Incidence of postoperative pain after single-visit and multiple-visit root canal therapy: A randomized controlled trial

An exploratory study to understand the relationship between diabetes and various pulpal conditions: An Indian perspective

Aim

Diabetes mellitus (DM) affects an estimated 100 million Indians, ranking second globally in diabetic prevalence. Despite this, the correlation between DM and specific pulpal diagnoses remains underexplored. This study compares pulpal conditions in DM patients and nondiabetic controls.

Designs

The study was started after taking ethical approval.

Subjects and Methods

Two thousand and five hundred and sixty teeth were examined over 4 months at the institute, evenly distributed between diabetic and nondiabetic cases, we assessed diagnoses - normal pulp, reversible pulpitis (RP), symptomatic irreversible pulpitis, asymptomatic irreversible pulpitis, pulp necrosis (PN), missing teeth (MT), and root canal-treated teeth (RCT). Statistical analysis used the Chi-square test.

Results

PN and MT prevalence in DM patients significantly exceeded the control group. Conversely, the control group showed higher RP prevalence in the older subgroup.

Conclusions

PN prevalence was higher in diabetics, suggesting reduced pulp sensitivity in individuals over 60 years. This diminished sensitivity might lead to delayed dental treatment, increasing PN prevalence.

Effect of apical foraminal enlargement on postoperative pain and inflammatory markers in asymtomatic single-rooted mandibular teeth with apical periodontitis - An in vivo randomized controlled trial

Aim of the Study

This study aims to assess the effect of apical foraminal enlargement on inflammatory markers and pain in patients with asymptomatic single-rooted mandibular teeth with apical periodontitis.

Materials and Methods

The study included 60 patients based on inclusion and exclusion criteria. Before beginning root canal treatment (RCT), a blood sample was obtained from the antecubital fossa to evaluate the inflammatory markers, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Access opening was done and initial irrigation was done. Working length (WL) was determined with an electronic apex locator and verified with a radiograph. In the control group, the determined WL was maintained, while in the experimental group, the WL was set till the apical foramen. Biomechanical preparation was done in both groups till F2 or F3 based on the initial apical file, followed by final irrigation and obturation based on the master apical file size. Patients were given a Visual Analog Scale to record pain sensations at 24, 48, and 72 h postoperative. After 72 h, patients were recalled for follow-up appointments, and blood was taken from the antecubital fossa again to evaluate inflammatory markers.

Statistical Analysis

The resultant findings for the reduction in inflammatory markers before and after RCT with or without foraminal enlargement were statistically analyzed using the Student's t-test. The pain was statistically examined with one-way "analysis of variance" and Tukey's post hoc test for inter-group comparison of pain. The level of significance was set at P < 0.05. The statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) Version 23 for Windows (SPSS Inc., Chicago, IL, USA). As pain in the control groups is zero before and after RCT, statistical analysis is not required as the overall pain score is zero.

Results

The P values of the CRP and ESR of the control group were 0.02 and 0.03, respectively, which indicates it is significant whereas the P values of the ESR and CRP of the experimental group were 0.0002 and 0.0008 which indicates it is highly significant. Results indicate that the experimental group is more effective compared to the control group in reducing inflammatory markers. Pain in the control group after RCT was zero at the end of 24, 48, and 72 h. In the experimental group, where RCT was done with apical foraminal enlargement, mild pain was present at the end of 24 h which gradually decreased at the end of 48 h and no pain was reported at the end of 72 h.

Conclusion

Reduction in inflammatory markers was more effective in RCT with apical enlargement than without apical enlargement. RCT with apical enlargement caused mild pain in the patients immediately after treatment which gradually decreased over time.

Evaluation of Postoperative Pain Perception Incidence after Single-Visit Versus Multiple-Visit Root Canal Therapy: A Randomized Controlled Trial

Background

Newer concept of root canal therapy is single-visit one rather than conventional multivisit therapy. Major complaint of patients after root canal therapy is mild or severe pain.

Aim

This study aims to assess the prevalence of postoperative discomfort after root canal treatment conducted in both single and multiple visits.

Materials and Methods

An experiment using a randomized controlled trial design was conducted, including a total of 80 participants. These individuals were then separated into two groups, with each group consisting of 40 participants. Group A had single-visit root canal therapy, whereas Group B received multivisit root canal treatment. The incidence of pain after therapy was evaluated and compared at four time points: 6 hours, 12 hours, 24 hours, and 48 hours after obturation.

Results

The level of pain experienced by patients in Group B was notably greater in comparison with individuals in Group A. Nevertheless, there was no statistically significant difference in the level of pain reported by the patients 48 hours after treatment in either of the groups.

Conclusion

There is no significant difference in the occurrence of discomfort after endodontic treatment conducted in either a single visit or many visits, as seen during a 48-hour period after obturation.

Association between single-nucleotide polymorphisms in serotonin receptor 2A and melatonin receptor 1A genes and pain after root canal treatment

AIM

This study aimed to investigate whether single-nucleotide polymorphisms (SNPs) in the genes encoding 5-HTR2A (5-Hydroxytryptamine (serotonin) receptor 2A) and MTNR1A (melatonin receptor 1A) may contribute to postoperative pain perception after root canal treatment. We hypothesised that SNPs in HTR2A and MTNR1A genes were associated with postoperative pain after root canal treatment.

METHODOLOGY

This genetic cohort study enrolled patients with single-rooted teeth diagnosed with pulp necrosis and asymptomatic apical periodontitis before root canal treatment. Root canal treatment was performed in one session using a standardized protocol. Postoperative pain and tenderness were assessed using a visual analogue scale (recorded every day for 7 days and on the 14th and 30th days after root canal treatment). Genomic DNA was extracted from saliva and used to genotype the SNPs in HTR2A (rs4941573 and rs6313) and MTNR1A (rs6553010, rs6847693 and rs13140012) using real-time polymerase chain reaction. Genotypes were compared using univariate and multivariate Poisson regression with generalized estimating equations (p < .05).

RESULTS

In total, 108 patients were enrolled in this study. The SNPs rs6553010 (MTNR1A), rs4941573 and rs6313 (HTR2A) were associated with an increased risk of developing pain after root canal treatment (p < .05).

CONCLUSIONS

This study suggests that SNPs in HTR2A and MTNR1A influence pain response after root canal treatment.

Comparative analysis of reduction in pain scores after single visit root canal treatment using endodontic irrigation protocols, namely, Conventional needle irrigation, PUI, PIPS and SWEEPS: A randomized control trial

Introduction

To assess the effects of different irrigation activation systems on postoperative pain using a Visual Analog Scale (VAS), using new laser irrigation activation system shock wave-enhanced emission photoacoustic streaming (SWEEPS), photon-induced photoacoustic streaming (PIPS), passive ultrasonic irrigation activation techniques, compared with the conventional irrigation (CI) method.

Materials and Methods

Sixty patients suffering from symptomatic irreversible pulpitis in maxillary or mandibular molars were enrolled and randomly assigned to four different irrigation activation groups (n = 15) after chemomechanical root canal preparation. Preoperative and postoperative pain scores were recorded using VAS. The data were collected and subjected to statistical analysis using IBM SPSS 20.0 software at a level of significance being 0.05.

Results

We observed that mean pain scores decreased with time in all patients in all groups. The decrease in pain score was found to be statistically significant (P < 0.05) among both the genders in Group 3 (PIPS) and Group 4 (SWEEPS). Postoperatively, pain scores decreased significantly using Group 4 (SWEEPS), followed by Group 3 (PIPS), Group 2 (ultrasonic activation), and Group 1 (conventional needle irrigation). No significant relation was observed statistically between pain scores and age groups among all groups, except for preoperative score in Group 3 and age groups.

Conclusion

Postoperative scores were lower in laser-activated irrigation systems as compared to the other activation systems. The highest pain scores were observed in case of CI method, at pre- and post-operative periods.

Comparative evaluation of the effect of calcium silicate and epoxy resinbased root canal sealers on postoperative pain in patients with primary endodontic lesion: A randomized clinical study

Introduction

This study's objective was to assess and compare postoperative pain response between bioceramic sealer (Nishika BG) and epoxy resin based (AH Plus) in patients with primary endodontic lesion at time interval of 24 h, 48 h, and 7 days using the Visual Analog Scale (VAS).

Materials and Methods

The study included 40 individuals with necrotic pulp and apical periodontitis. Calcium hydroxide was administered as the intracanal medication during the two-visit endodontic therapy. They were subsequently allocated randomly to either the AH Plus root canal sealer or the Nishika Canal Sealer BG, with a total of 20 participants in each group. Patients were told to use a VAS to rate their postoperative pain severity as none, minimal, moderate, or severe after 24 h, 48 h, and 7 days following obturation using the appropriate sealers.

Results

Nishika Canal Sealer BG (CS-BG) has a lower pain score as compared to the AH Plus group at 24-h time point. VAS ratings for both the groups decreased over time. According to the intergroup analysis, there was a significant difference in postoperative pain at the 24 h (P = 0.022), but not at the 48 h or 7 days (P > 0.05).

Conclusion

Although bioceramic sealer (Nishika Canal Sealer BG) resulted in significantly lower levels of pain as compared to epoxy resin-based sealer (AH Plus) at 24-h interval, there was no significant difference of postoperative pain at 48-h interval and 7-day period.

Single versus multiple visits for endodontic treatment of permanent teeth

BACKGROUND

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

OBJECTIVES

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

SEARCH METHODS

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

SELECTION CRITERIA

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

MAIN RESULTS

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

AUTHORS' CONCLUSIONS

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