Influence of Tooth Factors and Procedural Errors on the Incidence and Severity of Post-Endodontic Pain: A Prospective Clinical Study.

Lavanya Bamini,Ana Arias,Puridi Bhargavi,Anand Sherwood,Savadamoorthi Kamatchi Subramani

doi:10.3390/dj8030073

Lavanya Bamini, Ana Arias + Show 3 more

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https://doi.org/10.3390/dj8030073

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Abstract

The objective of this prospective study was to assess tooth-related factors that play a role in the incidence of postoperative pain (PP) and determining if procedural errors influence PP occurrence. A total of 442 patients referred for root canal treatment met the inclusion criteria and were included in this prospective study. The same protocol was used in all root canal treatments. Patient, tooth, treatment related factors and the occurrence of procedural errors were registered. Incidence and intensity of PP was assessed at 24 and 48 h by telephonic interview and in person seven and 15 days after treatment. A logistic and ordinal regression analysis was used to assess the role of patient, tooth and treatment related factors in the incidence and intensity of PP, respectively. Preoperative and intraoperative factors differently affected the incidence of PP at the different time intervals. The presence of procedural errors did not significantly influence PP occurrence. The presence of preoperative pain and the need of additional anesthesia during treatment were associated with higher incidence of PP 24 and 48 h after treatment; the extent of apical enlargement played a significant role in the presence of PP after seven days of treatment; and the excessive occlusal load induced by the absence of a contralateral tooth was the only factor related to the maintenance of PP up to 15 days. In conclusion, the presence of preoperative pain, the need of additional anesthesia during treatment, the extent of apical enlargement and the excessive occlusal load induced by the absence of a contralateral tooth were related to a higher incidence of PP.

Highlights

Postoperative pain (PP) following root canal treatment is a disconcerting event for both clinicians and patients
Several studies have identified those patient and tooth-related factors that play a role in the incidence of postoperative pain (PP) and they were confirmed in the present study [1,2,4,6]; on the other hand, this study tried to address the lack of information available in scientific literature regarding how some intraoperative decisions and procedural errors that occur during treatment could influence PP occurrence
The perception of pain is extremely subjective and dependent on the cultural, individual and economic background of patients. This is an important limitation for this type of studies. To minimize this limitation and considering the idiosyncrasy of patients seeking for treatment in university settings, a trained assistant was in charge of assessing the incidence and intensity of PP through a telephone interview in the first 24 and 48 h and patients were required to attend the facility for personal interviews and 15 days after treatment

Summary

Introduction

Postoperative pain (PP) following root canal treatment is a disconcerting event for both clinicians and patients. Postoperative pain after a root canal treatment can be either immediate or persistent long term [4,5]. Endodontic literature has reported incidence of PP varying from 3% to 65% 24 h after root canal treatment, that gradually decreased from 48 h onwards [5,6,7,8,9]. Such huge variations in results from different studies are likely due to the disparity in methods and

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Conclusion