Post-endodontic pain in curved canals prepared with different rotary instrumentation techniques: A randomized controlled trial

BACKGROUND

Curved root canals are associated with the highest number of procedural errors during endodontic instrumentation. Recently, numerous rotary instruments have been developed, with both manual and automated mechanisms, to facilitate endodontic treatment and manage the complications related to it.

OBJECTIVES

The aim of the study was to assess post-endodontic pain after using the HyFlex® EDM OneFile (HEDM), WaveOne® Gold (WOG) and XP-endo® Shaper (XPS) systems in the preparation of curved canals in patients with asymptomatic irreversible pulpitis.

MATERIAL AND METHODS

A total of 45 molars with curved canals and asymptomatic irreversible pulpitis were randomly divided into 3 equal groups based on the instrumentation used: HEDM (group A); WOG (group B); and XPS (group C). All teeth were prepared according to the manufacturers' instructions. Postendodontic pain was assessed using the visual analog scale (VAS) at 6, 12, 18, 24, 48, and 72 h after root canal instrumentation. The data was analyzed using the one-way analysis of variance (ANOVA) and the paired-samples t test with the Bonferroni correction, with a p-value of 0.05 set for statistical significance.

RESULTS

The highest levels of post-endodontic pain were recorded at 6 h after treatment. Then, the values gradually decreased until the pain nearly vanished after 72 h. No statistically significant differences were observed in the VAS scores between groups A and B. At the same time, group C showed the lowest VAS scores at all follow-up time points.

CONCLUSIONS

The use of the XPS system resulted in the lowest pain scores at all follow-ups. The HEDM and WOG groups showed no differences in the pain scores throughout the whole follow-up period.

Traditional Methods in Managing Post-Endodontic Pain: A Randomized Controlled Trial

The background of the study highlighted the common occurrence of post-endodontic pain and the need for effective pain management strategies.

Materials and Methods

Fifty patients were randomly assigned to two groups: the cold laser therapy (CLT) group and the traditional methods group (TMG). The CLT group received laser treatment at the affected area immediately following endodontic treatment, whereas the TMG received standard pain management techniques such as analgesics. Pain levels were assessed using a visual analog scale at baseline and at 6, 12, 24, and 48 hours post treatment. Pain scores were analyzed using appropriate statistical methods, including analysis of variance, and P values were calculated to determine the significance of differences between groups.

Results

This study found significant differences in post-endodontic pain levels between CLT and standard procedures. At 6 hours post treatment, the CLT group had a mean pain score of 2.1 ± 0.8, whereas the TMG had a mean pain score of 3.8 ± 1.2 (P = 0.012). Pain levels in the CLT group decreased with time, with scores decreasing to 1.5 ± 0.6 at 12 hours, 1.2 ± 0.5 at 24 hours, and 0.9 ± 0.4 at 48 hours post treatment. In contrast, the TMG had greater pain scores at each time point: 3.2 ± 1.0, 2.9 ± 1.1, 2.5 ± 0.9, and 2.1 ± 0.8 at 12, 24, and 48 hours post treatment, respectively. At 12, 24, and 48 hours post treatment, P values of 0.021, 0.036, and 0.004, respectively, indicated significant differences.

Conclusion

In managing post-endodontic pain, CLT demonstrated superior efficacy compared to traditional methods.

The efficacy of transdermal and oral diclofenac for post-endodontic pain control: A randomised controlled trial

Objective

The aim of the present study was to compare the effect of transdermal diclofenac patch against oral diclofenac for post-endodontic pain control.

Materials and Methods

Thirty-two patients with symptomatic irreversible pulpitis in single-rooted premolar teeth of either arch were treated endodontically in a single visit by a single endodontist. Oral diclofenac (50 mg twice daily) for group I and transdermal diclofenac patch (100 mg once daily) for group II were administered as post-endodontic analgesics for two days. Visual analogue scale (VAS) chart was used to record pain intensity scores preoperatively and at intervals of 4, 8, 12 and 24 h postoperatively for 2 days. Paracetamol 650 mg tablets were provided as rescue medication.

Results

There was a significant decrease in the postoperative pain intensity scores for both groups. The postoperative scores gradually decreased from day 1 to day 2 in both groups. Twelve out of sixteen patients who had received diclofenac tablets complained of gastric discomfort.

Conclusion

Transdermal diclofenac patch was as effective as an oral diclofenac tablet and can be used as an alternative and effective analgesic for post-endodontic pain management, especially in patients with gastric discomfort.