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Luo Z, He Y, Wu H, Li Y, Shen L, Cheng L, Zhou X, He L, Chen J. Efficacy of laser adjuvant therapy in the management of post-operative endodontic pain: A systematic review and meta-analysis. Int Endod J 2024. [PMID: 39287434 DOI: 10.1111/iej.14140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/14/2024] [Accepted: 08/16/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND Postoperative endodontic pain (PEP) is crucial in clinical practice. Recently, the effects of various laser adjuvant therapies in endodontic treatments have been widely evaluated. However, as a virtually side-effect-free treatment, its effect on postoperative pain management during endodontic treatment remains controversial. OBJECTIVES This review aimed to compare the efficacy of laser adjuvant therapy for pain management after endodontic treatment. METHOD The Cochrane Library, PubMed, Embase, Scopus and Web of Science databases were systematically searched for articles published until 12 February 2023. The risk of bias in the included studies was evaluated based on the Cochrane risk-of-bias assessment tool. Data on continuous outcomes of visual analogue scale pain scores are expressed as standard mean difference (SMD) and dichotomous outcomes of pain prevalence as relative risk (RR). RESULTS We included 22 studies, of which 15 enrolled 892 patients with visual analogue scale pain scores and 7 enrolled 422 patients with pain prevalence. Of the 22 studies, seven studies had a low risk of bias, 10 had a moderate risk of bias and 5 had a high risk of bias. For pain level, the pooled outcomes indicated reduced pain scores in all laser adjuvant therapy, including low-level laser therapy (SMD = -0.86 [95% CI: -1.16, -0.55] in 24 h and SMD = -0.64 [95% CI: -0.84, -0.43] in 48 h), diode laser therapy (SMD = -0.27 [95% CI: -0.50, -0.04] in 48 h) and photodynamic therapy (SMD = -1.12 [95% CI: -2.18, -0.05] in 24 h). For postoperative pain incidence, a significant correlation was observed with reduced pain incidence rates in the photodynamic therapy group (pooled RR = 0.47 [95% CI: 0.31, 0.72]) but not in the low-level laser therapy group (RR = 0.89 [95% CI: 0.30, 2.70] at 12 h and RR = 0.57 [95% CI: 0.09, 3.72] at 24 h). CONCLUSIONS High-quality evidence suggests that laser adjuvant therapies such as low-level laser therapy, diode laser therapy and photodynamic therapy have a positive impact on reducing postoperative endodontic pain intensity. However, the differences in PEP management effects between laser therapies are unknown, and no significant differences were observed among the subgroups. REGISTRATION CRD 42023402872 (PROSPERO).
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Affiliation(s)
- Zhiqiang Luo
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yiquan He
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Hongkun Wu
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Geriatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yuxuan Li
- School of Stomatology, Dalian Medical University, Dalian, Liaoning, China
| | - Leyao Shen
- School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Lei Cheng
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Libang He
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Jing Chen
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
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McGillivray A, Dutta A. The influence of laser-activated irrigation on post-operative pain following root canal treatment: A systematic review. J Dent 2024; 144:104928. [PMID: 38484867 DOI: 10.1016/j.jdent.2024.104928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 03/23/2024] Open
Abstract
OBJECTIVES Synthesise evidence on post-endodontic pain (PEP) in adult teeth undergoing primary root canal treatment with the adjunctive use of laser-activated irrigation (LAI) as compared with conventional needle irrigation (CNI) during the first post-operative week. DATA An electronic search was performed; no language constraints or restriction on the year of publication were applied. SOURCES Medline, Scopus, Cochrane and PubMed on 04 June 2023 STUDY SELECTION: Randomised clinical trials (RaCTs) that evaluated PEP after LAI of endodontic irrgants were included. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used. PEP was analysed at various time intervals until 1 week after treatment, related to the type of LAI used and the need for analgesia. REULTS Of the 793 articles identified through the electronic database search, 6 RaCTs were included. Qualitative review was favoured over meta-analysis due to substantial methodological heterogeneity between studies. Five studies were at high risk for bias determined by the Cochrane Risk-of-Bias 2 tool. Diode LAI demonstrated superior efficacy to needle irrigation in reducing pain 6-48 h post-treatment. The impact of LAI by photon-induced photoacoustic streaming (PIPS) was unclear and no difference was observed between PIPS and needle irrigation. However, PIPS mitigated PEP better than manual dynamic activation, sonic and ultrasonic activation. There was no difference in analgesia intake between LAI and needle irrigation groups. CONCLUSIONS LAI may help reduce PEP in the first 48 h. Methodological standardisation of future RaCTs on LAI would be beneficial in allowing a more accurate review with the possibility of quantitative synthesis. CLINICAL SIGNIFICANCE This unique synthesis used stringent criteria to reduce confounding factors and provided valuable evidence regarding PEP with different types of LAI. It helps clinicians choose an appropriate LAI technique as compared with CNI and predicts a time frame for reducing PEP.
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Affiliation(s)
- Alex McGillivray
- School of Dentistry, College of Biomedical and Lifesciences, Cardiff University, Cardiff CF14 4XY, United Kingdom
| | - Arindam Dutta
- School of Dentistry, College of Biomedical and Lifesciences, Cardiff University, Cardiff CF14 4XY, United Kingdom.
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Kazemipoor M, Moradi H, Mokhtari F, Kheirollahi K. Assessing the occurrence and severity of pre- and postendodontic pain in anemic and healthy female patients. Clin Exp Dent Res 2023; 9:1122-1128. [PMID: 37849023 PMCID: PMC10728548 DOI: 10.1002/cre2.799] [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: 09/25/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVES The objective of this current survey was to assess both the occurrence and severity of pre- and post-endodontic pain among female individuals, distinguishing between those with anemia and those without. MATERIALS AND METHODS In the current study, we included a total of 60 women with anemia (hemoglobin < 11) and those without anemia (hemoglobin > 13). We recorded the occurrence and severity of pain before and at 24, 48, and 72 h following root canal treatment using a visual analog scale (VAS) ranging from 0 to 10. Additionally, we collected data on patient age, tooth type, as well as pulpal and periapical conditions. Statistical analysis was carried out using two-way ANOVA, pairedt-tests, and Pearson correlation coefficient. The significance level for statistical tests was set at p ≤ .05. RESULTS The incidence of preoperative pain in both anemic and non-anemic patients was 80%. The total incidence of post-operative pain was recorded as 71.7% (82.2% in anemic and 61.1% in non-anemic women). Compared with the pretreatment pain incidence and intensity, the values increased in 24 h but declined in 48 h and 72 h after treatment. Considering the posttreatment pain intensity, the mean values were higher in the three time intervals (24, 48, and 72 h) in anemic patients. Pulpal and periapical status, in contrast to age and tooth type, significantly contributed to the intensity of posttreatment pain. CONCLUSION Regarding the importance of pain phenomenon in human life, it is recommended to consider anemia as an important risk factor for post-endodontic pain. Early diagnosis and analgesic treatment interventions in anemic females, alongside the pain control during root canal treatment, could promote the patient's satisfaction and quality of care.
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Affiliation(s)
- Maryam Kazemipoor
- Department of Endodontics, School of DentistryShahid Sadoughi University of Medical SciencesYazdIran
| | - Hooman Moradi
- Department of Endodontics, School of DentistryShahid Sadoughi University of Medical SciencesYazdIran
| | - Fatemeh Mokhtari
- Department of Endodontics, School of DentistryShahid Sadoughi University of Medical SciencesYazdIran
| | - Khatereh Kheirollahi
- Department of Oral Medicine, School of DentistryShahid Sadoughi University of Medical SciencesYazdIran
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Meire MA, Bronzato JD, Bomfim RA, Gomes BPFA. Effectiveness of adjunct therapy for the treatment of apical periodontitis: A systematic review and meta-analysis. Int Endod J 2023; 56 Suppl 3:455-474. [PMID: 36156804 DOI: 10.1111/iej.13838] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Adjunct therapy refers to any intracanal procedure going beyond chemomechanical preparation with instruments and traditionally delivered irrigants (excluding interim dressings). It is not clear whether and which of these adjunct therapies have a significant impact on the outcome of root canal treatment [healing of apical periodontitis (AP) and other patient-related outcomes]. OBJECTIVES This systematic review aimed to analyse available evidence on the effectiveness of adjunct therapy for the treatment of AP in permanent teeth, according to a population, intervention, comparison, outcome, time and study design framework formulated a priori by the European Society of Endodontology. METHODS Five electronic databases (PubMed, Embase, Scopus, Cochrane and Web of Science) were searched up to October 2021 to identify clinical studies comparing adjunct therapy to no adjunct therapy in adult patients with AP. Animal studies, reviews, studies with less than 10 patients per arm and studies with a follow-up time of less than 1 year, or less than 7 days for postoperative pain, were excluded. The quality of the included studies was appraised by the appropriate tools [Risk of Bias 2 (RoB2) for randomized clinical trials (RCTs) and Newcastle-Ottawa Scale for observational studies]. Meta-analysis was performed using a random-effects model. The certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS Fourteen studies (13 RCTs and one retrospective cohort) fulfilled the inclusion criteria for this review. They evaluated different types of adjunct therapy: antimicrobial photodynamic therapy (aPDT; three studies), diode laser canal irradiation (3), Nd:YAG laser canal irradiation (2), Er;Cr:YSGG laser canal irradiation (1), ozone therapy (2) and ultrasonically activated irrigation (UAI) (4). Radiographical healing was reported in seven studies, but meta-analysis was only possible for UAI (two studies), showing no statistically significant difference in healing after 12 months. Pain after 7 days was reported in seven studies. Meta-analysis on three studies that used aPDT and on two studies using diode laser irradiation showed no significant difference in the prevalence of pain after 7 days between the control and adjunct therapy. According to RoB2 tool, six studies had a high risk of bias, five studies had some concerns, and two studies low risk of bias. The GRADE assessment revealed a very low strength of evidence for diode laser, and low strength of evidence for PDT, ozone and UAI studies. DISCUSSION The included studies displayed significant heterogeneity in terms of type of adjunct therapy, technical details per adjunct therapy, outcome reporting and several combinations of these, limiting the potential for meta-analysis. CONCLUSIONS There is insufficient evidence to recommend any adjunctive therapy for the treatment of apical periodontitis. REGISTRATION Prospero CRD42021261869.
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Affiliation(s)
- Maarten A Meire
- Section of Endodontology, Department of Oral Health Sciences, Ghent University, Ghent, Belgium
| | - Juliana D Bronzato
- Division of Endodontics, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas - UNICAMP, Piracicaba, Brazil
| | - Rafael A Bomfim
- Department of Community Health, School of Dentistry, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Brenda P F A Gomes
- Division of Endodontics, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas - UNICAMP, Piracicaba, Brazil
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Duncan HF, Kirkevang LL, Peters OA, El-Karim I, Krastl G, Del Fabbro M, Chong BS, Galler KM, Segura-Egea JJ, Kebschull M. Treatment of pulpal and apical disease: The European Society of Endodontology (ESE) S3-level clinical practice guideline. Int Endod J 2023; 56 Suppl 3:238-295. [PMID: 37772327 DOI: 10.1111/iej.13974] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND The ESE previously published quality guidelines for endodontic treatment in 2006; however, there have been significant changes since not only in clinical endodontics but also in consensus and guideline development processes. In the development of the inaugural S3-level clinical practice guidelines (CPG), a comprehensive systematic and methodologically robust guideline consultation process was followed in order to produce evidence-based recommendations for the management of patients presenting with pulpal and apical disease. AIM To develop an S3-level CPG for the treatment of pulpal and apical disease, focusing on diagnosis and the implementation of the treatment approaches required to manage patients presenting with pulpitis and apical periodontitis (AP) with the ultimate goal of preventing tooth loss. METHODS This S3-level CPG was developed by the ESE, with the assistance of independent methodological guidance provided by the Association of Scientific Medical Societies in Germany and utilizing the GRADE process. A robust, rigorous and transparent process included the analysis of relevant comparative research in 14 specifically commissioned systematic reviews, prior to evaluation of the quality and strength of evidence, the formulation of specific evidence and expert-based recommendations in a structured consensus process with leading endodontic experts and a broad base of external stakeholders. RESULTS The S3-level CPG for the treatment of pulpal and apical disease describes in a series of clinical recommendations the effectiveness of diagnosing pulpitis and AP, prior to investigating the effectiveness of endodontic treatments in managing those diseases. Therapeutic strategies include the effectiveness of deep caries management in cases with, and without, spontaneous pain and pulp exposure, vital versus nonvital teeth, the effectiveness of root canal instrumentation, irrigation, dressing, root canal filling materials and adjunct intracanal procedures in the management of AP. Prior to treatment planning, the critical importance of history and case evaluation, aseptic techniques, appropriate training and re-evaluations during and after treatment is stressed. CONCLUSION The first S3-level CPG in endodontics informs clinical practice, health systems, policymakers, other stakeholders and patients on the available and most effective treatments to manage patients with pulpitis and AP in order to preserve teeth over a patient's lifetime, according to the best comparative evidence currently available.
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Affiliation(s)
- Henry F Duncan
- Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | | | - Ove A Peters
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| | - Ikhlas El-Karim
- School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Gabriel Krastl
- Department of Conservative Dentistry and Periodontology, University Hospital of Würzburg, Würzburg, Germany
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Bun San Chong
- Faculty of Medicine & Dentistry, Institute of Dentistry, Queen Mary University of London, London, UK
| | - Kerstin M Galler
- Department of Operative Dentistry and Periodontology, Friedrich-Alexander-University Erlangen-Nuernberg, Erlangen, Germany
| | - Juan J Segura-Egea
- Department of Stomatology, Endodontics Section, School of Dentistry, University of Sevilla, Sevilla, Spain
| | - Moritz Kebschull
- School of Dentistry, Institute of Clinical Sciences, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Community Healthcare NHS Trust, Birmingham, UK
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, New York, USA
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Kaplan T, Kaplan SS, Sezgin GP. The effect of different irrigation and disinfection methods on post-operative pain in mandibular molars: a randomised clinical trial. BMC Oral Health 2022; 22:601. [PMID: 36514017 PMCID: PMC9746019 DOI: 10.1186/s12903-022-02651-y] [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: 06/23/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To examine post-operative pain (PP) after conventional irrigation and sonic activation methods, with and without laser disinfection in mandibular molars. METHODS Eighty patients with symptomatic apical periodontitis were included in this randomized clinical study. There were four study groups. In group 1, conventional irrigation only was applied. In group 2, a sonic irrigation activation system (EDDY (VDW, Munich, Germany)), was applied. In groups 3 and 4, irradiation with a 980-nm diode laser was performed, following irrigation with the conventional method and sonic irrigation activation system, respectively. The patients were instructed to record their PP and analgesic intake using a numerical rating scale 8, 24, 48 h and 7 days post-procedure. A chi-square test, Fisher's exact chi-square test and Fisher-Freeman-Halton exact test were used to assess qualitative data. Inter-group and intra-group parameters were assessed using the Kruskal-Wallis test and Wilcoxon's test at a significance level of p < 0.05. RESULTS There was no statistically significant difference among the groups in terms of age, sex, pre-operative pain, PP and analgesic intake (p > 0.05). CONCLUSIONS The use of sonic irrigation activation system in the final irrigation protocol and irradiation with the 980-nm diode laser did not significantly reduce PP levels and analgesic intake.
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Affiliation(s)
- Tuna Kaplan
- Department of Endodontics, Faculty of Dentistry, Biruni University, Istanbul, Turkey
| | - Sema Sönmez Kaplan
- Department of Endodontics, Faculty of Dentistry, Biruni University, Istanbul, Turkey.
| | - Güzide Pelin Sezgin
- Department of Endodontics, Faculty of Dentistry, Biruni University, Istanbul, Turkey
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Al Omari T, El-Farraj H, Alzenate H, Al Charabi N, Al Khatib R, Ateş A. The usage of lasers in cleaning, shaping, and disinfection of root canal system. SAUDI ENDODONTIC JOURNAL 2022. [DOI: 10.4103/sej.sej_179_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kaplan T, Sezgin GP, Sönmez Kaplan S. Effect of a 980-nm diode laser on post-operative pain after endodontic treatment in teeth with apical periodontitis: a randomized clinical trial. BMC Oral Health 2021; 21:41. [PMID: 33482797 PMCID: PMC7821509 DOI: 10.1186/s12903-021-01401-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 01/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to assess the effect of a 980-nm diode laser following chemomechanical root canal preparation on the severity of post-operative pain (PP) after root canal treatment (RCT). METHODS This study included asymptomatic, single-rooted teeth with a periapical index (PAI) score of 3 or 4. All the patients received RCT, including dressing with calcium hydroxide (Ca(OH)2), during two visits. The patients were randomly divided into two groups (n:30): a control group, in which the final irrigation was performed using 5 ml of 2.5% sodium hypochlorite (NaOCI), followed by 5 ml of 17% and ethylenediaminetetraacetic acid (EDTA) and 5 ml of distilled water, and a laser group, in which the root canals were irradiated using a 980-nm diode laser after the final irrigation at both visits. The pain levels after both visits were evaluated using a visual analogue scale (VAS) after 8 h, 24 h, 48 h and 7 d. In addition, the time intervals to medication intake were recorded. The collected data were statistically analysed using the chi-square and Mann-Whitney U test (p < 0.05). RESULTS The average pain level in the control group 24 h after the first visit was significantly higher than that in the laser group (p < 0.05). The average pain level 24 h and 48 h after the second visit was significantly higher in the control group (p < 0.05). The levels of PP 24 h after the first visit were higher than those after the second visit only in the control group (p < 0.05). After the first visit, analgesic use in the control group was significantly higher after 8 h (40%) and 24 h (23%) as compared with that in the laser group (p < 0.05). CONCLUSIONS Root canal irradiation with a diode laser may reduce PP after RCT in single-rooted teeth with a PAI score of 3 or 4. TRIAL REGISTRATION Effect of the Diode Laser on Post-operative Pain After Endodontic Treatment in Teeth with Apical Periodontitis: NCT04486196. Registered 24 July 2020-Retrospectively registered, http://clinicaltrials.gov/ct2/show/NCT04486196.
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Affiliation(s)
- Tuna Kaplan
- Department of Endodontics, Faculty of Dentistry, Biruni University, Istanbul, Turkey
| | - Güzide Pelin Sezgin
- Department of Endodontics, Faculty of Dentistry, Biruni University, Istanbul, Turkey.
| | - Sema Sönmez Kaplan
- Department of Endodontics, Faculty of Dentistry, Biruni University, Istanbul, Turkey
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Guerreiro MYR, Monteiro LPB, de Castro RF, Magno MB, Maia LC, da Silva Brandão JM. Effect of low-level laser therapy on postoperative endodontic pain: An updated systematic review. Complement Ther Med 2020; 57:102638. [PMID: 33307205 DOI: 10.1016/j.ctim.2020.102638] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/31/2020] [Accepted: 11/30/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To evaluate the influence of low-level laser therapy (LLLT) on postoperative pain after endodontic treatment. METHODS The PICOS strategy was used to identify randomized clinical trials comparing low-level laser therapy and mock laser therapy to manage postoperative pain after endodontic treatment, retreatment, and endodontic surgery. An electronic search was performed in MEDLINE through PubMed, Web of Science, LILACS, Scopus and Cochrane Library, OpenGrey and Google Scholar. Quality assessment was performed using the Cochrane Collaboration's tool for assessing the risk of bias. The quality of evidence was rated on the basis of the GRADE approach. RESULTS Twelve studies were included in the qualitative synthesis. Within the 12 studies, 7 articles were classified as "low risk of bias," 4 studies were considered "unclear risk of bias" and 1 study was considered "high risk of bias." Six studies evaluated the postoperative pain after primary root canal treatment, two studies after root canal retreatment and four after periapical surgery. Most of the studies reported significantly less postoperative pain after LLLT in different time periods; two studies found no differences. The certainty of evidence was classified as low and very low to treatment / retreatment and endodontic surgery, respectively. CONCLUSIONS Based on the limited quality evidence, most of the included studies reported significantly less postoperative pain after LLLT. However, the lack of standardization in laser parameters, use of medications and the certainty of evidence classified as low and very low indicate the need for further studies.
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Affiliation(s)
| | | | | | - Marcela Baraúna Magno
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lucianne Cople Maia
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
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Nosrat A, Dianat O, Verma P, Nixdorf DR, Law AS. Postoperative Pain: An Analysis on Evolution of Research in Half-Century. J Endod 2020; 47:358-365. [PMID: 33271179 DOI: 10.1016/j.joen.2020.11.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/23/2020] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Examining the evolution of research parameters helps scientists to discover the well-developed and neglected aspects of knowledge. Pain after root canal treatment is a health problem affecting millions of patients. Research in this field has a meaningful impact on quality of lives. The aim of this study was to analyze the evolution of research on postoperative pain over the past 50 years. METHODS Electronic searches were performed in Scopus and MEDLINE databases to identify studies on pain after nonsurgical root canal treatments/retreatments. The full texts of eligible articles were reviewed to determine the study category and to extract and analyze the methodological variables. A series of statistical analyses were performed to determine the trend of publications based on the variable of interest over time. RESULTS Four hundred twenty-four articles were included. There was a positive trend for systematic reviews, studies with sample size <200, studies on single-visit treatment, and clinical trials on instrumentation and adjunct treatments (P < .05). There was a negative trend for the use of numeric rating scales, studies on multiple-visit treatments, clinical trials on medication/medicament, and studies on pain in maxillary incisors (P < .05). No trend was observed based on pulpal diagnosis or for studies with longer observation periods (>8 weeks) (P > .05). CONCLUSIONS A paradigm shift is needed toward clinical studies with larger sample sizes, longer observation periods, and more focus on pulpal diagnoses associated with higher rates of postoperative pain. There is a need to view postoperative pain as an important patient-centered outcome and to develop and disseminate standard reporting guidelines for future studies.
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Affiliation(s)
- Ali Nosrat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Maryland; Private Practice, Centreville Endodontics, Centreville, Virginia.
| | - Omid Dianat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Maryland
| | - Prashant Verma
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Maryland; Private Practice, Centreville Endodontics, Centreville, Virginia; Private Practice, Capitol Endodontics, Washington, DC
| | - Donald R Nixdorf
- Division of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, Minneapolis, Minnesota; Department of Neurology, Medical School, University of Minnesota, Minneapolis, Minnesota; HealthPartners Institute for Education and Research, Bloomington, Minnesota
| | - Alan S Law
- Private Practice, The Dental Specialists, Lake Elmo, Minnesota; Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, Minnesota
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Morsy DA, Negm M, Diab A, Ahmed G. Postoperative pain and antibacterial effect of 980 nm diode laser versus conventional endodontic treatment in necrotic teeth with chronic periapical lesions: A randomized control trial. F1000Res 2018; 7:1795. [PMID: 31372210 PMCID: PMC6659763 DOI: 10.12688/f1000research.16794.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Many challenges encounter the endodontist, especially when dealing with necrotic teeth with chronic periapical lesions. Postoperative pain may be induced following conventional endodontic therapy and total eradication of the bacteria is almost unachievable even with recently available techniques. In recent years, diode laser usage in the endodontic field has gained acceptance. Thus, this study aimed to investigate the ability of the diode laser (DL) to decrease postoperative pain and achieve root canal sterility. Methods: 56 patients with anterior teeth with chronic periapical lesions in upper anterior teeth were randomly divided into two groups (n = 28). All patients were treated with two visits of conventional root canal treatment with ProTaper Universal. The DL group: root canals were irradiated with 200 µm fiber optic at both visits; the control group (Endo): the DL fiber was placed in root canal with no activation. Bacterial samples were collected from all the cases at each step of the treatment. Pain levels were evaluated using a numerical rating scale preoperatively, and after 6, 12, 24, 48 hours and 7 days. Bacterial count was used to detect both aerobic and anaerobic bacterial load. Results: The qualitative pain scores revealed statistically significant lower pain levels in the DL group compared with the Endo group at all time intervals (P<0.001), except preoperatively where there was no significant difference. There was a statistically significant lower bacterial count for both aerobic and anaerobic bacteria in the DL group compared with the Endo group in both S3 samples (after laser application) and S4 samples (bacterial colonization) (P<0.001). Conclusion: The 980 nm diode laser may be a successful adjunct to conventional endodontic treatment of necrotic cases with chronic periapical lesions in terms of postoperative pain and root canal disinfection. Trail registration: PACTR201511001275414 (date: 23 rd September 2015).
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Affiliation(s)
- Dina A. Morsy
- Department of Endodontics, Faculty of Oral and Dental Medicine, Cairo University, Cairo, 11553, Egypt
| | - Maged Negm
- Department of Endodontics, Faculty of Oral and Dental Medicine, Cairo University, Cairo, 11553, Egypt
| | - Alaa Diab
- Department of Endodontics, Faculty of Oral and Dental Medicine, Cairo University, Cairo, 11553, Egypt
| | - Geraldine Ahmed
- Department of Endodontics, Faculty of Oral and Dental Medicine, Cairo University, Cairo, 11553, Egypt
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Montero-Miralles P, Castillo-Oyagüe R, de la Fuente IS, Lynch CD, Castillo-Dalí G, Torres-Lagares D. Effect of the Nd:YAG laser on sealer penetration into root canal surfaces: A confocal microscope analysis. J Dent 2014; 42:753-9. [DOI: 10.1016/j.jdent.2014.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 03/19/2014] [Accepted: 03/30/2014] [Indexed: 12/01/2022] Open
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13
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De Coster P, Rajasekharan S, Martens L. Laser-assisted pulpotomy in primary teeth: a systematic review. Int J Paediatr Dent 2013; 23:389-99. [PMID: 23171469 DOI: 10.1111/ipd.12014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The purpose of this systematic review was to identify high-quality articles comparing laser with conventional pulpotomy procedures, and to assess whether laser treatment may offer an appreciable benefit over conventional approaches. METHODS A systematic search was implemented for MEDLINE, WEB of SCIENCE and Cochrane's CENTRAL databases (1980-2012) to identify eligible studies. Two reviewers independently assessed the methodological quality of the articles (Κ = 0.89) using specific study design-related quality assessment forms (Dutch Cochrane Collaboration). RESULTS Seven articles met the inclusion criteria, of which five randomized control trials (RCT) and two case series (CS), involving Nd:YAG, Er:YAG, CO₂ and 632/980 nm diode lasers. Although heterogeneity between pulpotomy studies was high, odds ratios (OR) were generally <1, indicating that laser is less successful than conventional pulpotomy techniques. CONCLUSION Given the paucity and high heterogeneity of high-quality articles, general recommendations for the clinical use of laser in pulpotomy in primary teeth can yet not be formulated.
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Affiliation(s)
- Peter De Coster
- Oral Biology, Dental School, Ghent University, Ghent, Belgium
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14
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Fransson H, Larsson KM, Wolf E. Efficacy of lasers as an adjunct to chemo-mechanical disinfection of infected root canals: a systematic review. Int Endod J 2012; 46:296-307. [DOI: 10.1111/iej.12003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 08/24/2012] [Indexed: 12/01/2022]
Affiliation(s)
- H. Fransson
- Department of Endodontics; Faculty of Odontology; Malmö University; Malmö; Sweden
| | - K. M. Larsson
- Department of Pedodontics; Faculty of Odontology; Malmö University; Malmö; Sweden
| | - E. Wolf
- Department of Endodontics; Faculty of Odontology; Malmö University; Malmö; Sweden
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15
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Alonso-Ezpeleta LO, Gasco-Garcia C, Castellanos-Cosano L, Martín-González J, López-Frías FJ, Segura-Egea JJ. Postoperative pain after one-visit root-canal treatment on teeth with vital pulps: comparison of three different obturation techniques. Med Oral Patol Oral Cir Bucal 2012; 17:e721-7. [PMID: 22322522 PMCID: PMC3476040 DOI: 10.4317/medoral.17898] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 11/17/2011] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To investigate and compare postoperative pain after one-visit root canal treatment (RCT) on teeth with vital pulps using three different obturation techniques. STUDY DESIGN Two hundred and four patients (105 men and 99 women) aged 12 to 77 years were randomly assigned into three treatments groups: cold lateral compaction of gutta-percha (LC), Thermafil technique (TT), and Backfill - Thermafil obturation technique (BT). Postoperative pain was recorded on a visual analogue scale (VAS) of 0 - 10 after 2 and 6 hours, and 1, 2, 3, 4, 5, 6 and 7 days. Data were statistically analyzed using multivariate logistic regression analysis. RESULTS In the total sample, 87% of patients experienced discomfort or pain in some moment between RCT and the seventh day. The discomfort experienced was weak, light, moderate and intense in 6%, 44%, 20% and 6% of the cases, respectively. Mean pain levels were 0.4 ± 0.4, 0.4 ± 0.3, and 1.4 ± 0.7 in LC, BT, and TT groups, respectively. Patients of TT group experienced a significantly higher mean pain level compared to other two groups (p < 0.0001). In TT group, all patients felt some level of pain at six hours after RCT. CONCLUSIONS Postoperative pain was significantly associated with the obturation technique used during root canal treatment. Patients whose teeth were filled with Thermafil obturators (TT technique) showed significantly higher levels of discomfort than patients whose teeth were filled using any of the other two techniques.
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16
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Pain Prevalence and Severity before, during, and after Root Canal Treatment: A Systematic Review. J Endod 2011; 37:429-38. [DOI: 10.1016/j.joen.2010.12.016] [Citation(s) in RCA: 199] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Revised: 12/10/2010] [Accepted: 12/20/2010] [Indexed: 11/18/2022]
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17
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Tsesis I, Faivishevsky V, Fuss Z, Zukerman O. Flare-ups after Endodontic Treatment: A Meta-analysis of Literature. J Endod 2008; 34:1177-81. [DOI: 10.1016/j.joen.2008.07.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Revised: 07/06/2008] [Accepted: 07/16/2008] [Indexed: 10/21/2022]
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18
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Al-Negrish ARS, Habahbeh R. Flare up rate related to root canal treatment of asymptomatic pulpally necrotic central incisor teeth in patients attending a military hospital. J Dent 2006; 34:635-40. [DOI: 10.1016/j.jdent.2005.12.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2005] [Revised: 11/27/2005] [Accepted: 12/06/2005] [Indexed: 10/25/2022] Open
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Anjo T, Ebihara A, Takeda A, Takashina M, Sunakawa M, Suda H. Removal of Two Types of Root Canal Filling Material Using Pulsed Nd:YAG Laser Irradiation. Photomed Laser Surg 2004; 22:470-6. [PMID: 15684745 DOI: 10.1089/pho.2004.22.470] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The aim of this study was to examine the usefulness of a pulsed Nd:YAG laser in removing two types of endodontic obturation material from the root canal in vitro. BACKGROUND DATA Recently, a fine flexible glass fiber made of quartz has been developed to transmit the laser beam more effectively and permit its concentration in a specific area. This has increased the potential usefulness of the Nd:YAG laser in root canal treatment. METHODS The time required for removing the root canal obturation material (Gutta-percha cones and, Sealapex or AH26) by means of either Nd:YAG laser irradiation or a conventional method (Gates Glidden drills and K files) was measured. Contact microradiography was used to assess the radiopacity of the root canals before and after the removal of obturation material. The surfaces of the root canal after removal of the obturation materials were also observed by scanning electron microscopy. RESULTS Although none of the methods used in this study resulted in complete removal of debris from the root canal wall, the time required for the removal of any of the root canal obturation materials using laser ablation was significantly shorter than that required using the conventional method (p < 0.05). It appeared that some orifices of the dentinal tubules were blocked with melted dentin following laser irradiation. CONCLUSIONS Nd:YAG laser irradiation is an effective tool for the removal of root canal obturation materials, and may offer advantages over the conventional method.
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Affiliation(s)
- Tomoo Anjo
- Pulp Biology and Endodontics, Department of Restorative Sciences, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
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20
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Ng YL, Glennon JP, Setchell DJ, Gulabivala K. Prevalence of and factors affecting post-obturation pain in patients undergoing root canal treatment. Int Endod J 2004; 37:381-91. [PMID: 15186245 DOI: 10.1111/j.1365-2591.2004.00820.x] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM This longitudinal, prospective study (1) investigated the prevalence of post-obturation pain after root canal treatment and (2) evaluated the influence of factors affecting the pain experience. METHODOLOGY Twenty practitioners, comprising general dental practitioners, MSc graduates and Endodontists, participated in this study. The patient sample (n = 415) was derived from consecutive patients attending the practitioners' surgeries for root canal treatment on a single tooth. Demographic, medical history, preoperative and intra-operative data as well as pain experience on day 1 and day 2 after root canal obturation were recorded. Intensity of pain experienced was recorded on a visual analogue scale (VAS) of 0-5. The data were analysed using logistic regression models. RESULTS The prevalence of post-obturation pain within 48 h after treatment was 40.2% (n = 167) but less than 12% of patients experienced severe pain (VAS 4 or 5) on either day 1 or day 2. The factors that significantly influenced post-obturation pain experience were: gender (OR = 0.434, P < 0.001), tooth type (OR = 1.733, P = 0.007), size of periapical lesion (OR = 0.493, P = 0.004), history of post-preparation pain (OR = 4.110, P = <0.001) or generalized swelling (OR = 3.435, P = 0.005) and number of treatment visits (OR = 2.604, P < 0.001). CONCLUSIONS The prevalence of post-obturation pain was high (40.2%). The important prognostic determinants of post-obturation pain were female, molar tooth, size of periapical lesion smaller than 3 mm, history of post-preparation pain or generalized swelling and single-visit treatment.
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Affiliation(s)
- Y-L Ng
- Department of Endodontology, Eastman Dental Institute for Oral Health Care Sciences, University College London, London, UK
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21
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Negm MM. Intracanal use of a corticosteroid-antibiotic compound for the management of posttreatment endodontic pain. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2001; 92:435-9. [PMID: 11598580 DOI: 10.1067/moe.2001.115975] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this randomized, double-blind study was to determine the effect of a corticosteroid-antibiotic combination when used as an intracanal medicament for the treatment of posttreatment pain in endodontically involved teeth with vital pulp-test readings. STUDY DESIGN Out of 988 patients, 480 experienced intratreatment pain. Endodontic treatment was completed in 3 visits. Patients who experienced pain after the first or second visit (postextirpation or postinstrumentation) were given an emergency visit during which no local anesthetic was used. The patients randomly received either intracanal corticosteroid-antibiotic compound or a placebo. Patients subjectively rated their pain on a scale of 1 to 4 as none, mild, moderate, and severe. The ratings were done at 1, 2, 4, 8, 12, and 24 hours postmedication. RESULTS Intracanal use of the corticosteroid-antibiotic medication significantly reduced (P < .001) the mean pain score quite rapidly and was significantly superior to the placebo until the end of the study (P < .001). Furthermore, there were no reoccurrences of pain, and no side effects from use of the drug were noted. CONCLUSION These results support the intracanal use of corticosteroid-antibiotic combination for controlling posttreatment endodontic pain.
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Affiliation(s)
- M M Negm
- Department of Endodontics, Faculty of Oral and Dental Medicine, Cairo University, Egypt
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22
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Goya C, Yamazaki R, Tomita Y, Kimura Y, Matsumoto K. Effects of pulsed Nd:YAG laser irradiation on smear layer at the apical stop and apical leakage after obturation. Int Endod J 2000; 33:266-71. [PMID: 11307446 DOI: 10.1046/j.1365-2591.2000.00300.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM This study evaluated the removal of smear layer at the apical stop by pulsed Nd:YAG laser irradiation with or without black ink, and the degree of apical leakage after obturation in vitro. METHODOLOGY Sixty extracted human single-rooted teeth were used in this study. The teeth were instrumented up to a size 40 K-file, and then divided into three groups of 20 teeth each: group 1 was unlased as a control group; group 2 was treated with a laser; group 3 was treated with a laser and black ink. The laser was operated at 2 W and 20 pp for 2 s, and irradiation was performed twice with a 30-s interval. In each group, 10 teeth for the leakage study were obturated and immersed in rhodamine B solution for 48 h at 37 degrees C, and the others were used for evaluation of remaining smear layer. All teeth were bisected longitudinally and observed by stereoscopy or scanning electron microscopy. RESULTS The smear layer in the laser-treated groups almost melted or evaporated, and was removed significantly compared with the control group (P < 0.05). Leakage was observed in 60% of samples in group 1 and in 20% of samples in group 2. No leakage was observed in group 3, which was significantly different from the control (P < 0.05). CONCLUSIONS These results suggest that pulsed Nd:YAG laser irradiation with black ink increases the removal of smear layer compared with that without black ink, and reduces apical leakage after obturation significantly.
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Affiliation(s)
- C Goya
- Department of Endodontics, Showa University School of Dentistry, Ohta-ku, Tokyo, Japan
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Abstract
Since the development of the ruby laser by Maiman in 1960 and the application of the laser for endodontics by Weichman in 1971, a variety of papers on potential applications for lasers in endodontics have been published. The purpose of this paper is to summarize laser applications in endodontics, including their use in pulp diagnosis, dentinal hypersensitivity, pulp capping and pulpotomy, sterilization of root canals, root canal shaping and obturation and apicectomy. The effects of laser on root canal walls and periodontal tissues are also reviewed. The essential question is whether a laser can provide equal or improved treatment over conventional care. Secondary issues include treatment duration and cost/benefit ratio. This article reviews the role of lasers in endodontics since the early 1970s, summarizes many research reports from the last decade, and surmises what the future may hold for lasers in endodontics. With the potential availability of many new laser wavelengths and modes, much interest is developing in this promising field.
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Affiliation(s)
- Y Kimura
- Department of Endodontics, Showa University School of Dentistry, 2-1-1 Kitasenzoku, Ohta-ku, Tokyo 145-8515, Japan.
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Yu DG, Kimura Y, Tomita Y, Nakamura Y, Watanabe H, Matsumoto K. Study on removal effects of filling materials and broken files from root canals using pulsed Nd:YAG laser. JOURNAL OF CLINICAL LASER MEDICINE & SURGERY 2000; 18:23-8. [PMID: 11189108 DOI: 10.1089/clm.2000.18.23] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The aims of this study were to investigate the capability of removing the filling materials or broken files from root canals with pulsed Nd:YAG laser irradiation at three parameters, and to evaluate the temperature rises on root surfaces and morphological changes of root canal walls in vitro. SUMMARY BACKGROUND DATA There has been no report on removing the filling materials and broken instruments from root canals with laser irradiation. MATERIALS AND METHODS Thirty-six extracted human incisors were divided into two groups of 18 each. Eighteen root canals were shaped and obturated with gutta-percha and root canal sealer. In another 18 specimens, 3-mm long fractures of files were performed intentionally during root canal preparation. A pulsed Nd:YAG laser irradiation was performed repeatedly at three parameters of 1, 2, and 3 W to remove the filling materials or file fragments. Temperature rises on root surfaces during laser irradiation were measured by thermography, and the remaining of obturated materials and morphological changes of root canal walls were evaluated by stereoscopy and scanning electron microscopy. RESULTS In more than 70% of the teeth, the obturated materials were completely removed by laser, and in more than 55% of the teeth, the broken files were successfully removed. Temperature rises ranging from 17 degrees C to 27 degrees C were measured from 6 to 11 repeated times. CONCLUSION These results demonstrated that a pulsed Nd:YAG laser irradiation has the capability of removing the obturated materials in root canals and is useful for removing the broken files in same if the counter-measure reducing the temperature rise is performed.
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Affiliation(s)
- D G Yu
- Department of Endodontics, Showa University School of Dentistry, Tokyo 145-8515, Japan
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Koba K, Kimura Y, Matsumoto K, Gomyoh H, Komi S, Harada S, Tsuzuki N, Shimada Y. A clinical study on the effects of pulsed Nd:YAG laser irradiation at root canals immediately after pulpectomy and shaping. JOURNAL OF CLINICAL LASER MEDICINE & SURGERY 1999; 17:53-6. [PMID: 11189975 DOI: 10.1089/clm.1999.17.53] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The effects of pulsed Nd:YAG laser irradiation for the treatment of root canals immediately after pulpectomy and shaping with regard to improvement of symptoms were evaluated clinically. SUMMARY BACKGROUND DATA The effects of pulsed Nd:YAG laser irradiation for the treatment of root canals were experimentally investigated using an animal model, but not under clinical conditions. MATERIALS AND METHODS Thirty-eight teeth from 29 patients were diagnosed as normal or irreversible pulpitis were used. After extirpation of pulp and shaping using a step-back technique and cleansing with 5% sodium hypochlorite (NaOCl) and 3% hydrogen peroxide (H2O2), laser irradiation was applied at 1 W and 15 pps for 1 second in 23 teeth (laser-treated group). Root canals were then obturated with gutta-percha points and sealer by the lateral condensation method. The condition of the obturations was confirmed radiographically. The control teeth were treated in the same way, but without laser irradiation. Occurrence of spontaneous pain was recorded 1 day after treatment and occurrence of percussion pain was recorded 1, 2, and 3 weeks after treatment. RESULTS Effective ratio, which was the ratio of the number of "none" teeth to total teeth number in the laser-treated group, was higher than that in the control group, but there was no significant difference between 2 groups with regard to spontaneous and percussion pain (p > 0.05). CONCLUSION These results suggest that the clinical application of pulsed Nd:YAG laser might be advantageous for the one-visit treatment of root canals immediately after pulpectomy shaping and to reduce postoperative pain.
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Affiliation(s)
- K Koba
- Department of Endodontics, Showa University School of Dentistry, 2-1-1 Kitasenzoku, Ohta-ku, Tokyo, Japan
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