Postendodontic Pain Research Articles

Persistent pain in maxillary premolars following root canal treatment with apical transportation: A report of two cases without periapical pathology

Abstract Persistent pain after endodontic treatment is often associated with evidence of periapical pathology. Nonetheless, this case report presents two instances of persistent pain in maxillary premolars post root canal treatment (RCT), without evident periapical radiolucency on imaging. A 35-year-old Asian female experienced dull, aching pain on biting in tooth #25, whereas a 40-year-old Caucasian female reported similar symptoms in tooth #15. Both teeth showed tenderness to percussion but not palpation. Periapical radiographs and cone-beam computed tomography (CBCT) scans revealed completed RCT with apical transportation but no detectable periapical pathology. Thus, both teeth were diagnosed as previously treated with symptomatic apical periodontitis. Non-surgical retreatment successfully addressed untreated canal spaces, resolving symptoms. This report suggested persistent pain following RCT might stem from endodontic reasons, even in the absence of visible apical pathology on CBCT scans, highlighting the importance of thorough canal debridement to resolve symptoms associated with untreated canal spaces in apical transportation. Furthermore, this case report demonstrates that clinicians should make a diagnosis through thorough dental history and other clinical investigations, without relying solely on CBCT for the diagnosis of posttreatment endodontic pain.

Comparative Effects of Premedication with Ibuprofen and Essential Oil of Urtica Dioica on Post-Endodontic Pain: Clinical Trial.

Considering side effects of non-steroidal anti-inflammatory drugs (NSAIDs), herbal medicine includingUrtica dioicamight help reduce the pain. The present study aimed to compare the effects of premedication with essential oil of Urtica dioicaand ibuprofen on post-endodontic pain. The present randomized clinical trial study was conducted on 60 patients with symptomatic irreversible pulpitis of mandibular first or second molars. The patients were randomly assigned to three groups (n=20) for premedication with 400 mg ibuprofen, 400 mg essential oil of Urtica dioica(Netonal; Barij, Iran), and placebo. The medications were taken 30 minutes prior to the procedure. The patients' pain score was recorded before the intervention and treatment onset (Time1 or T1), after the intervention prior the treatment onset (10 minutes after anesthetic injection) (T2), upon completion of treatment (T3), and at 8 (T4), 12 (T5), and 24 hours after endodontic treatment (T6) using a visual analog scale (VAS) and Wong-Baker FACES Pain Rating Scale (WBS), and compared. Data were analyzed by Chi-square test, one-way and repeated measures analysis of variance (ANOVA), kruskal-wallis test, and LSD post-hoc test using IBM SPSS statistics version 21 with significance value of p< 0.05. The pain score was not significantly different among the three groups at T1, T2 and T3 according to both scales (p> 0.05). On the other hand, significantly lower pain scores were recorded in ibuprofen and Urtica dioicagroups at 8, 12, and 24 hours after treatment compared with the placebo group (p< 0.001). The pain score was not markedly different between the ibuprofen and Urtica dioicagroups (p> 0.05). It seems that analgesic effect of premedication with leaf extract of Urtica dioicais the same as ibuprofen. Further studies are warranted to find the optimal dosage of Urtica dioica for widespread use.

THE IMPACT AND ROLE OF CRYOTHERAPY IN ENDODONTIC PROCEDURES

In the fields of medicine and dentistry, Cryotherapy is an effective method to relieve edema, pain, bleeding and inflammation. Cryotherapy has been used extensively in dentistry to treat pain after intraoral surgery. The objective of this paper is to study how cryotherapy is used in endodontics in relieving and preventing post-endodontic pain in clinical procedure, effect on root canal irrigation, vital pulp therapy, to improve the cutting efficacy of Ni-Ti rotary endodontic instruments, to increase the success rateof Inferior alveolar nerve block.

EFFECT OF INTRACANAL CRYOTHERAPY ON THE POST ENDODONTIC PAIN IN TEETH WITH SYMPTOMATIC APICAL PERIODONTITIS

Objectives: To compare the effect of cryotherapy, room temperature saline and no saline as final root canal irrigants on post-endodontic pain in patients with symptomatic apical periodontitis.Materials and Methods: An observational study was done at the Endodontics Department of Rehman College of Dentistry, Peshawar from August 2023 to January 2024. Ninety patients were selected via purposive sampling technique and underwent root canal treatment. After root canal preparation, patients were equally divided into three groups using the lottery method: Cryotherapy group, room temperature saline group and no saline group. Pain on percussion was recorded pre-operatively and 24hours post-operatively for every patient using the visual analogue scale. Wilcoxon Signed ranks test was used to assess the signifi cant difference between mean pre-endodontic and post-endodontic pain levels. Post hoc analysis was used to compare the significant difference (p value&lt;0.05) between each group. Results: At 24 hour post-operatively, the mean post-endodontic pain scores on visual analogue scale were 2.50± 1.253 for cryotherapy group, 2.70±2.261 for room temperature saline group and 3.63±1.938 for no saline group. The result shows that the post-endodontic pain reduces signifi cantly in all the three groups(p&lt;0.05). However, cryotherapy as the final irrigant was found to be significantly more eff ective in reducing the post-endodontic pain than no saline as the final irrigant (p value 0.029). No significant difference was found in between the cryotherapy group and the room temperature saline groups (p value 0.964).Conclusion: Cryotherapy as the final root canal irrigant is the most effective method of reducing post-endodontic pain as compared to when no saline was used as the final irrigant. Room temperature saline is also as useful as cryotherapy in reducing post-endodontic pain. The findings of the study will be helpful for the dentists to minimize post-endodontic pain.

Influence of occlusal surface reduction on post endodontic pain following instrumentation and obturation: A randomized double blinded clinical study.

The purpose of this randomized clinical study was to investigate the influence of occlusal surface reduction on postendodontic pain. Sixty patients were included with a diagnosis of acute irreversible pulpitis and acute apical periodontitis and divided randomly into two groups. In the intervention group, occlusal surfaces were reduced and left intact in the control group. Postoperative pain was evaluated at the 6th, 12th, 24th, and 48th h after the root canal instrumentation and 6th and 12th h following obturation using visual analog scale. Data were evaluated using the Chi-square test, t-test, Friedman test, Mann-Whitney U-test, and Wilcoxon rank test. Postoperative pain levels in both groups were reduced significantly over the time period evaluated, however, between the two groups, there was no difference evident. Occlusal surface reduction did not influence the pain following root canal instrumentation and obturation.

IRON DEFICIENCY ANEMIA AS A RISK FACTOR FOR DENTAL PULP DISEASES: AN INTEGRATIVE REVIEW

Iron deficiency anemia is characterized by reduced blood capacity to transport oxygen due to insufficient iron, an essential component of hemoglobin. This condition can have various implications for oral health, including dental pulp health. The human body must balance physiological, nutritional, and environmental factors to maintain optimal functioning. Iron salts react with gingival crevicular fluid and subgingival bacterial metabolites, staining teeth. Iron supplements typically have a highly acidic pH compromising dental enamel microhardness and increasing the risk of cavities. However, the severity of the damage varies depending on supplement acidity, frequency, duration, and method of administration. This article aims to conduct a comprehensive literature search to investigate the association between iron deficiency anemia and oral health issues with pulp pathology aspects as the focus of the study. To sustain an integrative literature review, articles published in English from the databases PubMed, Wiley Library, Science Direct and Scholar Google were examined. Iron deficiency anemia is a contributing factor to the higher incidence of post-endodontic pain. Some studies indicate other results suggesting that iron has a cariostatic effect on dental decay.

Effect of a Long-Acting NSAID Premedication on Postendodontic Pain in Mandibular Molars with Non-vital Pulp: A Preliminary Randomized Controlled Trial

Effect of a Long-Acting NSAID Premedication on Postendodontic Pain in Mandibular Molars with Non-vital Pulp: A Preliminary Randomized Controlled Trial

Effectiveness of Two Intracanal Irrigation Solutions Delivered Through Cryotherapy on Post-Endodontic Pain Relieve. A Randomized Clinical Trial

Effectiveness of Two Intracanal Irrigation Solutions Delivered Through Cryotherapy on Post-Endodontic Pain Relieve. A Randomized Clinical Trial

Determining Efficacy of Intracanal Cryotherapy on Post Endodontic Pain in Irreversible Pulpitis

Endodontic cryotherapy is a procedure that reduces pain and inflammation by applying cold to tissues, aiming to decrease post-endodontic pain. Objectives: To compare the effectiveness of cryo-treated endodontic irrigant in reducing post-endodontic pain in mandibular molars with irreversible pulpitis. Methods: This comparative analytical study was conducted from December 2023 to February 2024 in the Department of Operative Dentistry at Lahore Medical and Dental College. It included patients of both genders, aged 18 to 60, with symptomatic irreversible pulpitis in mandibular molars and pre-endodontic pain of VAS 7-10 for 10 days or less. Patients were divided into two groups: Group A (normal saline) and Group B (cryotherapy). Patients were instructed on using the Visual Analogue Scale (VAS) to assess pain. Group B received final irrigation with 20 ml normal saline at 2.5°C for 5 minutes, while Group A received 20 ml normal saline at room temperature. Pain scores were recorded preoperatively and at 24 and 48 hours’ post-treatment via telephone interviews. Data were analyzed using SPSS version 25 and a repeated measures ANOVA test assessed VAS scores across time points. A p-value &lt;0.05 was considered significant. Results: 45 (46%) were male and 53 (54%) were female patients, with mean age of patients being 35.71 ± 10.71years. At 24 hours postoperatively, the mean VAS score was 1.51 ± 1.2 for the normal saline group and 0.98 ± 0.9 for the cryo-treated saline group. By 48 hours postoperatively, the mean VAS score further decreased to 0.27 ± 0.5 for the normal saline group and 0.12 ± 0.4 for the cryo-treated saline group. The mean differences in VAS scores at 24 hours showed significant difference in mean pain score (P-value&lt;0.05) but at 48 hours between the two groups showed no significant difference (p = 0.104). Conclusions: Both saline groups significantly decreased pain, the type of saline, normal or cryo-treated, did not significantly impact overall pain scores differently between the groups.

The Impact of Chlorhexidine as an Endodontic Irrigant/Medicament on Post-Obturation Pain in Patients Following Endodontic Therapy: A Preliminary Bayesian Meta-Analysis.

To assess the overall impact of chlorhexidine, when used as an endodontic irrigant/medicament, on post-obturation pain following endodontic treatment by the application of Bayes methods of meta-analysis. This study aimed to combine recently documented evidence using rigorous and specific search criteria. The available data were analyzed using Bayesian methods, which have the advantage of accounting for uncertainties in estimates. This is in contrast to commonly used frequentist meta-analysis methods, which are not able to model uncertainties as effectively, particularly when there is heterogeneity present. A preliminary search was conducted in the Pubmed, Cochrane, and Scielo databases using appropriate keywords. The search aimed to identify human randomized clinical studies that evaluated post-operative endodontic pain and involved the use of chlorhexidine as an endodontic irrigant or medicament. The preliminary Bayesian meta-analysis produced a more accurate estimate compared to a frequentist random effect meta-analysis model, with a narrower credible interval. The frequentist model demonstrated a detrimental impact of chlorhexidine on post-obturation pain, while the Bayesian model indicated a somewhat favorable effect of chlorhexidine on post-obturation pain. Based on the scope of this investigation, it can be inferred that a Bayesian random effects meta-analysis model demonstrated a somewhat favorable impact of chlorhexidine on post-endodontic pain, which carries significant therapeutic significance.

The incidence and intensity of postoperative pain and Flare-up following the use of three different intracanal medicaments in teeth with posttreatment apical periodontitis: a randomized clinical trial

ObjectivesThis randomized clinical trial aimed to compare the effect of intracanal medicaments on the incidence of postoperative pain and flare-up with posttreatment apical periodontitis (PTAP) of retreatment cases.Materials and methodsOne hundred twenty patients diagnosed with PTAP with single-rooted teeth with single-canal without spontaneous pain or swellings were included and randomly divided into three groups according to the intracanal medicament used. Intracanal medicaments were placed into the root canals following the removal of previous root canal fillings and re-instrumentation. Calcium hydroxide (Ca (OH)2), chlorhexidine gel (CHX), calcium hydroxide and chlorhexidine gel combinations were used as intracanal medicaments. Postoperative pain scores were recorded at 6 and 12 h and 1, 2, 3, 4, 5, 6, and 7 days using a visual analog scale (VAS). Sensitivity on percussion, spontaneous pain, swelling, antibiotic and analgesic requirements of the patients were evaluated during clinical examinations performed postoperatively after 2 and 7 days.ResultsThere were no statistically significant differences between groups in terms of VAS scores following the intracanal medicament application (p > 0.05). However, compared to the patients of 20–34 and 50–65 age groups, greater VAS scores were observed in patients of 35–49 age groups at 12 h, and 3, 4, 7 days (p < 0.05). Flare-up was observed in only one patient in the CHX gel group, and no flare-up was observed in other groups.ConclusionsSimilar postoperative pain incidence in all experimental groups indicates that all three medicaments are clinically acceptable in inter-appointment management of retreatment cases in terms of post-endodontic pain and flare-up.Clinical relevanceIn this randomized clinical trial, three different intracanal medicaments were utilized in nonsurgical endodontic retreatment and their effect on postoperative pain and flare-up incidence was examined. Thus, this study will be a significant contribution in the decision-making during clinical practice; since there are a limited number of prospective clinical trials in the literature about the severity of pain following retreatment procedures including intracanal medicament use.

Influence of Diclofenac Potassium versus Prednisolone on Postendodontic Pain and Pulpal Interleukin-8 Expression in Symptomatic Irreversible Pulpitis Cases: A Randomized Placebo-controlled Trial

AimThis prospective, randomized, double-blind clinical trial investigated the impact of diclofenac potassium, prednisolone, and placebo as oral premedication on postendodontic pain and pulpal interleukin (IL)-8 expression in patients with irreversible pulpitis. MethodsThirty-six patients undergoing conventional endodontic treatment were assigned into one of 3 groups (n = 12). Pulpal blood samples were taken after access cavity preparation and stored until they were analyzed using enzyme-linked immunosorbent asssay for quantification of IL-8. Postendodontic pain was scored using the visual analogue scale. Outcome data were statistically analyzed using one-way analysis of variance, Kruskal-Wallis, Friedman's, Dunn's, Chi-square, and Fisher's exact tests and Spearman's correlation coefficient. The significance level (α) was set at 0.05. ResultsApart from preoperative pain scores, all groups had similar baseline characteristics (P > .05). Immediate postendodontic pain scores had a significant difference between all groups (P < .05) where placebo group showed the highest score. There was no significant difference between all groups at 6 and 12 hours postoperatively (P > .05). Furthermore, there was no significant difference in the incidence of postendodontic pain and in mean IL-8 levels between the 3 groups (P > .05). ConclusionsThe only impact the premedications had was on the immediate postendodontic pain intensity, and they had no influence on the later time points, incidence of postendodontic pain or pulpal IL-8 levels.

Mirogabalin as a Therapeutic Option for Neuropathic Pain Emerging Post-endodontic Treatment: A Two-Case Report

IntroductionOcclusal and percussion pain may manifest occasionally following endodontic treatment, influencing retreatment decisions. Two cases of periapical neuropathic pain, classified as post-traumatic trigeminal neuropathic pain according to the International Classification of Orofacial Pain, are presented. Although mirogabalin is effective in managing neuropathic pain, there is a lack of clinical reports on its use for occasional post-traumatic trigeminal neuropathic pain after endodontic treatment. These cases highlight clinical symptoms and successful treatment with mirogabalin for post-traumatic trigeminal neuropathic pain after endodontic treatment, providing clinicians a “take-away” lesson for improving patient condition. MethodsThe patients, referred by their primary dentist due to postendodontic abnormal pain, found no relief with antibiotics or nonsteroidal anti-inflammatory drugs. Although no findings including swelling or periapical radiolucency were observed around the tooth, they experienced occlusal and percussion pain. Local anesthetic testing showed that the pain originated from the peripheral area around the tooth rather than from central sensitization. Dental radiography and cone-beam computed tomography revealed no abnormal findings. Root canal retreatment was performed by a specialist in endodontic treatment. Although endodontic retreatment drastically decreased visual analog scale pain score, pain persisted. Based on the International Classification of Orofacial Pain criteria, diseases other than post-traumatic trigeminal neuropathic pain were excluded. Mirogabalin (10 mg/d) was prescribed once daily before bedtime. ResultsVisual analog scale scores gradually and drastically decreased 2 weeks after mirogabalin therapy. Several months later, no recurrence of postendodontic pain was observed after tapering off and discontinuing mirogabalin. ConclusionsThese findings suggest the possibility of a new treatment method for post-traumatic trigeminal neuropathic pain after endodontic treatment.

Post-endodontic pain following root canal treatment in permanent teeth among Indian paediatric patients.

Pulp status in permanent teeth and post endodontic pain (PEP) has not been assessed properly in pediatric patients. Therefore, it is of interest to assess the prevalence, severity of PEP in permanent teeth after root canal therapy and retreatment in paediatric patients. Hence, 127 pediatric patients who had root canal therapy (RCT) for permanent teeth with necrotic pulp, vital pulporendodonticre treatment were considered. Assessment of incidence intensity of PEP at 6 hours and 18 hours after therapy was completed. The incidence and intensity of PEP in permanent teeth in paediatric patients was greater in teeth with vital pulp. It was low in teeth with necrotic pulp. The incidence of spontaneous PEP was greater in all treatment groups as compared to stimulated PEP at 6 hours after treatment. Thus, root canal therapy of teeth with viable pulp produced a noticeably greater incidence and intensity of PEP in permanent teeth in paediatric patients.

Effect of the Irrigation Agitation Technique on Postoperative Pain in Teeth With Symptomatic Irreversible Pulpitis.

Introduction Irrigation of the root canal system is a vital step in endodontic treatment aimed at disinfecting the canal. The efficacy of irrigation can be improved by various irrigation agitation methods. One such novel method of interest is the manual dynamic agitation (MDA) technique. However, the effect of MDA on postoperative pain as compared to needle irrigation (NI) with sodium hypochlorite has been scarcely explored.This study aimed to compare the effects of NI and MDA techniques on postoperative pain in teeth with symptomatic irreversible pulpitis. Materials and methods This quasi-experimental study was conductedat the Department of Operative and Paediatric Dentistry, Fauji Foundation Dental Hospital, over four months after gaining ethical approval. One hundred and sixty-eight participants diagnosed with symptomatic irreversible pulpitis were enrolled in the study through the purposive sampling technique.The participants were divided into two groups based on the irrigation technique used: Group A (NI) and Group B (MDA). Postoperativepain was recorded after six hours, 24 hours, 48 hours, and seven days using the 0-100mm visual analog scale (VAS). The VAS scores were compared using an independent sample t-test. Results Out of 168 participants, 48.2% were in Group A and 51.2% in Group B. The study found that VAS pain scores for Group B (MDA) were significantly lower at six hours, 24 hours, 48 hours, and seven days as compared to Group A (NI), with a p-value less than 0.001. Conclusion This study shows that the MDA technique leads to decreased postoperative pain both immediately after endodontic treatment and a week later as compared to the NI technique. Hence, the use of MDA can aid in controlling postendodontic pain and, therefore, ensure smoother recovery and increased patient satisfaction.

Assessment of Bacterial Load and Post-Endodontic Pain after One-Visit Root Canal Treatment Using Two Types of Endodontic Access Openings: A Randomized Controlled Clinical Trial.

The need for controlling bacteria and pain during root canal therapy is undeniable. This clinical trial aimed to assess whether there is a difference in colony-forming unit (CFU) reduction after instrumentation and post-endodontic pain after root canal treatment (RCT) using a traditional endodontic cavity (TEC) versus a conservative endodontic cavity (CEC). This clinical study was conducted on 89 patients designated for a single-visit RCT. Patients were allocated randomly (TEC n = 45 and CEC n = 44). The access opening was gained accordingly in each group by a single operator. A pre-instrumentation sample of root canal dentin was collected using an endodontic file; the second sample was collected similarly, right after shaping and cleaning the root canal. The CFU was calculated based on the samples collected. The pain level was recorded preoperatively and at 1, 7, and 21 days postoperatively utilizing a visual analog scale (VAS). There were no statistically significant differences in the CFU reduction between the TEC and CEC groups (p > 0.05). Additionally, there were no statistically significant differences found in postoperative pain levels between the TEC and CEC at 1, 7, and 21 days (p > 0.05). Despite the limitations of this study, both the CEC and TEC demonstrate a decrease in bacteria within the root canals and alleviate postoperative pain with no difference between them.

Laser Photobiomodulation as Noninvasive Therapeutic Modality in Pediatric Endodontics: A Comprehensive Review

Endodontics is evolving with modern innovations for conservatively managing the various dental problems involving pulpal or periradicular tissue of primary and permanent teeth. Lasers have been reported with favorable clinical evidence, particularly in tackling the endodontic problems effectively. Recently, the application of lasers in the form of photobiomodulation therapy or low-level laser therapy has been reported in many recent scientific studies/researches with successful results. Hence, this narrative review critically appraise the existing scientific literature and highlights the photobiomodulation technique of lasers as noninvasive therapeutic modality in different pediatric endodontic therapies or procedures (direct pulp capping, pulpotomy, noninvasive treatment of periapical lesion, regenerative endodontics, postendodontic pain management, etc.).

Comparing the Effects of Intramuscular Injections of Dexamethasone and Ketorolac Tromethamine on Post-treatment Endodontic Pain: An In Vivo Study.

Pain is the primary reason dental patients seek endodontic therapy. Post-treatment endodontic discomfort is a sequelae of periapical inflammation and anti-inflammatory drugs such as corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) would be reasonable therapy options. The purpose of this study was to compare and assess the efficacy of intramuscular injections of dexamethasone and ketorolac tromethamine versus placebo in reducing post-treatment endodontic pain in individuals undergoing root canal treatment. Patients diagnosed with symptomatic irreversible pulpitis were selected. Nonsurgical endodontic therapy was carried out in a single visit. After completion of the root canal therapy, the patients were randomly assigned to one of the three groups for intramuscular drug administration. In group 1, 2 ml of sterile saline was administered, in group 2, 1 ml of 4 mg dexamethasone was administered; and in group 3, 1 ml of 30 mg ketorolac tromethamine was administered.Preoperative and postoperative pain intensity was measured by a verbal rating scale. Postoperatively, the incidence and severity ofpain were recorded after four, 24, and 48 hours. All three groups showed a highly statistically significant reduction in pain scores when compared to preoperative levels. At the end of four hours, dexamethasone and ketorolac tromethamine showed highly significant results. Dexamethasone significantly reduced pain after 24 hours when compared to ketorolac and placebo groups. At the conclusion of 48 hours, all three groups experienced a gradual decrease in pain levels. Effective and complete debridement of infected root canal system provides predictable gradual reduction of post-endodontic pain.

Postendodontic Pain Using Single File System with Different Irrigation Protocols in Single-visit Root Canal Treatment: A Randomized Control Trial.

To evaluate the intensity of postendodontic pain (PEP) using final irrigation with side-vented needle (SV), EndoActivator (EA), and Ultra X (UX) in single-visit endodontics (SVE) with F-One rotary files. A total 150 patients indicated for endodontic treatment were selected. Single-visit endodontics treatment was performed under local anesthesia. For the final irrigation protocol, they were divided into three groups: group I (SV), group II (EA), and group III (UX). The severity of PEP was assessed using visual analogue scale (VAS) score after 6, 12, 24, and 48 hours. Analgesics taken by patients, for pain, were also recorded. Finally, the data were tabulated and statistically analyzed using SPSS 20.0 software at a level of significance being 0.05. Postendodontic pain was less in group III (UX) and group II (EA) compared with group I (SV) at 6 and 12 hours, which is statistically significant (p < 0.05). There was no statistically significant difference found after 24 hours and 48 hours. The intensity of PEP was minimum in patients treated with EndoActivator and ultrasonic along with single rotary file systems. The incidence of analgesic intake was similar in all three groups. How to cite this article: Kathiria NV, Attur K, Bagda KM, et al. Postendodontic Pain Using Single File System with Different Irrigation Protocols in Single-visit Root Canal Treatment: A Randomized Control Trial. J Contemp Dent Pract 2024;25(2):180-185.

Clinical Assessment of Preemptive Analgesia on Success of Pulpal Anesthesia and Postendodontic Pain in Children with Irreversible Pulpitis: A Randomized Comparative Study.

Optimal pain management of symptomatic pulpitis in formative years goes a long way in developing a positive dental attitude. Efforts should be made to increase the success of anesthesia, thus diminishing negative dental experiences. The aim of the study was to assess the efficacy of preemptive analgesia on the success of pulpal anesthesia following inferior alveolar nerve block (IANB) in children with symptomatic irreversible pulpitis and on reducing postendodontic pain. The research design was an in vivo, three-group, parallel, quadruple-blind study. A total of 75 patients were randomly allocated to one of the three groups-group I: ibuprofen, group II: combination of ibuprofen and paracetamol, and group III: multivitamin (placebo). Premedication was given 45 minutes before treatment, and patients received IANB in a standardized manner. Pain during pulpectomy was recorded using the face, legs, activity, cry, consolability (FLACC) scale and postoperatively using Wong-Baker's pain rating scale (WBPRS) at 4, 12, and 24 hours. Success was measured if the pain felt was of no or mild intensity. Success of IANB was 64% for ibuprofen, 72% for the combination group, and 40% for the placebo group, with no statistically significant difference between all groups (p = 0.06) on the FLACC scale. At 4 hours postoperatively, a significant difference (p = 0.02) was found among groups with more children experiencing no or mild pain in groups I and II and the highest number of rescue medications taken by the placebo group. Ibuprofen and a combination of ibuprofen and acetaminophen as preemptive analgesics had no significant effect on the success rate of IANB, although it was effective in reducing pain at 4 hours postoperatively. Gori NA, Patel MC, Bhatt RK, et al. Clinical Assessment of Preemptive Analgesia on Success of Pulpal Anesthesia and Postendodontic Pain in Children with Irreversible Pulpitis: A Randomized Comparative Study. Int J Clin Pediatr Dent 2024;17(1):72-78.