Comparative Evaluation of Postoperative Pain after using Open Ended, Closed Ended Endodontic Needles and Endoactivator during Final Root Canal Irrigation Procedure: A Randomised Controlled Trial

Abstract

Introduction: Apart from manual activation methods of irrigants during final irrigation procedure, multiple irrigant activation devices have been introduced which can influence the postoperative pain. Aim: To evaluate postoperative pain after final irrigation with open and closed-ended endodontic needles and Endoactivator during root canal treatment. Materials and Methods: This randomised controlled trial was conducted in Department of Conservative Dentistry and Endodontics, Bapuji Dental College and Hospital, Davangere, from June 2018 to August 2018. Total of 75 symptomatic irreversible pulpitis patients were randomly assigned into three groups. In group EN-1, final irrigation protocol was performed with 30-gauge notched tip needle (Pac-Dent, India), group EN-2 using side-vented, closed 30-gauge needle (Max-i-Probe, Dentsply, USA) and in group EA using Endoactivator (Dentsply, USA). Pain using Visual Analog Scale (VAS) was evaluated at 8, 24 and 48 hours. Participants were prescribed Non-steroidal Anti-Inflammatory Drugs (NSAIDs) as an escape medication. Comparison between the three groups at each time interval was done using Kruskal Wallis test followed by Mann-Whitney U test as post-hoc test. Change in VAS score over different time intervals (8, 24 and 48 hours) in each group was compared using Kruskal Wallis test and Mann-Whitney U test. The p-value less than 0.05 was considered statistically significant. SPSS version 20 was used for statistical analysis. Results: Mann-Whitney U test revealed significant difference between EN-1 and EN-2 (p=0.002) and between EN-1 and EA (p<0.001) at 8-hour time interval; between EN-1 and EA (p=0.002) at 24 hour time interval and between EN-1 and EN-2 (p=0.01) as well as between EN-1 and EA (p=0.002) at 48 hour time. Mann-Whitney U test showed significant difference (p<0.05) in number of NSAIDs taken at 8 hour between EN-1 and EA (p=0.04) and between EN-2 and EA (p=0.01); at 8-24 hour between EN-1 and EA and between EN-1 and EN-2 (p<0.001); at 24-48 hour between EN-1 and EA and between EN-1 and EN-2 (p<0.001). Conclusion: Number of NSAIDS taken by patients was significantly higher in open-ended needle irrigation group compared to side-vented needle and Endoactivator group in all the three time intervals along with postoperative pain. Thus, during final irrigant activation, application of Endoactivator or side-vented needle can be more beneficial in decreasing the incidence of postendodontic pain.