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Kundgulwar P, Agarwal DA, Pawar M, Biswas K, Joshi C, Galav A, Singh R. Incidence and Intensity of Pain Following Endodontic Treatment by Different Instrumentation Techniques in Teeth With Periapical Lesion. Cureus 2023; 15:e35354. [PMID: 36994258 PMCID: PMC10042503 DOI: 10.7759/cureus.35354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 02/18/2023] [Indexed: 02/25/2023] Open
Abstract
AIM AND OBJECTIVES This study was carried out to compare the effectiveness of hand and rotary instrumentation techniques on postoperative pain in asymptomatic necrotic premolars with periapical lesions and instrumented by a modified step-back technique using a K file, crown down by continuous rotary motion technique using ProTaper Universal (Dentsply Mailefer, Ballaigues, Switzerland), and with the reciprocation technique using WaveOne (Dentsply Sirona, Charlotte, NC, USA). MATERIALS AND METHODS For this study, 66 premolars with single roots and canals were chosen. The procedure was completed in a single visit. Following access opening, the working length was initially determined using an apex locator and then confirmed after inserting K file #10 by radiograph. The canal was cleaned and shaped using a grouping system. After the master apical preparation, the canal was dried by paper point and obturated with gutta-percha and AH plus sealer, an epoxide-amine resin pulp canal sealer. In order to confirm the obturation, a radiograph was taken. After that, a permanent restoration material was used to seal the access cavity. Following that, patients to whom the visual analog scale (VAS) had already been explained were contacted by phone at six, 12, 24, and 48 hours. RESULTS In this study, compared to a stainless steel instrumentation technique, WaveOne instrumentation caused more noticeable pain. The results of the current study showed that, on average, postoperative pain scores decreased over the course of the 12 to 48-hour period, reaching a minimum or a maximum at 48 hours (p<0.01). CONCLUSION Postoperative pain was produced by all instrumentation methods used in the study. In comparison to ProTaper and WaveOne, instrumentation using the modified step-back technique with K files caused less pain, especially over the course of a 24-hour period.
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Monteiro CMC, Martins ACR, Reis A, de Geus JL. Effect of endodontic sealer on postoperative pain: a network meta-analysis. Restor Dent Endod 2023; 48:e5. [PMID: 36875812 PMCID: PMC9982236 DOI: 10.5395/rde.2023.48.e5] [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: 04/01/2022] [Revised: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 01/11/2023] Open
Abstract
This systematic review and network meta-analysis aimed to answer the following focused research question: "Does the type of endodontic sealer affect the postoperative pain in patients who received endodontic treatment?" Different databases and grey literature were surveyed. Only one randomized controlled trial were included. The risk of bias in the studies was evaluated by using the Cochrane Collaboration's tool. A random-effects meta-analysis was conducted to compare the risk and intensity of postoperative pain. The quality of the body of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Out of 11,601 studies, 15 remained for qualitative analyses and 12 for meta-analysis. Seven studies were classified at high risk of bias, and 8 studies raised some concerns. No significant differences between the endodontic materials were observed in the direct comparisons, both in risk and in intensity of postoperative pain (pairwise comparisons with 2 studies: I2 = 0%; p > 0.05 and 8 studies: I2 = 23%; p > 0.05, respectively). The certainty of the evidence was graded as low or moderate. There was no difference in the risk and intensity of postoperative pain after filling with different endodontic sealers. Further systematic reviews should be conducted. Trial Registration PROSPERO Identifier: CRD42020215314.
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Affiliation(s)
| | | | - Alessandra Reis
- Department of Restorative Dentistry, State University of Ponta Grossa, Ponta Grossa, PR, Brazil
| | - Juliana Larocca de Geus
- Department of Endodontics, Paulo Picanço School of Dentistry, Fortaleza, CE, Brazil.,Department of Restorative Dentistry, State University of Ponta Grossa, Ponta Grossa, PR, Brazil
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Vijayran VK, Khetarpal A, Vats A, Ahlawat M, Singhal N, Harshita. Comparison of the incidence of postoperative pain in single sitting root canal treatment after using two reciprocating systems and two continuous rotary systems: An in vivo study. J Conserv Dent 2023; 26:12-19. [PMID: 36908735 PMCID: PMC10003282 DOI: 10.4103/jcd.jcd_331_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/28/2022] [Accepted: 08/19/2022] [Indexed: 12/12/2022] Open
Abstract
Aim The aim of the present study was to compare the incidence of postoperative pain in single sitting root canal treatment after using two reciprocating and two continuous rotating file systems. Methodology One hundred and four permanent mandibular canine and first premolar teeth were selected for the study and were divided into two groups 1 and 2 comprising 52 teeth each. Group 1 was treated using reciprocating file systems and was subdivided into two subgroups A and B using WaveOne Gold (WOG) and Reciproc Blue (RB), respectively. Group 2 was treated using continuous rotating file systems and was divided into two subgroups A and B using One Curve (OC) and Vortex Blue (VB), respectively. Treatments were performed in a single sitting. After the visit, the patients were given a prescription for ibuprofen 400 mg to be taken every 6 h if they experience pain. Participants were asked to rate the intensity of the postoperative pain on a visual analog scale according to four classes (no pain, mild pain, moderate pain, and severe pain) after 24 h, 48 h, 72 h, and 7 days. Patients were also asked to record the number of prescribed analgesic medication tablets taken at these time points. Results There was a statistically significant difference (P = 0.00) among the reciprocating file systems and continuous file systems regarding the incidence of postoperative pain after 24, 48, and 72 h which signifies that pain incidence and duration is less with respect to reciprocation instrumentation as compared to continuous instrumentation. Conclusion The use of Reciproc instrumentation system (WOG and RB) showed significantly less intensity and duration of posttreatment pain compared to the single-file rotary system (OC and VB) in patients with symptomatic irreversible pulpitis with apical periodontitis.
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Affiliation(s)
- Vijay Kumar Vijayran
- Department of Conservative Dentistry and Endodontics, PDM University, Bahadurgarh, Haryana, India
| | - Ambica Khetarpal
- Department of Conservative Dentistry and Endodontics, PDM University, Bahadurgarh, Haryana, India
| | - Asit Vats
- Department of Conservative Dentistry and Endodontics, PDM University, Bahadurgarh, Haryana, India
| | - Monika Ahlawat
- Department of Conservative Dentistry and Endodontics, PDM University, Bahadurgarh, Haryana, India
| | - Neha Singhal
- Department of Conservative Dentistry and Endodontics, PDM University, Bahadurgarh, Haryana, India
| | - Harshita
- Department of Conservative Dentistry and Endodontics, PDM University, Bahadurgarh, Haryana, India
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Severity of Post-Operative Pain after Instrumentation of Root Canals by XP-Endo and SAF Full Sequences Compared to Manual Instrumentation: A Randomized Clinical Trial. J Clin Med 2022; 11:jcm11237251. [PMID: 36498825 PMCID: PMC9740715 DOI: 10.3390/jcm11237251] [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: 11/11/2022] [Revised: 11/27/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
This investigation aimed to examine the post-operative pain experienced following single-visit root canal treatment using the XP-endo shaper sequence (XPS), full-sequence self-adjusting file (SAF), and manual K-files (HKF). A randomized equivalence parallel design, double-blinded clinical study was conducted on 120 patients with symptomatic irreversible pulpitis, with or without clinical signs of apical periodontitis. Only teeth with fully formed roots and no periapical lesions were incorporated in the study. Patients were apportioned to one of three groups (n = 40) randomly: Group 1-XPS, Group 2-SAF, and Group 3-HKF. Pre- and post-instrumentation pain was rated utilizing Visual Analog Scale (VAS) with a spectrum of 0-100 mm. The descriptive statistics and one-way ANOVA with 95% confidence intervals were used for statistical analysis. The mean VAS scores before instrumentation were consistent in all three groups. At 6, 24, 48, and 72 h, patients with root canals instrumented by SAF had the lowest post-instrumentation mean VAS score, followed by XPS. For all time intervals, the patients in the HKF group had the highest VAS score. The full-sequence SAF instrumentation resulted in less post-operative pain than the XP-endo plus protocol, while manual instrumentation with K-files resulted in the highest post-operative pain.
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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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Emara RS, Gawdat SI, El-Far HMM. Effect of XP-endo Shaper versus conventional rotary files on postoperative pain and bacterial reduction in oval canals with necrotic pulps: a randomized clinical study. Int Endod J 2021; 54:1026-1036. [PMID: 33560531 DOI: 10.1111/iej.13494] [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] [Received: 10/07/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 12/26/2022]
Abstract
AIM To assess postoperative pain and bacterial reduction following the use of XP-endo Shaper versus conventional rotary files in preparation of oval canals with necrotic pulps. METHODOLOGY This superiority, parallel, randomized, double blinded clinical trial was conducted in the clinic of the Endodontic Department, Faculty of Dentistry, Cairo University, Egypt. Sixty single-canalled mandibular premolars with necrotic pulps were randomly assigned into two equal groups. Canals were instrumented using XP-endo Shaper files in the intervention group and iRaCe rotary files in the control group. Bacterial samples were taken before and after canal instrumentation. Incidence and severity of postoperative pain was assessed using a modified VAS after 6, 12, 24 h and daily for 5 days. A culture method was used to assess the number of bacterial colony forming units. Incidence of analgesic intake as well as flare-ups was recorded. Data were analysed using chi-square, Fisher Exact, Mann-Whitney, Independent t-test, and Spearman's correlation for pain and bacterial counts. RESULTS The XP-endo Shaper compared with the iRaCe group was associated with a significantly lower incidence of postoperative pain at 6, 12, and 24 h (P = 0.039, 0.047, and 0.026, respectively), and severity of postoperative pain at 6 h (mean difference: 1.33, 95% CI: 0.307-2.352, P = 0.02), 12 h (mean difference: 1.1, 95% CI: 0.26-1.936, P = 0.007), 24 h (mean difference: 0.94, 95% CI: 0.178-1.701, P = 0.008) and 48 h (mean difference: 0.97, 95% CI: 0.192-1.747, P = 0.038). There was a significant decrease in bacterial count following canal instrumentation in both groups (P < 0.001) with no significant difference between them (mean difference: 0.83 × 105 , 95% CI: 0.336 × 105 -1.996 × 105 , P = 0.56). A weak correlation existed between postoperative pain severity and bacterial counts (P = 0.54). There was no significant difference in analgesic intake between the two groups (P = 0.085). Flare-ups occurred in 3.3% of teeth in the iRaCe group, while no flare-ups occurred in the XP-endo Shaper group. CONCLUSIONS XP-endo Shaper was associated with a significantly lower frequency of postoperative pain for up to 24 h, and lower severity of postoperative pain for up to 48 h compared with iRaCe files. Both systems were equally effective in bacterial reduction from oval root canals with necrotic pulps.
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Affiliation(s)
- R S Emara
- Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - S I Gawdat
- Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - H M M El-Far
- Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
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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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da Silveira MT, Batista SM, Mamede Veloso SR, de Oliveira NG, de Vasconcelos Carvalho M, de Melo Monteiro GQ. Effect of Reciprocating and Rotary Systems on Postoperative Pain: A Systematic Review and Meta-Analysis. IRANIAN ENDODONTIC JOURNAL 2021; 16:1-16. [PMID: 36704409 PMCID: PMC9709880 DOI: 10.22037/iej.v16i1.27944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 11/05/2020] [Accepted: 11/22/2020] [Indexed: 01/28/2023]
Abstract
Introduction Our study aimed to compare the incidence and intensity of postoperative pain after endodontic instrumentation with reciprocating and rotary systems. Methods and Materials An electronic literature search was performed with MEDLINE via PubMed, Scopus, and Web of Science databases from January 2008 to June 2020. Two high-impact endodontic journals were also hand searched. The selection criteria were: 1) Population; patients requiring endodontic treatment (primary or secondary), 2) Intervention and Comparison; endodontic instrumentation with reciprocating versus rotary systems, and 3) Outcome; postoperative pain. We extrapolated all included research data and reported them as dichotomized ordinal variables to evaluate the incidence of pain and continuous variables to assess pain intensity. Standardized mean difference (SMD) was calculated with Inverse Variance method for pain intensity; the incidence of postoperative pain was calculated using relative risk (RR) with the Mantel-Haenszel method. Random-effects model and 95% confidence interval (CI) were used for all meta-analyses. The I2 statistic was used to evaluate the statistical heterogeneity among studies (P<0.05). Results Twenty-one articles were selected and 17 of them were included in the meta-analysis for the evaluation of postoperative pain in the first 24 h. The meta-analysis was performed in two steps: a) all studies were included; b) subsequently studies with preoperative pain were excluded. A significant difference was observed in the intensity of postoperative pain; with rotary system having more favorable in both steps [a) SMD: 0.27; 95% CI: 0.13 to 0.41; P=0.0002; b) SMD: 0.37; 95% CI: 0.15 to 0.58; P=0.0010]. There was no significant difference in the incidence of pain, and the incidence of mild, moderate and severe pain (P>0.05). Conclusion The meta-analysis results revealed that rotary system were the instrument of choice as they had lower intensity of postoperative pain. Further controlled studies are advocated to provide clarification for intensity/incidence of postoperative pain in endodontic treatment with mechanized instruments.
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Affiliation(s)
| | | | | | | | - Marianne de Vasconcelos Carvalho
- Dental School, Universidade de Pernambuco/FOP-UPE, Brazil,Corresponding author: Marianne de Vasconcelos Carvalho, Av. General Newton Cavalcanti, 1650; Tabatinga, Camaragibe-PE, Brazil; Zip code: 54.756-220. Tel: +55 81 3184-7659, E-mail:
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Lima Neto JC, Fernandes LM, Magno MB, Rocha Lima TF, de Almeida LDFD, Santiago BM, Cavalcanti YW. The Effect of Reciprocating and Rotary Systems on Postoperative Endodontic Pain: A Systematic Review and Meta-analysis. IRANIAN ENDODONTIC JOURNAL 2020; 15:198-210. [PMID: 36704110 PMCID: PMC9709834 DOI: 10.22037/iej.v15i4.23778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/02/2020] [Accepted: 09/16/2020] [Indexed: 01/28/2023]
Abstract
Introduction The objective of this study was to evaluate the influence of the instrumentation kinematics on endodontic postoperative pain. Methods and Materials PubMed, Scopus, Web of Science, Lilacs, Cochrane Library and the System for Information on Gray Literature in Europe were searched electronically without time or language limitations up to June 2020. Subsequently, data extraction, quality assessment and meta-analysis were conducted. The meta-analysis was performed using random-effects inverse-variance methods, and heterogeneity was tested using the I 2 index (P<0.05). Results A total of 318 articles were successfully identified in the search. Sixteen studies were used in qualitative synthesis and fourteen used for quantitative synthesis. Meta-analysis showed that patients treated with reciprocating system had lower risk of pain 48 h after endodontic treatment (Risk ratio [RR]=1.04, 95% Confidence interval [CI]=1.01-1.06, P=0.003) (I2=0%), but the mean postoperative pain for the reciprocating system was greater 24 h post endodontic treatment (Standardized mean difference [SMD]=0.25, 95% CI=0.06 to 0.44, P=0.01) (I2=43%). Other time points presented similar rates of postoperative pain (P>0.05). The certainty of evidence ranges from very low to high. Conclusions The rate of postoperative endodontic pain was low, and reciprocating systems evoked more pain within the 24 h interval. Overall, the incidence and level of postoperative pain did not vary between reciprocating and rotary systems. There is no consensus if there is a relationship between the kinematics (rotary and reciprocating) and the incidence of postoperative pain.
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Affiliation(s)
| | | | | | - Thiago Farias Rocha Lima
- Department of Restorative Dentistry, Federal University of Paraiba (UFPB), Brazil; ,Corresponding author: Thiago Farias Rocha Lima, Departamento de Odontologia Restauradora, Centro de Ciências da Saúde, Universidade Federal da Paraíba, Cidade Universitária, Campus I. Castelo Branco. CEP 58051-123, Brazil. Tel: +83-32167251, E-mail:
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