Post-endodontic pain evaluation after different intracanal laser assisted disinfection techniques. A Systematic Review

Effect of the Irrigation Agitation Technique on Postoperative Pain in Teeth With Symptomatic Irreversible Pulpitis

Introduction Irrigation of the root canal system is a vital step in endodontic treatment aimed at disinfecting the canal. The efficacy of irrigation can be improved by various irrigation agitation methods. One such novel method of interest is the manual dynamic agitation (MDA) technique. However, the effect of MDA on postoperative pain as compared to needle irrigation (NI) with sodium hypochlorite has been scarcely explored. This study aimed to compare the effects of NI and MDA techniques on postoperative pain in teeth with symptomatic irreversible pulpitis. Materials and methods This quasi-experimental study was conducted at the Department of Operative and Paediatric Dentistry, Fauji Foundation Dental Hospital, over four months after gaining ethical approval. One hundred and sixty-eight participants diagnosed with symptomatic irreversible pulpitis were enrolled in the study through the purposive sampling technique. The participants were divided into two groups based on the irrigation technique used: Group A (NI) and Group B (MDA). Postoperative pain was recorded after six hours, 24 hours, 48 hours, and seven days using the 0-100mm visual analog scale (VAS). The VAS scores were compared using an independent sample t-test. Results Out of 168 participants, 48.2% were in Group A and 51.2% in Group B. The study found that VAS pain scores for Group B (MDA) were significantly lower at six hours, 24 hours, 48 hours, and seven days as compared to Group A (NI), with a p-value less than 0.001. Conclusion This study shows that the MDA technique leads to decreased postoperative pain both immediately after endodontic treatment and a week later as compared to the NI technique. Hence, the use of MDA can aid in controlling postendodontic pain and, therefore, ensure smoother recovery and increased patient satisfaction.

Comparison of postoperative pain reduction following laser, ultrasonic activation and conventional needle irrigation after root canal treatment - A randomized clinical trial

Background

To compare the incidence of postoperative pain and analgesic intake on the administration of passive ultrasonic irrigation (PUI) using IrriSafeTM, laser-activated irrigation (LAI) using Er:Cr: YSGG in comparison to conventional needle irrigation (CNI) in participants diagnosed with symptomatic irreversible pulpitis (SIP).

Material and Methods

In this randomised double-blinded parallel trial, 75 participants requiring root canal treatment in mandibular first molars diagnosed with SIP were enrolled. A 10 cm visual analogue scale (VAS) was used for pain assessment and patients presented with a preoperative pain score of 5 cm and above were only selected. After biomechanical preparation, the final irrigation protocols varied based on the irrigation protocol employed. In CNI, intracanal irrigation was conducted without agitation using a 31G side vented needle. In PUI, irrigant activation was conducted using IrriSafeTM and in LAI, irrigant activation was conducted using a pulsed Er:Cr: YSGG (2940 nm) laser with radial firing tip (RFT - 2). The pain scores and analgesic intake were assessed postoperatively after obturation at 6, 24 and 48 h.

Results

A significant reduction in postoperative pain levels and analgesic intake was seen among all groups at assessed time intervals (p<0.05). Overall, mean postoperative pain scores and analgesic intake were CNI>LAI>PUI (p<0.05) respectively.

Conclusions

Participants diagnosed with SIP receiving PUI and LAI showed low and comparable levels of postoperative pain scores. Based on the analgesic intake, PUI showed the least analgesic intake when compared to LAI and CNI respectively. Key words:Endodontics, Root canal irrigants, Postoperative Pain, Passive ultrasonic activation, Laser ultrasonic activation.