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Kim DH, Choi YW, Kang S, Shin SJ, Jung IY. Postoperative pain of minimally invasive root canal treatment:a randomized clinical trial. Odontology 2024; 112:1307-1315. [PMID: 38429393 DOI: 10.1007/s10266-024-00912-6] [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: 12/02/2023] [Accepted: 02/07/2024] [Indexed: 03/03/2024]
Abstract
This randomized clinical trial compared postoperative pain between a minimally invasive (MP) and conventional root canal treatment protocol (CP). A total of 170 mature permanent teeth (either with vital or necrotic pulp), were randomly assigned into two groups. In the CP group, ProTaper Gold (Dentsply Sirona, Ballaigues, Switzerland) and a continuous wave of condensation technique were used, whereas, in the MP group, TruNatomy (Dentsply Sirona), ultrasonic-assisted irrigation (UI), calcium hydroxide, and a sealer-based obturation technique were used. Patients recorded preoperative and postoperative pain using a 0-10 numerical rating scale (NRS) at 4 h, 1, 2, 3, 4, 5, 6, and 7 days after instrumentation and 1 day after canal obturation, respectively. There were no significant differences in pain intensity at any time points assessed between the two groups (p > 0.05). The occurrence of moderate/intense pain after instrumentation was significantly associated with preoperative periapical index (PAI) (p = 0.017) and NRS scores (p < 0.001). Preoperative pulp status (p = 0.009) and NRS score (p = 0.006) were identified as significant factors in the occurrence of moderate/intense pain after obturation. Instrumentation unequivocally reduced pain severity for both groups. The post-endodontic pain associated with the use of MP, combined with UI, Ca(OH)2, and calcium-silicate cement, did not differ from that of CP. Preoperative pain score, PAI, and preoperative pulp status were determined to be prognostic factors for postoperative pain.
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Affiliation(s)
- Do-Hyun Kim
- Department of Conservative Dentistry and Oral Science Research Center, Microscope Center, College of Dentistry, Yonsei University, 50-1 Yonsei-ro, Sudaemun-gu, Seoul, 03722, Korea
| | - Yoon-Woo Choi
- Department of Conservative Dentistry and Oral Science Research Center, Microscope Center, College of Dentistry, Yonsei University, 50-1 Yonsei-ro, Sudaemun-gu, Seoul, 03722, Korea
| | - Sumi Kang
- Department of Conservative Dentistry and Oral Science Research Center, Microscope Center, College of Dentistry, Yonsei University, 50-1 Yonsei-ro, Sudaemun-gu, Seoul, 03722, Korea
| | - Su-Jung Shin
- Department of Conservative Dentistry, Gangnam Severance Dental Hospital, Yonsei University, Seoul, Korea
| | - Il-Young Jung
- Department of Conservative Dentistry and Oral Science Research Center, Microscope Center, College of Dentistry, Yonsei University, 50-1 Yonsei-ro, Sudaemun-gu, Seoul, 03722, Korea.
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Immich F, de Araújo LP, da Gama RR, da Rosa WLDO, Piva E, Rossi-Fedele G. Fifteen years of engine-driven nickel-titanium reciprocating instruments, what do we know so far? An umbrella review. AUST ENDOD J 2024; 50:409-463. [PMID: 38923176 DOI: 10.1111/aej.12870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024]
Abstract
Numerous systematic reviews (SRs) have produced conflicting findings on engine-driven nickel-titanium reciprocating instruments (reciprocating instruments) since Yared's seminal study 15 years ago. This umbrella review analysed SRs examining the clinical and laboratory evidence regarding reciprocating instruments for root canal treatment. SRs that evaluated qualitatively and/or quantitatively the outcomes postoperative pain, oral health-related quality of life (OHRQoL), shaping ability, debris extrusion, microbial load, endotoxins reduction, cyclic fatigue, file fracture, dentinal cracks and root canal filling removal were included. The AMSTAR 2 tool was used to evaluate SRs quality, while the ROBIS tool to assess risk of bias (RoB). Forty SRs were included. The SRs revealed predominantly 'high' RoB and 'critically low' quality. Most focused on technical outcomes, exhibiting significant methodological and statistical heterogeneity. Findings suggest comparable efficacy between reciprocating and rotary instruments. However, due to the scarcity of high-quality evidence, future well-designed studies and reviews considering core outcome measures are needed.
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Affiliation(s)
- Felipe Immich
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - Lucas Peixoto de Araújo
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
- School of Dentistry, Catholic University of Pelotas, Pelotas, Brazil
| | | | | | - Evandro Piva
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
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Machado R, Moreira G, Comparin D, Barroso AP, Nascimento J, Ferraz CCR, Ignácio SA, da Fonseca Roberti Garcia L, Amaral RR, Shadid D, da Silva Neto UX. Postoperative pain after single-visit root canal treatments in necrotic teeth comparing instruments' kinematics and apical instrumentation limits - a prospective randomized multicenter clinical trial. BMC Oral Health 2024; 24:481. [PMID: 38643087 PMCID: PMC11032596 DOI: 10.1186/s12903-024-04225-6] [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: 12/28/2023] [Accepted: 04/04/2024] [Indexed: 04/22/2024] Open
Abstract
OBJECTIVES This prospective randomized multicenter clinical trial (PRMCT) investigated postoperative pain after single-visit root canal treatments in teeth affected by pulp necrosis (PN), and asymptomatic apical periodontitis (AAP) (with apical radiolucent areas) or normal periradicular tissues (without apical radiolucent areas) comparing different instruments' kinematics and apical instrumentation limits. METHODS Before chemomechanical preparation, 240 patients/teeth were randomly distributed into four groups (n = 60) according to the instruments' kinematics (rotary or reciprocating) and apical instrumentation limits (with or without intentional foraminal enlargement [IFE]). After that, specimens were submitted to the same irrigation and obturation techniques, and the patients were referred to undergo the definitive restorations. No medication was prescribed, but the patients were instructed to take either paracetamol (750 mg every 6 h for three days) or ibuprofen (600 mg every 6 h for three days) in pain cases. Postoperative pain incidence and levels were assessed at 24-, 48-, and 72 h following treatment completion according to a verbal rating scale (VRS) following a score. The Kolmogorov-Smirnov test was applied to assess the normality of the data. Mann-Whitney U, Chi-square, Friedman's ANOVA, and Friedman's multiple 2 to 2 comparison tests were employed to identify potential significant statistical differences among the variables in the study groups (P < .05). RESULTS Significant statistical differences were only observed among the groups considering tooth, periradicular status, and the occurrence of overfilling (sealer extrusion) (P < 0.00). Patients with teeth instrumented through rotary kinematics and without IFE experienced lower rates of postoperative pain; however, this difference was relevant only at 24 h (P < 0.05). CONCLUSIONS Postoperative pain was lower after using a rotary file system (Profile 04) inserted up to the apical constriction (AC). However, this finding was just statistically meaningful at 24 h. TRIAL REGISTRATION This PRMCT was approved by the Human Research Ethics Committee of the Paranaense University - UNIPAR, Francisco Beltrão, PR, Brazil (CAAE. 46,774,621.6.0000.0109) on 02/09/2021. It was registered at The Brazilian Registry of Clinical Trials - ReBEC (RBR-3r967t) on 01/06/2023, was performed according to the Principles of the Helsinki Declaration and is reported following the Consolidated Standards of Reporting Trials Statement.
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Affiliation(s)
- Ricardo Machado
- College of Dentistry, Department of Restorative Sciences, Division of Endodontics, Health Sciences Center, University of Oklahoma - COD/OUHSC, Oklahoma City, Oklahoma, USA.
| | - Guilherme Moreira
- Clinical Practice Limited to Endodontics, Francisco Beltrão, Paraná, Brazil
| | - Daniel Comparin
- Clinical Practice Limited to Endodontics, Cunha Porã and Francisco Beltrão, Paraná, Brazil
| | - Arthur Pimentel Barroso
- Piracicaba Dental School, Department of Restorative Dentistry, Division of Endodontics, State University of Campinas - FOP/UNICAMP, Piracicaba, São Paulo, Brazil
| | - Jaqueline Nascimento
- School of Dentistry, Department of Endodontics, Pontifical Catholic University of Paraná - PUC/PR, Curitiba, Paraná, Brazil
| | - Caio Cézar Randi Ferraz
- Piracicaba Dental School, Department of Restorative Dentistry, Division of Endodontics, State University of Campinas - FOP/UNICAMP, Piracicaba, São Paulo, Brazil
| | - Sérgio Aparecido Ignácio
- School of Dentistry, Department of Statistics, Pontifical Catholic University of Paraná - PUC/PR, Curitiba, Paraná, Brazil
| | - Lucas da Fonseca Roberti Garcia
- Department of Dentistry, Division of Endodontics, Federal University of Santa Catarina - UFSC, Florianópolis, Santa Catarina, Brazil
| | | | - David Shadid
- College of Dentistry, Department of Restorative Sciences, Division of Endodontics, Health Sciences Center, University of Oklahoma - COD/OUHSC, Oklahoma City, Oklahoma, USA
| | - Ulisses Xavier da Silva Neto
- School of Dentistry, Department of Endodontics, Pontifical Catholic University of Paraná - PUC/PR, Curitiba, Paraná, Brazil
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Laslami K, Khaldoune S, Sy A, Drouri S, Benkiran I. Apical Extrusion: Is It an Inherent Occurrence During Every Endodontic Treatment? Cureus 2023; 15:e45211. [PMID: 37720124 PMCID: PMC10504573 DOI: 10.7759/cureus.45211] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 09/19/2023] Open
Abstract
The aim of this literature review was to analyze all available scientific data on apical extrusion and to identify and associate the possible factors influencing the occurrence of apical extrusion, ranging from the choice of the canal shaping system, the irrigation technique, to the choice of diameter and the apical limit of preparation. A bibliographic search for relevant articles on apical extrusion of debris, irrigants, and bacteria was performed using the following databases: PubMed, Cochrane Library, and ScienceDirect. This search identified articles published between 2010 and 2023 in two languages (French and English). After selective sorting, 25 relevant documents were included. All the studies retained clearly agree on the inherent nature of apical extrusion during endodontic treatment. At the same time, we also understand that the amount of extrusion can be influenced by a number of parameters throughout endodontic therapy. According to this review, despite the undeniable nature of apical extrusion during endodontic therapy, studies with relatable experimental models that approach in vivo conditions are required to establish exploitable conclusions regarding apical extrusion and its prevention.
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Affiliation(s)
- Kaoutar Laslami
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Medicine, University Hassan II, Casablanca, MAR
| | - Salma Khaldoune
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Medicine, University Hassan II, Casablanca, MAR
| | - Aly Sy
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Medicine, University Hassan II, Casablanca, MAR
| | - Sofia Drouri
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Medicine, University Hassan II, Casablanca, MAR
| | - Imane Benkiran
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Medicine, University Hassan II, Casablanca, MAR
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Yang X, Zheng T, Yang N, Yin Z, Wang W, Bai Y. A Review of the research methods and progress of biocompatibility evaluation of root canal sealers. AUST ENDOD J 2023; 49 Suppl 1:508-514. [PMID: 36480411 DOI: 10.1111/aej.12725] [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: 04/08/2022] [Revised: 09/22/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022]
Abstract
The function of root canal sealer was to achieve an appropriate three-dimensional filling effect by filling the root canal and some irregular lumen, thereby inhibiting the residual bacteria. There were many types of sealers, but research to find the most suitable ones was still ongoing. In recent years, researchers had continuously improved the performance of sealers by developing new sealers or adding active ingredients to the sealers. However, most sealers exhibit varying degrees of cytotoxicity and tissue responses, which affect clinical therapy efficacy. This review describes different technical approaches, and recent research progress in the biocompatibility evaluation of root canal sealers and provides brief insights into this field by summarising the performance studies of different root canal sealers.
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Affiliation(s)
- Xiliang Yang
- Department of Oral, College of stomatology, North China University of Science and Technology, Tangshan City, China
| | - Tianxia Zheng
- Department of Oral, College of stomatology, North China University of Science and Technology, Tangshan City, China
| | - Nuoya Yang
- Department of Oral, College of stomatology, North China University of Science and Technology, Tangshan City, China
| | - Zihan Yin
- Department of Oral, College of stomatology, North China University of Science and Technology, Tangshan City, China
| | - Wuliang Wang
- Department of Oral, College of stomatology, North China University of Science and Technology, Tangshan City, China
| | - Yuhong Bai
- Department of Oral, College of stomatology, North China University of Science and Technology, Tangshan City, China
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Post-Operative Quality of Life after Single-Visit Root Canal Treatment Employing Three Different Instrumentation Techniques-An Institutional Randomized Clinical Trial. J Clin Med 2023; 12:jcm12041535. [PMID: 36836070 PMCID: PMC9965264 DOI: 10.3390/jcm12041535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/04/2023] [Accepted: 02/14/2023] [Indexed: 02/17/2023] Open
Abstract
Root canal treatment (RCT) eliminates damaged pulpal tissue and protects the tooth from recurrent microbial invasion. Post-endodontic pain (PEP) is a frequently encountered complication of root canal therapy. It can have an impact on patients' quality of life (QoL) and their subjective perception of treatment options. Thus, a self-assessment questionnaire was used to evaluate and compare the influence of manual, rotary, and reciprocating file shaping procedures on immediate post-operative quality of life (POQoL) involving single-visit root canal therapy. It was a double-blinded, randomized, controlled clinical trial. A total of 120 participants were randomly assigned sequentially to three groups comprising 40 patients in each group: Group A: Hand K file (positive control); Group B: ProTaper Next file system; and Group C: WaveOne Gold. Post-operative pain was evaluated using a 4-point visual analog scale (VAS) after 12 h, 24 h, 48 h, 72 h, and 1 week. The highest post-operative pain was with manual instrumentation using hand K files, and the lowest was with reciprocating and rotating instrumentations. No significant difference was noted between the parameters of quality of life assessed, suggesting the filing system or technique had a similar effect.
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Elmallawany A, Hussein YF, Ali MM, Montasser K, Aly Y, Sharaf N. Effect of Ultrasonic and Diode Laser Irrigation Activation on Post-operative Pain and Microbial Reduction in Single Visit Endodontic Treatment of Necrotic Mandibular Molars. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: To clinically evaluate the effect of continuous ultrasonic and diode laser 810 wave length irrigation activation techniques on postoperative pain and bacterial reduction in single visit endodontic treatment of mandibular molars.
Material and methods: Forty patients requiring root canal treatment therapy for necrotic mandibular molars teeth were included in this study with age ranges between 20 and 45 years. In all cases, single visit endodontic treatment was carried out using Revo-S rotary file system in crown down sequence. NaOCl 2.5% irrigation solution was used during treatment. Patients were randomly and equally assigned into two groups according to irrigation technique. Group (1): conventional syringe irrigation and group (2): continuous ultrasonic irrigation. Each group was subdivided into two sub groups (n = 10); subgroup 1A (conventional syringe irrigation with no laser), subgroup 1B (conventional syringe irrigation with diode laser), subgroup 2A (continuous ultrasonic irrigation with no laser) and subgroup 2B (continuous ultrasonic irrigation with diode laser).
Postoperative pain evaluation was done using Visual Analogue Scale (VAS) at 6, 12, 24, 36, 48 hours and 7 days postoperatively. Microbiological detection of bacterial reduction was done by taking Samples (S1 and S2) for bacterial cultures. S1 after finishing access cavity and before mechanical preparation and S2 after finishing mechanical preparation and irrigation activation and before obturation. Samples were cultured on blood agar and determined as colony forming units (CFU/mL). Microbiological bacterial reduction was calculated accordingly. Statistical analyses were analyzed using the Mann-Whitney U test. The significance level was set at p < 0.05.
Results: In all sub groups, postoperative pain decreased by time in all time intervals but pain was significantly lower in subgroup (2B) (continuous ultrasonic irrigation with diode laser) than subgroup (1A) (conventional syringe irrigation with no laser) in all time interval. Microbiological results showed the highest bacterial reduction was in subgroup (2B) (continuous ultrasonic irrigation with diode laser) and least bacterial reduction was in subgroup (1A) (conventional syringe irrigation with no laser).
Conclusion: Using diode laser and continuous ultrasonic irrigation activation techniques as adjunctive methods showed improvement in postoperative pain records and enhanced bacterial reduction in root canal therapy.
Keywords: Continuous ultrasonic irrigation, diode laser 810, post-operative pain, bacterial reduction, single visit endodontic treatment.
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Di Spirito F, Scelza G, Fornara R, Giordano F, Rosa D, Amato A. Post-Operative Endodontic Pain Management: An Overview of Systematic Reviews on Post-Operatively Administered Oral Medications and Integrated Evidence-Based Clinical Recommendations. Healthcare (Basel) 2022; 10:healthcare10050760. [PMID: 35627897 PMCID: PMC9141195 DOI: 10.3390/healthcare10050760] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 01/08/2023] Open
Abstract
Endodontic treatment comprises the overall management of pre-, intra- and post-operative symptoms, including post-operative endodontic pain, considered as a complication susceptible of chronicization. Post-operative pain is very common and highly unpreventable and has a multi-factorial etiology and a potential pathogenic link to the acute inflammation of the periapical area, secondary to localized chemical, mechanical, host and/or microbial damage occurring during endodontic treatment. Considering the multitude of heterogeneous technical and pharmacological approaches proposed to control post-operative endodontic pain, the present study primarily comprised an overview of systematic reviews of systematic reviews of randomized clinical trials, summarizing findings on post-operatively administered oral medications for post-operative endodontic pain control, in order to note the most effective type and dosage of such drugs. Secondarily, a narrative review of the current evidence on technical solutions to be observed during endodontic treatment procedures, to control post-operative pain, was conducted to provide integrated evidence-based clinical recommendations for optimal post-operative endodontic pain management.
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Affiliation(s)
- Federica Di Spirito
- Department of Medicine, Surgery and Dentistry “Schola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (G.S.); (F.G.); (D.R.); (A.A.)
- Correspondence: or
| | - Giuseppe Scelza
- Department of Medicine, Surgery and Dentistry “Schola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (G.S.); (F.G.); (D.R.); (A.A.)
| | | | - Francesco Giordano
- Department of Medicine, Surgery and Dentistry “Schola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (G.S.); (F.G.); (D.R.); (A.A.)
| | - Donato Rosa
- Department of Medicine, Surgery and Dentistry “Schola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (G.S.); (F.G.); (D.R.); (A.A.)
| | - Alessandra Amato
- Department of Medicine, Surgery and Dentistry “Schola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (G.S.); (F.G.); (D.R.); (A.A.)
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Milani AS, Froughreyhani M, Taghiloo H, Nouroloyouni A, Jafarabadi MA. The effect of antibiotic use on endodontic post-operative pain and flare-up rate: a systematic review with meta-analysis. Evid Based Dent 2022:10.1038/s41432-021-0205-z. [PMID: 35165442 DOI: 10.1038/s41432-021-0205-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/14/2021] [Indexed: 06/14/2023]
Abstract
Aim Antibiotics are widely used to prevent flare-ups after endodontic treatment of non-vital teeth. This systematic review assessed the effect of antibiotic administration on post-endodontic treatment pain and flare-up rate.Methods Five major databases including Web of Science, Cochrane Library, PubMed, Scopus and Embase were searched to identify randomised clinical trials (RCTs) published until September 2020. Retrieved papers were critically appraised using the revised Cochrane risk of bias tool (RoB 2). To reduce the clinical heterogeneity, the included studies were divided into two groups: studies on symptomatic non-vital teeth and studies on asymptomatic non-vital teeth. The primary outcomes were 'post-operative pain' and 'flare-up rate'. The data of included studies were statistically combined through meta-analysis using random-effect model. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of evidence.Results Six RCTs involving two RCTs (N = 61) on symptomatic teeth and four RCTs (N = 310) on asymptomatic teeth were included. In two RCTs on asymptomatic teeth, prophylactic antibiotic had been used, while in the remaining two RCTs, antibiotics had been administered after treatment. Quantitative synthesis of the RCTs showed that antibiotic administration following endodontic treatment of symptomatic non-vital teeth has no effect on pain severity at 24 hours following treatment (weighted mean difference [WMD] = -0.03; 95% confidence interval [CI]: -0.53 to 0.47), and the use of antibiotics before endodontic treatment of asymptomatic non-vital teeth has no effect on flare-up rate (relative risk [RR] = 0.58; 95% CI: 0.22-1.54). The GRADE approach revealed that the overall quality of evidence on the topic is low.Conclusions The antibiotic administration following endodontic treatment of symptomatic non-vital teeth has no effect on pain severity at 24 hours following treatment. Also, prophylactic antibiotics are ineffective in reducing the flare-up rate following treatment of asymptomatic non-vital teeth. However, to evaluate the effect of post-treatment antibiotics on flare-up rate in asymptomatic non-vital teeth, more high-quality RCTs are needed.
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Affiliation(s)
- Amin Salem Milani
- Associate Professor of Endodontics, Research Centre for Evidence-Based Medicine (EBM), Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mohammad Froughreyhani
- Professor of Endodontics, Department of Endodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Taghiloo
- Assistant Professor, Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Tabriz University of Medical sciences, Tabriz, Iran
| | - Ahmad Nouroloyouni
- Assistant Professor of Endodontics, Department of Endodontics, Faculty of Dentistry, Ardebil University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari Jafarabadi
- Department of Statistics and Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
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Chalub LO, Nunes GP, Ferrisse TM, Strazzi-Sahyon HB, Dos Santos PH, Gomes-Filho JE, Cintra LTA, Sivieri-Araujo G. Postoperative pain in root canal treatment with ultrasonic versus conventional irrigation: a systematic review and meta-analysis of randomized controlled trials. Clin Oral Investig 2022; 26:3343-3356. [DOI: 10.1007/s00784-022-04386-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/11/2022] [Indexed: 11/03/2022]
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Shaik RP, Chukka RS, Bandlapally A, Vemuri S, Bolla N, Basam RC, Tammineedi S. Assessment of postoperative pain after single-visit root canal treatment using rotary and reciprocating file systems: an in vivo study. J Dent Anesth Pain Med 2022; 22:267-275. [PMID: 35991361 PMCID: PMC9358273 DOI: 10.17245/jdapm.2022.22.4.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/28/2022] [Accepted: 07/08/2022] [Indexed: 11/26/2022] Open
Abstract
Background Various instrument kinematics used in single-visit endodontics influence the occurrence of pain after endodontic therapy. This study aimed to evaluate the occurrence of pain after mechanical instrumentation with Hyflex EDM (HEDM) and WaveOne Gold (WOG) during single-visit endodontic therapy. Methods Sixty patients diagnosed with asymptomatic irreversible pulpitis and normal apical tissues in mandibular premolar teeth were included in the study for single-visit root canal therapy. The patients were divided into two groups (n = 30) according to the rotary instrument used during root canal preparation (group A [HEDM] and group B [WOG]). Pain was evaluated after endodontic therapy at 8, 24, and 48 h intervals using the visual analog scale (VAS). Data obtained were analyzed using the chi-square test, independent t-test, MannWhitney U test, and Wilcoxon matched-pairs test. Results Statistically significant differences were observed between the two groups (P < 0.001) at 8, 24, and 48 h, with WOG exhibiting less pain than HEDM files. Conclusion Postoperative pain was lower in the WOG file system than in the HEDM file system after single-visit root canal therapy at 8, 24, and 48 h.
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Affiliation(s)
- Reshma Parveen Shaik
- Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
| | - Ram Sunil Chukka
- Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
| | - Anila Bandlapally
- Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
| | - Sayesh Vemuri
- Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
| | - Nagesh Bolla
- Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
| | - Ram Chowdary Basam
- Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
| | - Sravanthi Tammineedi
- Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
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Antony D, Subramanian A, Nivedhitha M, Solete P, Balasubramaniam A. Post-endodontic pain with different engine-driven endodontic instruments in multi-visit root canal therapy: A systematic review and meta-analysis. J Int Oral Health 2022. [DOI: 10.4103/jioh.jioh_127_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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13
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Atesci AA, Topaloglu-Ak A, Turan E, Oncag O, Kaval ME. Evaluation of Postoperative Pain Following Single-Visit Root Canal Treatment with Rotary and Reciprocal Ni–Ti File Systems in Children. Medicina (B Aires) 2021; 58:medicina58010050. [PMID: 35056358 PMCID: PMC8780144 DOI: 10.3390/medicina58010050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/17/2021] [Accepted: 12/23/2021] [Indexed: 12/05/2022] Open
Abstract
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.
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Affiliation(s)
| | - Aslı Topaloglu-Ak
- Department of Pediatric Dentistry, School of Dentistry, Istanbul Aydın University, Istanbul 34295, Turkey
- Correspondence:
| | - Ece Turan
- Independent Researcher, Izmir 35220, Turkey; (A.A.A.); (E.T.)
| | - Ozant Oncag
- Department of Pediatric Dentistry, School of Dentistry, Ege University, Izmir 35040, Turkey;
| | - Mehmet Emin Kaval
- Department of Endodontics, School of Dentistry, Ege University, Izmir 35040, Turkey;
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Machado R, Comparin D, Ignácio SA, da Silva Neto UX. Postoperative pain after endodontic treatment of necrotic teeth with large intentional foraminal enlargement. Restor Dent Endod 2021; 46:e31. [PMID: 34513637 PMCID: PMC8411006 DOI: 10.5395/rde.2021.46.e31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/17/2020] [Accepted: 12/31/2020] [Indexed: 01/01/2023] Open
Abstract
Objectives To evaluate postoperative pain after endodontic treatment of necrotic teeth using large intentional foraminal enlargement (LIFE). Materials and Methods The sample included 60 asymptomatic necrotic teeth (with or without chronic apical periodontitis), and a periodontal probing depth of 3 mm, previously accessed and referred to perform endodontic treatment. After previous procedures, the position and approximate size of the apical foramen (AF) were determined by using an apex locator and K flexo-files, respectively. The chemomechanical preparation was performed with Profile 04 files 2 mm beyond the AF to achieve the LIFE, using 2.5 mL of 2.5% NaOCl at each file change. The filling was performed by Tagger's hybrid technique and EndoFill sealer. Phone calls were made to all the patients at 24, 48 and 72 hours after treatment, to classify postoperative pain. Statistical analysis was performed by different tests with a significance level of 5%. Results Age, gender, periradicular status and tooth type did not influence postoperative pain (p > 0.05). Only 1 patient (1.66%) reported severe pain after 72 hours. Moderate pain was reported by 7, 4 and 3 patients after 24, 48 and 72 hours, respectively (p = 0.0001). However, paired analyses showed a statistically significant difference only between 24 and 72 hours (p = 0.04). Sealer extrusion did not influence the postoperative pain (p > 0.05). Conclusions Acute or moderate postoperative pain was uncommon after endodontic treatment of necrotic teeth with LIFE. Trial Registration The Brazilian Clinical Trials Registry Identifier: RBR-3r967t
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Affiliation(s)
- Ricardo Machado
- Department of Endodontics, School of Health and Bioscience, Pontifical Catholic University of Paraná - PUC/PR, Curitiba, Paraná, Brazil
| | - Daniel Comparin
- Department of Endodontics, School of Dentistry, Paranaense University - UNIPAR, Francisco Beltrão, Paraná, Brazil
| | - Sérgio Aparecido Ignácio
- Department of Statistics, School of Health and Bioscience, Pontifical Catholic University of Paraná - PUC/PR, Curitiba, Paraná, Brazil
| | - Ulisses Xavier da Silva Neto
- Department of Statistics, School of Health and Bioscience, Pontifical Catholic University of Paraná - PUC/PR, Curitiba, Paraná, Brazil
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Predicting postoperative pain following root canal treatment by using artificial neural network evaluation. Sci Rep 2021; 11:17243. [PMID: 34446767 PMCID: PMC8390654 DOI: 10.1038/s41598-021-96777-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 08/12/2021] [Indexed: 01/17/2023] Open
Abstract
This study aimed to evaluate the accuracy of back propagation (BP) artificial neural network model for predicting postoperative pain following root canal treatment (RCT). The BP neural network model was developed using MATLAB 7.0 neural network toolbox, and the functional projective relationship was established between the 13 parameters (including the personal, inflammatory reaction, operative procedure factors) and postoperative pain of the patient after RCT. This neural network model was trained and tested based on data from 300 patients who underwent RCT. Among these cases, 210, 45 and 45 were allocated as the training, data validation and test samples, respectively, to assess the accuracy of prediction. In this present study, the accuracy of this BP neural network model was 95.60% for the prediction of postoperative pain following RCT. To conclude, the BP network model could be used to predict postoperative pain following RCT and showed clinical feasibility and application value.
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Kandemir Demirci G, Miçooğulları Kurt S, Serefoglu B, Kaval ME, Çalışkan MK. The influence of different NiTi instrumentation techniques on postoperative pain after single-visit root canal treatment. AUST ENDOD J 2021; 47:559-568. [PMID: 34278665 DOI: 10.1111/aej.12547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/27/2021] [Accepted: 07/04/2021] [Indexed: 11/30/2022]
Abstract
This study aimed to evaluate the effect of multi-file rotary (Protaper Universal) and reciprocating single-file (Reciproc Blue) root canal preparation techniques on the occurrence of postoperative pain in asymptomatic mandibular molar teeth with large periapical lesions in single-visit root canal treatment (RCT). A hundred and twenty teeth were randomly assigned to two groups: Protaper Universal (PTU) or Reciproc Blue (RB) instruments. Postoperative pain at 6, 12, 24, 48, 72 h and 7 days after obturation was measured. Mann-Whitney U-test was performed to compare the pain scores between the groups and to assess the relation of pain with patients' age and gender. Spearman's rank correlation was utilized to correlate the pain intensity and analgesic intake at different time points. There was no significant difference between the instrumentation techniques regarding postoperative pain at any time points evaluated (P > 0.05). There was a correlation between analgesic intake and intensity of pain (P < 0.05). No statistically significant difference was found among the groups assessed in the study in terms of analgesic intake (P > 0.05).
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Affiliation(s)
| | | | - Burcu Serefoglu
- Department of Endodontology, School of Dentistry, Ege University, Izmir, Turkey
| | - Mehmet E Kaval
- Department of Endodontology, School of Dentistry, Ege University, Izmir, Turkey
| | - Mehmet K Çalışkan
- Department of Endodontology, School of Dentistry, Ege University, Izmir, Turkey
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Influence of occlusal reduction on pain after endodontic treatment: a systematic review and meta-analysis. Sci Rep 2021; 11:14019. [PMID: 34234168 PMCID: PMC8263790 DOI: 10.1038/s41598-021-93119-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 06/14/2021] [Indexed: 12/03/2022] Open
Abstract
The purpose of this systematic review was to analyze the influence of occlusal reduction on the postoperative pain levels after endodontic treatment (instrumentation and obturation of the root canal system). This review followed the PRISMA statement and was registered at PROSPERO (CRD42018107918). Two independent reviewers searched the Lilacs, Cochrane Library, PubMed (Medline), Web of Science, Scopus, Scielo, and ScienceDirect for articles published until April 2021. The research question was, "Does occlusal reduction decrease postoperative pain in endodontically treated teeth?". Only randomized clinical trials were included. The RevMan 5 program was used for meta-analysis, calculating the relative risk (RR) and 95% confidence interval (CI) of the dichotomous outcome (presence or absence of pain). The search strategies retrieved 4114 studies. Twelve studies were included for qualitative analysis and nine for quantitative analysis. The meta-analysis results did not reveal a significant difference in the reduction of postoperative pain levels for endodontic instrumentation at 6, 12, 24, 48 h and for endodontic obturation at 6 or 12 h after occlusal reduction. According to the GRADE tool, the analyzed outcome was classified as having a moderate level of certainty. It is concluded that occlusal reduction does not interfere with postoperative pain levels after endodontic treatment.
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Xavier F, Zuolo M, Nevares G, Kherlakian D, Velozo C, de Albuquerque D. Postoperative Pain after Use of the WaveOne Gold and XP-endo Shaper Systems: A Randomized Clinical Trial. J Endod 2021; 47:1550-1556. [PMID: 34171356 DOI: 10.1016/j.joen.2021.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/30/2021] [Accepted: 06/16/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The present study aimed to clinically compare the incidence of postoperative pain after endodontic treatment of posterior teeth using the WaveOne Gold (WOG; Dentsply Sirona, Ballaigues, Switzerland) and XP-endo Shaper (XPES; FKG Dentaire, La Chaux-de-Fonds, Switzerland) systems. METHODS In a single-blind randomized clinical trial, 148 vital teeth with an indication for conventional endodontic therapy for prosthetic purposes were treated by 5 specialists following a preestablished protocol. All participants were unaware of the treatment they received. The teeth were randomly divided into 2 groups (n = 74) according to the instrumentation system used (the WOG group and XPES group). The treatments were performed in a single session. The participants were asked to rate the intensity of postoperative pain on a visual analog scale (no pain, mild pain, moderate pain, and severe pain) after 24, 48, and 72 hours and 7 days. RESULTS The incidence of postoperative pain was higher in the XPES group after 24, 48, and 72 hours compared with those in the WOG group (P < .05). Two participants in the WOG group experienced severe postoperative pain after 24 hours. None of the participants in either group reported pain after 7 days (P > .05, Mann-Whitney test). CONCLUSIONS Postoperative pain is expected after preparation of the root canal system with the WOG and XPES systems tested, but it only persists for a short period. Although more common after the use of the XPES system, the pain was classified as mild at all time points.
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Affiliation(s)
- Felipe Xavier
- Department of Restorative Dentistry and Endodontics, Dental College of Pernambuco, University of Pernambuco, Camaragibe, Brazil.
| | - Mário Zuolo
- Faculdade de Odontologia, APCD, São Paulo, Brazil
| | - Giselle Nevares
- Department of Restorative Dentistry and Endodontics, Dental College of Pernambuco, University of Pernambuco, Camaragibe, Brazil
| | | | - Christianne Velozo
- Department of Restorative Dentistry and Endodontics, Dental College of Pernambuco, University of Pernambuco, Camaragibe, Brazil
| | - Diana de Albuquerque
- Department of Restorative Dentistry and Endodontics, Dental College of Pernambuco, University of Pernambuco, Camaragibe, Brazil
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Hosny NS, El Khodary SA, El Boghdadi RM, Shaker OG. Effect of Neem (Azadirachta indica) versus 2.5% sodium hypochlorite as root canal irrigants on the intensity of post-operative pain and the amount of endotoxins in mandibular molars with necrotic pulps: a randomized controlled trial. Int Endod J 2021; 54:1434-1447. [PMID: 33884661 DOI: 10.1111/iej.13532] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/14/2021] [Accepted: 04/16/2021] [Indexed: 12/13/2022]
Abstract
AIM To assess the effect of Neem versus 2.5% NaOCl as root canal irrigants on the intensity of post-operative pain and amount of endotoxins following root canal treatment of mandibular molars with necrotic pulps. METHODOLOGY This parallel, prospective, double-blinded, randomized controlled trial with allocation ratio 1:1 was conducted in the out-patient clinic of the Endodontic Department, Faculty of Dentistry, Cairo University, Egypt. Fifty healthy patients with mandibular molars with necrotic pulps were randomly assigned into two equal groups using computer software. In the intervention group, root canals were irrigated using Neem; whilst 2.5% NaOCl was used in the control group. A standard root canal treatment was performed in two visits using ProTaper Next rotary files, with no intracanal medication. Pain intensity was assessed using a numerical rating scale (NRS) 6, 12, 24 and 48 h following instrumentation and canal filling. Endotoxin samples were collected using three paper points before and after canal instrumentation and a sandwich ELISA method was used to quantify the level of endotoxins. Demographic, baseline, and outcome data were collected and analysed using chi-square tests (for the comparisons of categorical variables), Mann-Whitney tests (for non-normally distributed variables) and Student's t tests (for normally distributed variables), A P-value < 0.05 was considered to be statistically significant. RESULTS The mean pain scores within the two groups decreased continually over time. The mean pain scores in the Neem group were lower than those in the 2.5% NaOCl group at 6, 12, 24 and 48 h following instrumentation and canal filling with no significant difference between them except at 24 h following instrumentation (P = 0.012). Both irrigants significantly reduced endotoxin levels compared to the pre-instrumentation samples (P < 0.001) by 8% for the NaOCL group and 18% for the Neem group. CONCLUSION Neem and 2.5% NaOCl were not significantly different in terms of reducing the intensity of post-operative pain during all follow-up periods except at 24 h following instrumentation where Neem was associated with lower pain intensity. Both irrigants significantly reduced endotoxin levels but were not effective in eliminating endotoxins completely from root canals of mandibular molars with necrotic pulps.
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Affiliation(s)
- N S Hosny
- Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - S A El Khodary
- Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - R M El Boghdadi
- Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - O G Shaker
- Department of Biochemistry, Faculty of Medicine, Cairo University, Cairo, Egypt
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Bürklein S, Donnermeyer D, Hentschel TJ, Schäfer E. Shaping Ability and Debris Extrusion of New Rotary Nickel-Titanium Root Canal Instruments. MATERIALS 2021; 14:ma14051063. [PMID: 33668333 PMCID: PMC7956538 DOI: 10.3390/ma14051063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 11/29/2022]
Abstract
The aim was to evaluate the canal straightening and the amount of apically extruded debris associated with five rotary nickel-titanium when preparing curved root canals. A total of 100 root canals in extracted human teeth (angles of curvatures 20°–30°; radii 5.9–13.5 mm) were divided into five groups (n = 20/group). The groups were balanced with respect to the angle and the radius of canal curvature. The root canals were prepared using conventional austenite 55-NiTi alloy instruments F360, F6 SkyTaper (both Komet, Lemgo, Germany), and the heat-treated NiTi Jizai, Silk-Complex and Silk-Standard instruments (all Mani, Tochigi, Japan) to an apical size 25. The amount of extruded debris was assessed with a micro balance. Statistical analysis was performed using Kruskal–Wallis test with Bonferroni correction at a significance level of p < 0.05. During canal preparation, neither instrument fractures nor procedural preparation errors were noticed. Regarding canal straightening, the use of Jizai instruments resulted in the significantly lowest straightening (p < 0.05), while no significant differences were obtained between all other groups (p > 0.05). Regarding the amount of apically extruded debris, no significant differences between all groups were obtained (p > 0.05). Within the limitations of this study, all instruments performed well, and especially the Jizai instruments showed an excellent shaping ability.
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Affiliation(s)
- Sebastian Bürklein
- Central Interdisciplinary Ambulance in the School of Dentistry, Westphalian Wilhelms-University, Albert-Schweitzer-Campus 1, Building W 30, 48149 Münster, Germany;
| | - David Donnermeyer
- Department of Periodontology and Operative Dentistry, Westphalian Wilhelms-University, Albert-Schweitzer-Campus 1, Building W 30, 48149 Münster, Germany;
| | - Tim Julian Hentschel
- Private Practice, Zahnärztliche Gemeinschaftspraxis Die Kessels, Brüsseler Straße 11a, 53332 Bornheim, Germany;
| | - Edgar Schäfer
- Central Interdisciplinary Ambulance in the School of Dentistry, Westphalian Wilhelms-University, Albert-Schweitzer-Campus 1, Building W 30, 48149 Münster, Germany;
- Correspondence: ; Tel.: +49-251-8347040; Fax: +49-251-8343749
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Effect of Rotary and Reciprocating Instrumentation Motions on Postoperative Pain Incidence in Non-Surgical Endodontic Treatments: A Systematic Review and Meta-Analysis. Eur Endod J 2021; 6:3-14. [PMID: 33609019 PMCID: PMC8056811 DOI: 10.14744/eej.2020.51523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE A systematic review and meta-analysis were conducted to determine whether there are postoperative pain differences resulting from rotary and reciprocation engine-driven instrumentation motions in non-surgical endodontic treatment or retreatment at 12, 24, and 48 hours. METHODS Four electronic databases (PubMed, Embase, Cochrane Library, and Scopus) were searched to identify randomised controlled trials that compared the effects of rotary and reciprocating instrumentation motions on postoperative pain. Two authors independently screened the search results, extracted the data, and assessed the quality using the Cochrane risk of bias tool. Due to numerous variables across studies, the random effect inverse variance method for meta-analysis was applied. When significant heterogeneity among studies was present, the random effects multi-variable meta-regression analysis was performed to determine the source of heterogeneity. RESULTS At all time intervals, the incidence of postoperative pain was higher in the reciprocating instrumentation group, but was not statistically significant. There was no significant difference in the analgesic intake between groups. Meta-regression analysis determined study population sizes as a significant heterogeneous factor, while significance was not observed for preoperative pain or the pulpal diagnosis. CONCLUSION There was no difference in postoperative pain at 12, 24, and 48 hours after non-surgical root canal treatment and retreatment, using reciprocating or rotary instrumentation motions.
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Lakshmanan L, Somasundaram S, Jeevanandan G, Subramanian EMG. Evaluation of Postoperative Pain after Pulpectomy using Different File Systems in Primary Teeth: A Systematic Review. Contemp Clin Dent 2021; 12:3-8. [PMID: 33967530 PMCID: PMC8092099 DOI: 10.4103/ccd.ccd_561_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/22/2020] [Accepted: 08/24/2020] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The purpose of this systematic review was to compare the incidence and intensity of postoperative pain after pulpectomy using different instrumentations in primary teeth. MATERIALS AND METHODS An extensive literature search in PubMed, Cochrane Library, Science Direct, LILAC, SIGLE, and Google Scholar was performed to identify English language articles with human subjects that evaluated the effects of different instruments on postoperative pain after pulpectomy. RESULTS The search retrieved 187 references. After screening of the abstracts and articles, based on the inclusion and exclusion criteria, a total of three articles were included in the systematic review. Of the three included studies, two of them had a moderate risk of bias and one showed a high risk of bias. CONCLUSION The use of rotary instruments contributed to a lower incidence and intensity of postoperative pain than did the hand instruments in all the three studies. More high-quality randomized clinical trials are needed in this field in future studies to support the evidence.
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Affiliation(s)
- Lakshimi Lakshmanan
- Department of Pediatric and Preventive Dentistry, Saveetha Dental College, Saveetha Institute of Medical and Technical Science, Chennai, Tamil Nadu, India
| | - Sujatha Somasundaram
- Department of Pediatric and Preventive Dentistry, Saveetha Dental College, Saveetha Institute of Medical and Technical Science, Chennai, Tamil Nadu, India
| | - Ganesh Jeevanandan
- Department of Pediatric and Preventive Dentistry, Saveetha Dental College, Saveetha Institute of Medical and Technical Science, Chennai, Tamil Nadu, India
| | - EMG Subramanian
- Department of Pediatric and Preventive Dentistry, Saveetha Dental College, Saveetha Institute of Medical and Technical Science, Chennai, Tamil Nadu, India
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The Influence of Sodium Hypochlorite and Chlorhexidine on Postoperative Pain in Necrotic Teeth: A Systematic Review. Eur Endod J 2020; 5:177-185. [PMID: 33353925 PMCID: PMC7881388 DOI: 10.14744/eej.2020.94830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: The purpose of this systematic review was to provide the answer to the question: Can sodium hypochlorite and chlorhexidine influence postoperative pain after the endodontic treatment in necrotic teeth? Methods: The PROSPERO registration number is CRD42018096433 and was conducted following the PRISMA statements. The MeSH and free terms were used to search for articles published in the electronic databases (PubMed, Web of Science, Scopus, Cochrane Library, and Virtual Health Library), in the gray literature, and by a manual search. The reviewers selected the studies considering predetermined eligibility criteria, performed data extraction, and evaluated the risk of bias. Only clinical trials comparing the effect of sodium hypochlorite and chlorhexidine on postoperative pain in teeth of adult patients with necrotic pulps were included. Results: Five studies were qualified for the systematic review. Two studies were considered a low risk of bias. The results showed no statistically significant difference regarding postoperative pain in the groups. Only 1 study reported a statistically significant difference in the sixth postoperative hour, and the pain was associated with the sodium hypochlorite group. Conclusion: There was no influence of auxiliary chemical substance (NaOCl and CHX) on postoperative pain used in endodontic treatment in the teeth with pulp necrosis. However, one study observed a significant difference in the sixth postoperative hour, associated with the sodium hypochlorite group.
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Cost-Effectiveness Analysis of Rehabilitation Interventions for Teeth With Extensive Coronary Destruction. Value Health Reg Issues 2020; 23:122-130. [PMID: 33217715 DOI: 10.1016/j.vhri.2020.07.581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 05/05/2020] [Accepted: 07/07/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To perform a cost-effectiveness analysis of rehabilitation interventions for management of posterior teeth (molar) with extensive coronary destruction. METHODOLOGY An economic model by Markov simulated a hypothetical 10-year cohort with 1,000 patients requiring treatment for a molar tooth with pulp necrosis and extensive coronary destruction. This study adopted the perspective of a local manager from Specialized Center in Dentistry, based on the transfer from the Ministry of Health. Treatments were proposed: Tooth Extraction + Removable Partial Denture (TE+RPD); Root Canal Treatment + Intra-Radicular Restoration + Single Crown (RCT+RIR+SC); and Tooth Extraction + Dental Implant + Single Crown (TE+DI+SC). The costs were obtained from the SUS Integrated System of Procedures, Medicines and orthoses; prostheses and special materials table management (SIGTAP). Failure and survival rates were obtained from systematic reviews. The variable "years of survival" was an outcome of effectiveness. The probabilistic simulation considered the confidence interval of 95%, variation of parameters by 5% and annual discount rate of 5%. RESULTS TE+RPD intervention presented lower cost and effectiveness. The incremental cost-effectiveness ratio (ICER) of RCT+IRR+SC and TE+DI+SC interventions compared to TE+RPD were $13.06 and $9.92 per year of survival. Compared to RCT+IRR+SC, the TE+DI+SC intervention had an ICER=$26.90 per year of survival. The acceptability curve indicates that the choice of intervention depends on the willingness to pay. CONCLUSION The RCT+IRR+SC intervention presented a balance of cost-effectiveness. Rehabilitation with implants can be considered in view of the higher expectation of longevity and, especially, greater willingness to pay.
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Nguyen-Nhon D, Nagendrababu V, Pulikkotil SJ, Rossi-Fedele G. Effect of occlusal reduction on postendodontic pain: A systematic review and meta-analysis of randomised clinical trials. AUST ENDOD J 2020; 46:282-294. [PMID: 31638301 DOI: 10.1111/aej.12380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2019] [Indexed: 11/26/2022]
Abstract
The purpose of this systematic review was to assess the effect of occlusal reduction on post-operative pain following root canal treatment and was performed in accordance with the PRISMA statement being registered in the PROSPERO database (CRD42018089941). Two reviewers independently conducted a systematic literature search in the PubMed (MEDLINE), Dentistry & Oral Sciences Source and the Cochrane Library databases. Seven studies were included, of which three were used to perform meta-analysis for 6 days post-operative and the rest for qualitative synthesis. Three studies were assessed as low risk of bias, three as some concern, and one as high risk of bias. Occlusal reduction diminishes the post-operative pain (SMD -1.10 (95%CI -2.06, -0.15) I2 = 96.9%) at 6 days for teeth diagnosed as irreversible pulpitis, and, overall, likely reduces post-operative pain for patients presenting with irreversible pulpitis and/or symptomatic apical periodontitis. Future high-quality clinical trials are needed to better understand the role of occlusal reduction.
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Affiliation(s)
- David Nguyen-Nhon
- Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
| | - Venkateshbabu Nagendrababu
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Shaju J Pulikkotil
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
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Adiguzel M, Tufenkci P, Pamukcu II. Comparison of postoperative pain intensity following the use of three different instrumentation techniques: A randomized clinical trial. J Dent Res Dent Clin Dent Prospects 2019; 13:133-140. [PMID: 31592309 PMCID: PMC6773924 DOI: 10.15171/joddd.2019.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 07/07/2019] [Indexed: 11/09/2022] Open
Abstract
Background. The aim of this study was to compare the postoperative pain intensity following the root canal preparation carried out with XP-endo Shaper (XPS; FKG Dentaire SA, La Chauxde-Fonds, Switzerland), iRace (iRC; FKG Dentaire SA) and Reciproc Blue (REC Blue; VDW, Munich, Germany) files. Methods. Mandibular molar teeth with asymtomatic necrotic pulps in 69 patients were randomly divided into three groups (n=23). The root canals were prepared using XPS, iRC or REC Blue instruments and obturated using the lateral condensation technique. The patients were asked to record their pain intensity at 24-, 48- and 72-hour and 1-week postoperative intervals on VAS. For intolerable pain after the procedure, ibuprofen (400 mg) was prescribed. Data were analyzed using chi-squared, Friedman, Kruskal-Wallis, and Mann-Whitney U tests. Results. The postoperative pain gradually decreased during the study period in all the groups (P<0.05). No statistically significant difference was found between iRC system and the two other systems at 12-, 24- 48-hour and 1-week intervals (P>0.05). When compared to XPS system, a higher level of postoperative pain was observed with REC Blue system at 24- and 48-hour intervals (P<0.05). Conclusion. The XPS group exhibited less postoperative pain than the REC Blue group at 24- and 48-hour intervals. iRC, XPS and REC Blue systems were found to be similar in terms of postoperative pain severity.
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Affiliation(s)
- Mehmet Adiguzel
- Department of Endodontics, Faculty of Dentistry, Mustafa Kemal University, Hatay, Turkey
| | - Pelin Tufenkci
- Department of Endodontics, Faculty of Dentistry, Mustafa Kemal University, Hatay, Turkey
| | - Ismail Ilker Pamukcu
- Department of Endodontics, Faculty of Dentistry, Mustafa Kemal University, Hatay, Turkey
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Influence of endodontic procedure on postoperative pain: Evidence from systematic reviews. BALKAN JOURNAL OF DENTAL MEDICINE 2019. [DOI: 10.2478/bjdm-2019-0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Pain control, during and after root canal treatment is one of the important issues in endodontic practice. Occurrence of pain after intervention often presents considerable distress to both patient and dentist. In many studies influence of different endodontic treatment factors on incidence of postoperative pain has been investigated. However, different and inconsistent results between studies and growth in number of published papers each year made professional updating and clinical-decision making challenging. Systematic reviews synthesized and combined data from relevant studies to find the answer to a research question providing the highest level of scientific evidence. Thus, their use may facilitate decision making in clinical practice. The aim of this article was to present results from systematic reviews about the influence of endodontic treatment on postoperative pain.
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