Patients Undergoing Root Canal Treatment Research Articles

Clinical Considerations for Elderly Patients Undergoing Root Canal Treatment

Clinical Considerations for Elderly Patients Undergoing Root Canal Treatment

Postoperative pain incidence and intensity following root canal obturation with bioceramic and other sealers: A systematic review with meta-analysis

Aims: To investigate whether bioceramic sealers induce a lower incidence and intensity of postoperative pain compared to other sealers.
 Materials and Methods: Six electronic databases were searched for studies published up to April 2022, following the PICOS strategy: (P) adult patients undergoing root canal treatment or retreatment; (I) root canal filling using bioceramic sealer; (C) root canal filling using other types of sealers; (O) Primary: postoperative pain incidence and/or intensity; Secondary: number of medication intake; (S) randomized clinical trials. Risk of bias assessment was performed with the revised Cochrane risk of bias tools for randomized trials (RoB 2). Overall certainty of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool.
 Results: Ten studies were included. Eight studies had a low risk of bias, and two had some concerns risk. Meta-analyses showed no differences regarding postoperative pain intensity and incidence between bioceramic sealers and AH Plus. Number of medication intake seemed to be associated to the preoperative diagnosis. Zinc oxide-eugenol sealer demonstrated an intense postoperative pain compared to bioceramic sealers and AH Plus. GRADE analysis showed a low certainty of evidence for all outcomes.
 Conclusions: There seem to be no differences between bioceramic sealers and AH Plus regarding postoperative pain intensity and incidence. Number of medication intake seem to be associated to the preoperative diagnosis. Zinc oxide-eugenol evoked a more pronounced postoperative pain.

Evaluation of the Impact of Different Instrumentation Techniques on the Incidence of Postoperative Pain in Patients Undergoing Root Canal Treatment.

Postoperative pain is a common concern in root canal treatment, and the choice of instrumentation technique can significantly impact patient comfort. This study aimed to evaluate the impact of different instrumentation techniques on the incidence of postoperative pain in patients undergoing root canal treatment. A randomized controlled trial was conducted on 208 patientsrandomly assigned to four groups: step-back preparation, crown-down preparation, hybrid technique, and conventional instrumentation. Pain intensity was assessed using a verbal rating scale (VRS) at six, 12, 24, 48, and 72 hours postoperatively. Data were analyzed using appropriate statistical methods. The mean pain scores and standard deviations (SDs) were calculated for each instrumentation technique at different time intervals. At six hours, the step-back preparation group reported a mean pain score of 2.3 (SD = 0.8), the crown-down preparation group had a score of 2.8 (SD = 0.9), the hybrid technique group had a score of 2.5 (SD = 0.7), and the conventional instrumentation group had a score of 3.1 (SD = 0.1). The differences in pain scores between the groups were statistically significant at all time intervals (p < 0.05). The choice of instrumentation technique significantly influenced the incidence of postoperative pain in root canal treatment. The step-back preparation technique was associated with lower pain intensity than the crown-down preparation, hybrid technique, and conventional instrumentation. These findings highlight the importance of considering the instrumentation technique to optimize patient comfort during and after root canal treatment.

PRESENCE OF EXTRA CANAL IN PERMANENT MANDIBULAR FIRST MOLAR

Background: The success of root canal therapy depends on proper knowledge of root canal system, presence of extra canals, complete debridement and three-dimensional obturation of the entire root canal system. Previous studies have reported three to five canals in mandibular first molars.  There might be chance of missing the canal that may lead to root canal failure, because of the variability in the number of root canals. The objective of this study was to determine the percentage of extra canal in the permanent mandibular first molar in patients undergoing root canal treatment. Methods: This cross-sectional study was conducted in the Department of Conservative Dentistry and Endodontics of Peoples Dental College and Hospital over a period of ten months from 6th September 2021 to 31st July 2022  after receiving ethical clearance from Institutional review Committee (IRC) Peoples dental college on 5th September 2021 (ref no1/ch no 5,2078/2079). About 350 mandibular first molar was selected by convenient sampling. After access preparation, all canal orifices were located and data were recorded. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 22.0 with frequency table. Results: Out of 350 patients, the percentage of three canals, four canals and five canals were respectively 273(78%), 76(21.7%) and 1(0.3%). Conclusions: The finding of this study supports the presence of extra canals in mandibular first molar.  Thus, the clinicians require more diagnostic approaches, access modifications, and skills to locate, clean and shape the entire root canal system.

Main clinical evidence of ultrasound and ozone therapy in the endodontics treatments: the systematic review

Introduction: Issues related to endodontic treatment are intrinsically linked to the prevention and total control of pulp and periapical infections. The presence of microorganisms is not limited to the endodontic but is also present in the periradicular regions, characterized by an apical biofilm that is strongly adhered to the surface. In this context of decontamination of root and periapical canals, ozone has been highlighted as an important sanitizer. Objective: To demonstrate the main experimental and clinical findings of the use of ozone therapy alone and in association with conventional treatments as an antiseptic in the treatment of root canals. Methods: The research was carried out from May 2021 to June 2021 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar, following the Systematic Review-PRISMA rules. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results: There is moderate evidence to provide important preliminary information about ozone therapy. As for reducing the microbial load for patients undergoing root canal treatment, ozone therapy has inferior results when compared to conventional chemomechanical techniques using NaOCl. The joint action of these treatments proved to be quite effective. Conclusion: Ozone therapy is proving to be a useful new treatment modality that offers great benefits to patients. The strong antimicrobial power of ozone, together with its ability to stimulate the circulatory system and modulate the immune response, makes it a corrective agent of choice in the treatment of various oral infectious diseases. More research is needed to help with its reproducibility, its use should be indicated by the dentist in clinical practice.

Comparative evaluation of machine assisted irrigation activation technique and conventional syringe irrigation on postoperative pain in patients undergoing endodontic treatment: A Systematic review and meta-analysis

Objective: This systematic review and meta-analysis aimed to assess whether machine- assisted agitation resulted in less postoperative pain (PP) compared with syringe irrigation with needle alone in adult patients undergoing root canal treatment. Methodology: PICO strategy was used to electronically search key terms in the PubMed, Science Direct, Cochrane Library, Google Scholar and Wiley Online databases up to 2021 for randomized control trials (RCTs) with an observation period of at least 6 hours. The bias risk for RCTs was assessed using the Cochrane risk of bias tool. Meta-analysis was performed using RevMan 5.4 (RevMan 5.4, The Nordic Cochrane Centre, Copenhagen). Results: A total of 9 studies (for systematic review) including 1075 patients with a 565/530 male to female ratio and a mean age of 40.5 years met the inclusion criteria. Out of 9, 6 studies were selected for the meta-analysis. Meta-analysis of the 6 studies indicated that overall, the use of machine-assisted irrigation technique showed better postoperative pain reduction than conventional syringe irrigation. Conclusion: Overall, machine-assisted irrigation causes reduction in postoperative pain compared to conventional syringe irrigation.

Patient record assessment of results and related resources spent during 1year after initiation of root canal treatment in a Swedish public dental organization.

AimTo document treatment outcomes and related resources, in patients undergoing root canal treatment (RCT) in county public dental clinics, by monitoring patient records for 12 months from treatment start.MethodologyThe subjects comprised 243 patients starting RCT at 20 public dental clinics in Västra Götaland county, Sweden. Their computerized dental records were monitored prospectively for a year after starting their endodontic treatment. Treatment was completed with either a root filling or extraction. The following treatment‐specific variables were registered: number of appointments and days until treatment was completed, possible complications and prescriptions for antibiotics, and for the root filled teeth: type of coronal restoration and further procedures undertaken within the year. The treatment outcomes were compared with the preoperative variables and in a logistic regression analysis.ResultsComplete data were available for 240 patients (98.8%): 128 women and 112 men, with a mean age of 48.5 years (SD = 16.3). Molar teeth predominated (n = 113, 47.1%). Most cases were completed with a root filling (n = 169, 70.4%). The remainder were extracted (n = 32, 13.3%) or were still uncompleted (n = 39, 16.3%). On average, a root filling was completed in 2.4 (SD = 0.9) appointments, or extraction at the third appointment (SD = 1.6). The molars were less often completed and often predominant among the extracted teeth. The indication for extraction was often for endodontic or RCT‐related reasons. Most complications were registered in the molars and antibiotics were prescribed in 20 cases. Most root filled teeth were restored with a direct restoration. Four root filled teeth (2.4%) were extracted within the time period.ConclusionsPatient records, followed from the start of treatment, show that 12 months on, the root filling had not been completed in just under 30% of the teeth. Of these, about half were extracted. Of particular concern is the outcome for endodontic treatment of molar teeth. In the general practice setting, molar endodontics are not only technically challenging but also very demanding in terms of chairside resources. In the present study, a successful outcome was achieved in just over half the cases.

Effect of Phytic acid on the tissue dissolving ability of Sodium hypochlorite: An ex-vivo study

Aim: To evaluate the effect of Phytic acid on the pulp dissolving ability of sodium hypochlorite (Naocl).&#x0D; Methodology: Pulp tissue was collected from patients undergoing root canal treatment using barbed broach and stored in 10% formalin. The tissue was then divided into fragments of equal weight and immersed in solutions consisting of 5.25 % Naocl and mixture of 1:1(w/w) Phytic acid and 5.25% Naocl for a period of 30 minutes. Tissue fragments were removed and weighed again. The difference between the initial and final weight was used to calculate weight loss there by representing tissue dissolving ability of each solution used.&#x0D; Results: No significant difference was found in the tissue dissolving ability for both the tested groups. (P˂0.05).&#x0D; Conclusion: Addition of Phytic acid did not alter the pulp dissolving ability of Naocl.&#x0D;  

Impact of Educational Videos on Dental Anxiety and Fear in Patients Undergoing Root Canal Treatment in Shiraz, Iran

Impact of Educational Videos on Dental Anxiety and Fear in Patients Undergoing Root Canal Treatment in Shiraz, Iran

Major approaches on the use of ozone therapy in endodontics: a concise systematic review

Introduction: Issues related to endodontic treatment are intrinsically linked to the prevention and total control of pulp and periapical infections. The presence of microorganisms is not limited to the endodontic but is also present in the periradicular regions, characterized by an apical biofilm that is strongly adhered to the surface. In this context of decontamination of root and periapical canals, ozone has been highlighted as an important sanitizer. Objective: To demonstrate the main experimental and clinical findings of the use of ozone therapy alone and in association with conventional treatments as an antiseptic in the treatment of root canals. Methods: The research was carried out from May 2021 to June 2021 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar, following the Systematic Review-PRISMA rules. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results: There is moderate evidence to provide important preliminary information about ozone therapy. As for reducing the microbial load for patients undergoing root canal treatment, ozone therapy has inferior results when compared to conventional chemomechanical techniques using NaOCl. The joint action of these treatments proved to be quite effective. Conclusion: Ozone therapy is proving to be a useful new treatment modality that offers great benefits to patients. The strong antimicrobial power of ozone, together with its ability to stimulate the circulatory system and modulate the immune response, makes it a corrective agent of choice in the treatment of various oral infectious diseases. More research is needed to help with its reproducibility, its use should be indicated by the dentist in clinical practice.

Extra canal in permanent maxillary first molar in patients undergoing root canal treatment at a tertiary care dental hospital, Nepal

Background: Permanent maxillary first molar normally has three root canals but it can have extra root canals for which several studies were done in many parts of the globe. However, this type of study to explore extra canal is lagging in the context of Nepal. Objectives: The objective was to determine the percentage of extra canal in permanent maxillary first molar in patients undergoing root canal treatment and to compare the same between male and female. Methods: The descriptive cross-sectional study was conducted in the department of conservative dentistry and endodontics of People’s Dental College and Hospital from 20th December 2019 to 20th December 2020 after receiving ethical approval from Nepal Health Research Council on 18th December 2019 (ERB protocol No 888/2019) . One hundred and eighty permanent maxillary first molar teeth without root canal calcification were enrolled. Convenient sampling was done. Access opening was done and all canal orifices were located and recorded. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 22.0 with frequency table. Chi-square test was used for inferential statistics. Results: Out of 180 teeth, extra canals were present in 44(24.4%) having more numbers in male than in females. Extra canal was present in the mesiobuccal root. Conclusion: Extra canal in the permanent maxillary first molar is present in Nepalese population with greater number in male than in female. Thus, exploration of the pulp chamber in search of an extra canal is necessary to prevent failure of root canal treatment.

Association of age and gender among patients undergoing root canal treatment in mandibular first molars

Association of age and gender among patients undergoing root canal treatment in mandibular first molars

Occurence of Number of Canals in Maxillary Second Molar in South Indian Population - A Retrospective Study

Maxillary molars contain various anatomical variations with diverse shapes and forms. The variations in root canal anatomy may be due to developmental patterns or may have a genetic influence. The root morphological studies have led to a better understanding of canal morphology that contributes to successful cleaning and shaping of the root canal system. This study was done to assess the prevalence of the number of canals in Maxillary second molars and to determine its association with age and gender in a South Indian Population by evaluating post- operative periapical radiographs. A total of 384 case sheets of root canal treated maxillary second molars were reviewed and analyzed. The patients undergoing root canal treatment for maxillary second molars were screened, and cases selected for the study were in the age group of 18- 65 years. Data was analyzed using SPSS software. Out of 384 teeth, 211 were male and 173 were female patients. Number of canals had no significant correlation with age but had significant association with gender (p=0.085). There were 3 canals in most of the cases. Within the limitations of the study, the maxillary second molars consisted mostly of 3 canals in both male and female patients. There was significant association between gender and number of canals.

Comparing Quality of Life of Patients Undergoing Root Canal Treatment or Tooth Extraction

IntroductionThe knowledge of patient-centered outcomes concerning the consequences of root canal treatment in daily life is limited. The treatment option is often tooth extraction with possible prosthetic replacement. This study aimed to achieve a greater understanding of the patient perspective by evaluating the effect of root canal treatment in terms of quality of life and quality-adjusted life year (QALY) weights in comparison with patients who underwent tooth extraction. MethodsPatients with either root canal treatment or extraction were recruited from 6 clinics in the general public dental service during a predetermined period of 8 weeks. Three different instruments were used: the Oral Health Impact Profile evaluating the oral health–related quality of life (OHRQOL), the EQ-5D-5L evaluating health-related quality of life (HRQOL) and QALY weights, and a disease-specific questionnaire evaluating satisfaction regarding the root canal treatment. The evaluation was assessed at the initiation of treatment and after 1 month. Patient-based and tooth-specific characteristics were obtained from the dental records. ResultsEighty-five patients were included. The distribution between sexes was even, with 43 women and 42 men. The mean age was 51.1 years. Forty-eight patients (56.5%) had a tooth extraction, and 37 patients (43.5%) initiated root canal treatment. The response rate for the questionnaire at baseline was 95.3%, and at the 1-month follow-up, it was 74.1%. Two relevant and comparable groups were obtained after exclusion of the extracted third molars (n = 20), resulting in 65 patients for further analyses. At follow-up, the patients who initiated root canal treatment registered a significant improvement in perceived HRQOL according to the QALY weights (P = .02 and P < .01, respectively). Patients initiating root canal treatment reported generally high satisfaction. ConclusionsA cohort of patients either initiating root canal treatment or tooth extraction as a control group was established. Initiating root canal treatment had a positive impact on perceived HRQOL. The included patients in general dental practice registered overall high satisfaction regarding root canal treatment.

The effect of ozone therapy in root canal disinfection: a systematic review.

To answer the following focused question: 'As regards microorganism load reduction for patients undergoing root canal treatment, is the use of ozone therapy comparable to conventional chemomechanical techniques using sodium hypochlorite (NaOCl)?' A systematic review was conducted using controlled vocabulary and free-text key words in the following databases: PubMed, Science Direct, Scopus, Web of Science and Open Grey until 2 November 2018. Additional studies were sought through hand searching of endodontic journals. The inclusion criteria comprised studies that compared microbial reduction in root canals after treatments with ozone and NaOCl in extracted mature human teeth or randomized clinical trials. The quality assessment of included laboratory studies was performed with the following parameters: (i) sample size calculation, (ii) samples with similar dimensions, (iii) control group, (iv) standardization of procedures, (v) statistical analysis and (vi) other risk of bias. For randomized clinical trials, the qualitative analysis of the studies was performed from the bias risk assessment using the tool 'Bias Risk Assessment of Randomized Controlled Studies' Cochrane Handbook 5.0.2. The search resulted in 180 published studies. After removal of duplicate studies and full-text analysis, eight studies were selected and seven were considered low risk of bias (seven ex vivo studies and one random clinical trial). Overall, the results demonstrated that ozone therapy provides significantly less microbial load reduction than NaOCl. As an adjunct in chemomechanical preparation, ozone was ineffective in increasing the antimicrobial effect of NaOCl. Ozone performance was strongly associated with the application protocol used: it is dose, time and bacterial strain dependent, besides the correlation with the use of complementary disinfection sources. A restricted number of randomized clinical trial was found, and the difference amongst the methodology of the studies did not allow a meta-analysis to be performed. Although the selected studies had limitations, this review reached a satisfactory methodological and moderate evidence quality contributing to important preliminaryinformation regarding ozone therapy. As regards load reduction of microorganisms for patients undergoing root canal treatment, ozone is not indicated neither to replace nor to complement the antimicrobial action of NaOCl.

Is articaine more effective than lidocaine in patients with irreversible pulpitis? An umbrella review.

Pain management can be challenging during root canal treatment of teeth with irreversible pulpitis. To identify whether articaine or lidocaine is the most appropriate local anaesthetic solution for teeth with irreversible pulpitis undergoing root canal treatment. The protocol of this umbrella review is registered in the PROSPERO database (CRD42019137624). PubMed, EBSCHO host and Scopus databases were searched until June 2019. Systematic reviews published in English comparing the effectiveness of local anaesthesia following administration of articaine or lidocaine in patients undergoing root canal treatment of teeth diagnosed with irreversible pulpitis were included. Two independent reviewers selected the studies and carried out the data extraction and the appraisal of the included reviews. Disagreements were resolved in consultation with a third reviewer. The quality of the included reviews was appraised by two independent reviewers using the AMSTAR tool (a measurement tool to assess systematic reviews). Each of the 11 AMSTAR items was given a score of 1 if the specific criterion was met, or 0 if the criterion was not met or the information was unclear. Five systematic reviews with meta-analyses were included. The AMSTAR score for the reviews ranged from 8 to 11, out of a maximum score of 11, and all reviews were categorized as 'high' quality. Two reviews scored 0 for item 8 in AMSTAR because the scientific quality of the clinical trials included in these reviews was not used in the formulation of the conclusions. Systematic reviews published only in the English language were included. Only a small number of studies were available to assess pain intensity during the injection phase, the time until the onset of anaesthesia and the occurrence of adverse events. Articaine is more effective than lidocaine for local anaesthesia of teeth with irreversible pulpitis undergoing root canal treatment. There is limited evidence that injection of articaine is less painful, has more rapid onset and has fewer adverse events compared with lidocaine.

Subcutaneous emphysema in patients undergoing root canal treatment: a systematic review of the factors affecting its development and management.

Subcutaneous emphysema is an infrequent mishap during root canal treatment which, in rare cases, can lead to severe complications. To systematically review the literature on the factors affecting the development of subcutaneous emphysema during root canal treatment, and on its management. An electronic search was conducted in EMBASE (1947-2018), LILACS (1982-2018), PubMed (1950-2018), SciELO (1997-2018), Scopus (1970-2018), Web of Science (1900-2018) and two grey literature databases. Moreover, all issues of nine journals and four endodontic textbooks were hand-searched. The retrieved studies were screened by two reviewers to select clinical studies, case reports or case series describing subcutaneous emphysema that developed during or immediately after root canal treatment in adult patients. Included studies were critically appraised according to a custom list of quality requirements. The extracted data were arranged in tables, and combined through a narrative synthesis. The search retrieved 99 unique articles. Thirty six case reports and 15 case series describing a total of 65 cases of subcutaneous emphysema were included in this review. The methodological quality was medium. Reported cases of emphysema more often involved females and maxillary teeth. Drying of the root canal system with air under pressure, inadvertent extrusion of hydrogen peroxide through the apical foramen, the air-water spray produced by handpieces or laser devices, and the use of ozone gas were the most commonly suspected causes. Its management involved prescription of antibiotics and NSAIDs/analgesics, local application of ice packs or compresses and hospitalization. The signs and symptoms resolved completely within 1-17days. Case reports and case series are a low level of evidence. Subcutaneous emphysema can develop during both nonsurgical and surgical root canal treatment. Pressurized air streams or air-water sprays should not be directed towards the root canals or areas with mucosal discontinuity. None of the management approaches were clearly related to expedited recovery. Guidelines should be developed in order to avoid unnecessary or potentially harmful interventions.

How Successful is Supplemental Intraseptal and Buccal Infiltration Anaesthesia in the Mandibular Molars of Patients Undergoing Root Canal Treatment or Tooth Extraction?

ABSTRACTObjectivesTo investigate the success rate of supplemental intraseptal and buccal infiltration anaesthesia in mandibular molars undergoing endodontic therapy/extraction when the inferior alveolar nerve block has failed.Material and MethodsA prospective clinical trial including 200 patients undergoing lower molar root canal treatment/teeth extraction was conducted. Only 80 patients of the participants who had profound lower lip anaesthesia after the administration of inferior alveolar nerve block (IANB) were in pain within treatment. Patients experiencing moderate to severe pain upon using elevators, forceps, bur, or endodontic file were randomly allocated to the 2% lidocaine intraseptal injection and 4% articaine buccal infiltration groups. Level of pain was assessed every 2 to 10 min on standard 100 mm visual analogue scales.ResultsOverall, 55 (69%) of patients who were given either intraseptal injection of 2% lidocaine or buccal infiltration of 4% articaine had successful anaesthesia of lower molar teeth within 10 min. However, 25 (31%) of participating patients in the buccal infiltration and the intraseptal groups had failed anaesthesia within the study duration (10 min), and they received additional local anaesthetic. IANBs were more painful than buccal and intraseptal injections. However, buccal articaine injections were significantly more comfortable than intraseptal lidocaine injections (P > 0.001).ConclusionsSupplemental intraseptal injection of 2% lidocaine and buccal infiltration of 4% articaine achieved profound pulpal anaesthesia in 69% of patients when the inferior alveolar nerve block failed. Recommendations can be given to dental practitioners to use infiltration of 4% articaine in conjunction with intraseptal injection of 2% lidocaine to anaesthetize the lower molar teeth when inferior alveolar nerve block fails.

Preliminary in vivo Investigation into the Relationship between Canal Preparation Protocol and Incidence of Postoperative Pain in Single-visit and Two-visit Endodontic Therapy: A Randomized Controlled Clinical Trial

ABSTRACTIntroductionPostoperative pain is a major concern for patients undergoing root canal treatment. Much research has gone into the alteration of several variables to determine the elusive technique that will result in no postoperative pain.AimThe aim of our study was to investigate the incidence, severity, and duration of postoperative pain in relation to technique of root canal preparation and compare the difference in incidence, severity, and duration of postoperative pain in single- and two-sitting root canal therapy when different instrumentation techniques are used.Materials and methodsSixty adult patients requiring root canal therapy were selected and divided into six groups. Singlesitting root canal treatment was carried out in three groups, with three different canal preparation methods (group I – Conventional hand files, group II – hand ProTaper files, and group III – rotary ProTaper files). Two-sitting root canal treatment was carried out in three groups, with the same canal preparation methods (group IV – conventional hand files, group V – hand ProTaper files, and group VI – rotary ProTaper files). Postoperatively, the subjects were instructed to fill out a series of self-report questionnaires for pain incidence after 1 day, 2 days, 3 days, 1 week, and 2 weeks. After 2 weeks, the patients were recalled and their responses were duly noted.ResultsResults were tabulated and statistically analyzed using Mann–Whitney U test.ConclusionThere was a significant difference in incidence, character, and duration of postoperative pain in rotary-prepared canals as compared with hand-prepared canals in both singleand two-sitting endodontics.Clinical significanceThe purpose of this study was to search for a predictability in incidence, duration, and character of postoperative pain in canals instrumented with hand and rotary instruments. Knowing this will enable clinicians to make more prudent choices in instruments, techniques, and protocols for root canal therapy.How to cite this articleBhagwat S, Sheth N, Padhye L. Preliminaryin vivoInvestigation into the Relationship between Canal Preparation Protocol and Incidence of Postoperative Pain in Single-visit and Two-visit Endodontic Therapy: A Randomized Controlled Clinical Trial. J Contemp Dent 2017;7(1):48-52.

Post-instrumentation pain after the use of either Mtwo or the SAF system: a randomized controlled clinical trial.

This randomized controlled trial compared the incidence of post-instrumentation pain associated with Mtwo rotary NiTi files and the self-adjusting file system following canal shaping and cleaning. Following sample size estimation, a total of 130 patients were randomized into two groups based on selection criteria [group Mtwo and group SAF (self-adjusting file)]. Root canal treatment was carried out in two appointments. The teeth were endodontically treated with the appropriate allotted systems following the similar clinical parameters. Patients were asked to rate the intensity of pre-instrumentation and post-instrumentation pain (at 2, 4, 6, 8, 24, 48h) using the VAS score. The Kruskal-Wallis test was carried out for the overall comparisons of the two systems. The Friedman test was used to compare between time-points with each system. Subgroup analyses for independent variables (gender, pulp status and diagnosis) used the Mann-Whitney test and Wilcoxon signed ranks test (P<0.05). No significant difference was found between the two groups with respect to post-instrumentation pain. Teeth with pulpal necrosis had significant pain at 8h compared with teeth with vital pulps (P=0.04). Teeth with vital pulps in the SAF group had significantly less post-instrumentation pain compared with those in the Mtwo group at 6h (P=0.042). Patients who had teeth with nonvital pulps in the SAF group experienced more post-instrumentation pain at 8h (P=0.017) and 24h (P=0.005). The incidence of post-instrumentation pain at different time intervals in patients undergoing root canal treatment was similar for both the self-adjusting file and Mtwo file systems.