Apical periodontitis healing and postoperative pain following endodontic treatment with a reciprocating single-file, single-cone approach: A randomized controlled pragmatic clinical trial.

Fabricio Eneas Diniz De-Figueiredo,Manoel Brito-Junior,Manoel Sousa-Neto,André Luis Faria E Silva,Giana Silveira Lima,Maria Amália Ribeiro,Ludmila Smith Oliveira,Marcos Brito Correa,Laila Fernandes Lima,Chun-Pin Lin

doi:10.1371/journal.pone.0227347

Abstract

This trial assessed post-operative pain and healing of apical periodontitis following endodontic therapy with a reciprocating system compared to a crown-down technique with hand files and lateral compaction filling. One-hundred and twenty nonvital anterior teeth with apical periodontitis were randomly treated using either a reciprocating single file followed by matching-taper single-cone filling or a hand file and lateral compaction filling. Postoperative pain was assessed during the 7 days after the treatment, using a visual analogue scale and a verbal rating scale. Apical healing was assessed using the periapical index score after a 12-month follow-up. The hypothesis tested was that both protocols were equivalent and present similar effectiveness in healing periapical lesions. Data were analyzed through two one-sided tests, t-tests, as well as Mann-Whitney and Chi-squared tests (α = 0.05). Logistic regression was used to investigate the association of clinical and demographic factors with the success of treatment. Regardless of the assessment time, no difference in incidence (38%-43% at first 24h), intensity of postoperative pain, and incidence of flare-up (≈ 3%) was observed between the two endodontic protocols. Both protocols resulted in a similar healing rate of apical periodontitis. After 12 months, the success rate ranged from 73% to 78% and the difference between the treatments fell within the pre-established equivalence margin (-0.1; -0.41 to 0.2). Endodontic treatment combining a reciprocating single file with matching-taper single cone showed similar clinical effectiveness to the treatment using hand-file instrumentation and the lateral compaction filling.

Highlights

The use of reciprocating motion with nickel-titanium (NiTi) files for root canal preparation was an important advance in endodontic therapy [1,2], primarily because it extends the lifespan of NiTi files [3] and reduces treatment time [4]
Some studies have suggested that reciprocating NiTi files are associated with increased debris extrusion compared to rotary NiTi files [10], a drawback that can increase the likelihood of postoperative complications such as a higher incidence and severity of postoperative pain [11]
Out of the 120 participants enrolled in the study, 33 did not attend the 12-month follow-up visit (15 in the single-file and single-cone (SFSC) group and 18 in the hand files with the lateral compaction obturation (HFLC) group) resulting in a drop-out rate of 27.5%

Summary

Introduction

The use of reciprocating motion with nickel-titanium (NiTi) files for root canal preparation was an important advance in endodontic therapy [1,2], primarily because it extends the lifespan of NiTi files [3] and reduces treatment time [4]. It enables filling the canal with a matching-taper single cone, which is simpler than other root canal filling techniques. Some studies have suggested that reciprocating NiTi files are associated with increased debris extrusion compared to rotary NiTi files [10], a drawback that can increase the likelihood of postoperative complications such as a higher incidence and severity of postoperative pain [11]

Methods

Results

Conclusion