 14 June 2016), and Embase Ovid (1980 to 14 June 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials to 14 June 2016. We did not place any restrictions on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) and quasi-RCTs of people needing RoCT. We excluded surgical endodontic treatment. The outcomes of interest were tooth extraction for endodontic problems; radiological failure after at least one year, i.e. periapical radiolucency; postoperative pain; swelling or flare-up; painkiller use; sinus track or fistula formation; and complications (composite outcome including any adverse event).

DATA COLLECTION AND ANALYSIS

We collected data using a specially designed extraction form. We contacted trial authors for further details where these were unclear. We assessed the risk of bias in the studies using the Cochrane tool and we assessed the quality of the body of evidence using GRADE criteria. When valid and relevant data were collected, we undertook a meta-analysis of the data using the random-effects model. For dichotomous outcomes, we calculated risk ratios (RRs) and 95% confidence intervals (CIs). For continuous data, we calculated mean differences (MDs) and 95% CIs. We examined potential sources of heterogeneity. We conducted subgroup analyses for necrotic and vital teeth.

MAIN RESULTS

We included 25 RCTs in the review, with a total of 3780 participants, of whom we analysed 3751. We judged three studies to be at low risk of bias, 14 at high risk, and eight as unclear.Only one study reported data on tooth extraction due to endodontic problems. This study found no difference between treatment in one visit or treatment over multiple visits (1/117 single-visit participants lost a tooth versus 2/103 multiple-visit participants; odds ratio (OR) 0.44, 95% confidence interval (CI) 0.04 to 4.78; very low-quality evidence).We found no evidence of a difference between single-visit and multiple-visit treatment in terms of radiological failure (risk ratio (RR) 0.91, 95% CI 0.68 to 1.21; 1493 participants, 11 studies, I² = 18%; low-quality evidence); immediate postoperative pain (dichotomous outcome) (RR 0.99, 95% CI 0.84 to 1.17; 1560 participants, 9 studies, I² = 33%; moderate-quality evidence); swelling or flare-up incidence (RR 1.36, 95% CI 0.66 to 2.81; 281 participants, 4 studies, I² = 0%; low-quality evidence); sinus tract or fistula formation (RR 0.98, 95% CI 0.15 to 6.48; 345 participants, 2 studies, I² = 0%; low-quality evidence); or complications (RR 0.92, 95% CI 0.77 to 1.11; 1686 participants, 10 studies, I² = 18%; moderate-quality evidence).The studies suggested people undergoing RoCT in a single visit may be more likely to experience pain in the first week than those whose RoCT was over multiple visits (RR 1.50, 95% CI 0.99 to 2.28; 1383 participants, 8 studies, I² = 54%), though the quality of the evidence for this finding is low.Moderate-quality evidence showed people undergoing RoCT in a single visit were more likely to use painkillers than those receiving treatment over multiple visits (RR 2.35, 95% CI 1.60 to 3.45; 648 participants, 4 studies, I² = 0%).

AUTHORS' CONCLUSIONS

There is no evidence to suggest that one treatment regimen (single-visit or multiple-visit root canal treatment) is better than the other. Neither can prevent all short- and long-term complications. On the basis of the available evidence, it seems likely that the benefit of a single-visit treatment, in terms of time and convenience, for both patient and dentist, has the cost of a higher frequency of late postoperative pain (and as a consequence, painkiller use).

Assessment of the Incidence of Posttreatment Endodontic Flare-ups in Patients undergoing Single-sitting Root Canal Therapies: A Clinical Study

INTRODUCTION

Endodontic therapy is one of the commonly used procedures for treating the teeth affected by various pathologies. One of the major problems for endodontists despite the advancements in the root canal procedures is the posttreatment endodontic flare-ups. Much debate exists regarding the completion of endodontic therapy in a single sitting or multiple sittings. Hence, we assessed the incidence of endodontic flare-ups in patients undergoing single-sitting root canal therapies.

MATERIALS AND METHODS

The present study included 200 patients who underwent single-sitting endodontic therapy. Clinical details and conditions of each and every tooth of every patient were recorded before and after the completion of endodontic therapy. Irrigation during the root canal procedures was done by 2.5% NaOCl solution in most of the cases while others were irrigated with various combinations of ethylenediaminetetraacetic acid (EDTA) and cycloheximide (CHX) solutions. Follow-up records and readings of the patents were noted and were subjected to statistical analysis.

RESULTS

Four groups were formed which divided the patients equally on the basis of their age. Out of 50 patients in the age group of 21 to 30 years, only 4 showed posttreatment endodontic flare-ups, while no endodontic flare-up was recorded in patients with age group of 31 to 50 years. Only two male and four females showed flare-ups postoperatively. A nonsignificant correlation was obtained when flare-up cases were compared on the basis of type of irrigation solution used during canal preparation.

CONCLUSION

Single-sitting endodontic therapy appears to be a successful procedure with good prognosis and minimal posttreatment flare-up results, even in patients with periapical pathologies.

CLINICAL SIGNIFICANCE

Single-sitting root canal procedures can be successfully carried in patients with vital or nonvital pulp tissues and also in patients with periapical lesions.

Incidence of Postoperative Pain after Single Visit and Two Visit Root Canal Therapy: A Randomized Controlled Trial

INTRODUCTION

Root Canal Treatment (RCT) has become a mainstream procedure in dentistry. A successful RCT is presented by absence of clinical signs and symptoms in teeth without any radiographic evidence of periodontal involvement. Completing this procedure in one visit or multiple visits has long been a topic of discussion.

AIM

To evaluate the incidence of postoperative pain after root canal therapy performed in single visit and two visits.

MATERIAL AND METHODS

An unblinded/ open label randomized controlled trial was carried out in the endodontic department of the Dental Institute, where 78 patients were recruited from the regular pool of patients. A total of 66 maxillary central incisors requiring root canal therapy fulfilled the inclusion and exclusion criteria. Using simple randomization by biased coin randomization method, the selected patients were assigned into two groups: group A (n=33) and group B (n=33). Single visit root canal treatment was performed for group A and two visit root canal treatment for group B. Independent sample t-test was used for statistical analysis.

RESULTS

Thirty three patients were allotted to group A where endodontic treatment was completed in single visit while 33 patients were allotted to group B where endodontic treatment was completed in two visits. One patient dropped-out from Group A. Hence in Group A, 32 patients were analysed while in Group B, 33 patients were analysed. After 6 hours, 12 hours and 24 hours of obturation, pain was significantly higher in Group B as compared to Group A. However, there was no significant difference in the pain experienced by the patients 48 hours after treatment in both the groups.

CONCLUSION

Incidence of pain after endodontic treatment being performed in one-visit or two-visits is not significantly different.