Postendodontic Pain Research Articles

Cryotherapy: A paragon for endodontic therapy

Patients undergoing endodontic treatment may develop post-endodontic pain, leading to pain and inflammation. Cryotherapy is a remedial procedure widely used in the field of medicine and dentistry, considered to be effective at reducing edema, pain, bleeding and inflammation. In endodontics, it is relatively new and may be beneficial in the prevention and treatment of post-endodontic pain. Additionally, cryogenic treatment is considered a key factor in strengthening rotary NiTi endodontic files. Further well-designed clinical studies will be conducted to establish the effective use of cryotherapy in the control of post-endodontic pain in clinical practice. This article describes the concept of cryotherapy and its potential clinical implications in endodontics.

Assessment of apical patency maintenance and its influence on post-endodontic pain of root canal treated teeth: A systematic review and meta-analysis

Assessment of apical patency maintenance and its influence on post-endodontic pain of root canal treated teeth: A systematic review and meta-analysis

Advances in the management of post-endodontic pain: a review

This review describes the management of post-endodontic pain pharmacologically and non-pharmacologically. Acute periapical inflammation brought on by endodontic treatment-related chemical, mechanical, and/or microbiological damage to the periapical region causes postoperative pain, which is multifactorial in nature. A wide range of technical and pharmacological techniques are taken into consideration and proposed to control post-operative endodontic pain, the present study primarily comprised an overview of systematic reviews, randomized clinical trials,and invitrostudies summarizing advancement in the management of post- operative endodontic pain.

Comparative analysis of postendodontic pain using multiple versus single rotary file systems in single-visit endodontics: A randomized clinical trial

ABSTRACT Aim: The aim of this study was to compare and evaluate the severity of PEP using ProTaper Gold (PTG), ProTaper Next (PTN), and F-One rotary files in single-visit endodontic (SVE) treatment. Materials and Methods: In a randomized factorial clinical trial, 150 patients indicated for endodontic treatment in maxillary molars and mandibular molars were selected. They were separated into three groups: Group 1 (PTG), Group 2 (PTN), and Group 3 (F-One). SVE treatment was done under local anesthesia. The intensity of PEP was assessed using the Visual Analog Scale (VAS) after 24, 48, 72 h, and 1 week. Finally, the data were tabulated and statistically analyzed using SPSS software. VAS was analyzed using analysis of variance test with Scheffe’s post hoc test. Results: PEP was less in Group 3 (F-One) and Group 2 (PTN) as compared to Group 1 (PTG) at 24.48 h which is statistically significant (P < 0.05), whereas the difference between PTN and F-One was statistically insignificant. Conclusion: All file systems showed PEP, but the intensity of pain was minimum in F-One single rotary file system followed by PTN and PTG Multi-file systems.

Revelation of Outcome of Single visit V/s Multiple visit Endodontic Therapy

Abstract Aim: This study aims to investigate whether there is a substantial difference between single- and multiple-visit root canal treatment (RCT) in regard to the incidence and intensity of postendodontic pain and flare-up. Materials and Methods: The following databases were searched and evaluated “Cochrane Database of Systematic Reviews, Web of Science, PubMed, and Scopus databases” for studies published from January 2000 to August 2021. The articles were chosen using the PRISMA protocol. The review includes 22 articles. Results: The other studies assessed either the incidence or the intensity, while three studies compared both. The majority of studies irrigated with sodium hypochlorite and used both hand-driven and rotary equipment. Thirteen trials made use of an intracanal medicament. Conclusion: The systematic review demonstrated that there was no significant difference in the incidence or the intensity of the pain as measured between single-visit RCT and multiple-visit RCT. The incidence of postendodontic pain or a flare-up is not independently determined by the number of visits required for root canal therapy.

Advances in the management of post-endodontic pain: a review

This review describes the management of post-endodontic pain pharmacologically and non-pharmacologically. Acute periapical inflammation brought on by endodontic treatment-related chemical, mechanical, and/or microbiological damage to the periapical region causes postoperative pain, which is multifactorial in nature. A wide range of technical and pharmacological techniques are taken into consideration and proposed to control post-operative endodontic pain, the present study primarily comprised an overview of systematic reviews, randomized clinical trials, and invitro studies summarizing advancement in the management of post-operative endodontic pain.

The Effect of Trypsin-Chymotrypsin on Postoperative Pain after Single Visit Endodontic Treatment: A Randomized Controlled Trial

IntroductionThe efficacy of trypsin-chymotrypsin in postoperative pain management following single-visit root canal treatment of teeth with symptomatic irreversible pulpitis was evaluated. Additionally, synergistic effects with nonsteroidal anti-inflammatory drugs and reported side effects were also investigated. MethodsThis prospective, parallel, triple-blinded phase IV randomized controlled trial included 60 patients with mandibular first molars exhibiting symptomatic irreversible pulpitis. The patients were randomly allocated using computer software to one of four treatment groups (n = 15 each), and either ibuprofen (600 mg), ambezim-G (trypsin 5mg-chymotrypsin 5 mg), a combination of both, or a placebo drug were administered postoperatively. The participants scored pain intensity at different time-intervals using a numerical scale, and passive surveillance of harm was used to detect clinical safety. Age was compared between groups using a one-way analysis of variance test. Pain scores were analyzed using the Kruskal-Wallis and Friedman's tests and, if significant, Dunn's test was used for pairwise comparisons. The chi-square test was used to compare qualitative data, and the significance level was set at P value ≤ .05. ResultsAll interventions were found to be effective in reducing postoperative pain, and no statistically significant differences were observed between the ibuprofen, trypsin-chymotrypsin, and combination groups. However, all 3 groups differed significantly from the placebo group. The safety profile of the interventions did not differ significantly. ConclusionsTrypsin-chymotrypsin exhibits comparable efficacy to nonsteroidal anti-inflammatory drugs. No synergistic effects occur when the 2 are used in combination. This is the first randomized controlled trial to assess the effects of proteolytic enzymes on postendodontic pain. Trial registrationclinicaltrials.gov, Identifier: NCT05479747

C.E. Credit. Cryotherapy in Endodontics: A Critical Review

In medicine, cryotherapy is used to destroy tissue of both benign and malignant lesions by the freezing and rethawing process. In dentistry, cold application has been frequently employed for postoperative pain control following intraoral surgical procedures. The purpose of this paper is to review the applications of cryotherapy in endodontics including its effects on post-endodontic pain, effectiveness against endodontic infections, hazardous effects on dentin and efficacy on cutting efficiency of Ni-Ti rotary instruments, etc.

Plasma Rich in Growth Factors in the Treatment of Endodontic Periapical Lesions in Adult Patients: 3-Dimensional Analysis Using Cone-Beam Computed Tomography on the Outcomes of Non-Surgical Endodontic Treatment Using A-PRF+ and Calcium Hydroxide: A Retrospective Cohort Study.

The study presents results of periapical lesion healing after one-visit root canal treatment (RCT) with Advanced Platelet Rich Fibrin plus (A-PRF+) application compared to a two-visit RCT with an inter-appointment calcium hydroxide filling. The comparison was made based on CBCT-Periapical Index (PAI) lesion volume changes and the occurrence of post endodontic pain. The results of 3D radiographic healing assessments based on volume reduction criteria were different from the CBCT-PAI. Based on volume changes, the healing assessment criteria-9 cases from the Study Group and six cases in the Control Group were defined as healed. Based on the CBCT-PAI healing assessment criteria, 8 cases from the Study Group and 9 cases from the Control Group were categorized as healed. The volumes of apical radiolucency were, on average, reduced by 85.93% in the Study Group and by 72.31% in the Control Group. Post-endodontic pain occurred more frequently in the Control than in the Study Group. The highest score of pain in the Study Group was five (moderate pain, n = 1), while in the Control Group, the highest score was eight (severe pain, n = 2). In the 6-month follow-up, CBCT scans showed a better healing tendency for patients in the Study Group.

Effect of Prednisolone Premedication on Postoperative Pain after Single Visit Endodontic Therapy: A Randomized Controlled Trial part (XIII)

This study was designated to evaluate the effect of Prednisolone as premedication in controlling post-endodontic pain after single visit treatment of acute irreversible pulpitis using in a randomized controlled trial. 40 Mandibular Molar teeth were treated using Revo S system, Patients were asked To sign a printed consent and obligated the patient to fill the pain diary 6,12,24 hours after root canal treatment. The patients were randomly divided into 2 groups: experimental group (A): prednisolone 40 mg and control group (B): placebo. The pain was measured using VAS measurement, a triple blind randomized study used to minimize bias and to allow sufficient comparison between groups. The outcome of this study showed that Prednisolone resulted in statistically significant reduction in post endodontic pain at 6, 12 hours post operatively which was considered as large and moderate effect size respectively. At 24 hours postoperatively; Prednisolone group didn’t seem to differ significantly from placebo group with small effect size and this is may be due to prednisolone half life is from 3 hours to 4 hours. So, in absence of contraindications for corticosteroid administration, the use of single-dose prednisolone appears to be a safe and effective method to reduce postoperative pain. It is possible that these favorable results might help to prevent post-endodontic pain.

Comparative evaluation of post-operative pain after using manual irrigation and EDDY during root canal irrigation

Objectives: Post-endodontic pain (PEP) represents a significant challenge for dentists and patients. It can worsen patients’ quality of life and teeth function. This study compared the risk of PEP between irrigations using an EDDY device and a conventional endodontic needle among patients seeking initial non-surgical root canal treatment. Methods: This prospective single-center randomized controlled clinical trial was conducted at the Dental Clinic of the Faculty of Dental Medicine of the University of Porto, Portugal. The participants were diagnosed with irreversible pulpitis or pulp necrosis. Eighty single- rooted teeth were randomly assigned to one of two irrigation groups: EDDY or manual syringe irrigation with needles with up-and-down movement (control group). PEP was assessed at 8, 24, and 48 hours postoperatively using the visual analog scale. Student’s t-test, Kruskal-Wallis test, Pearson’s chi-square test with Fisher’s exact test, and Friedman’s posthoc sign test were used. Results: Eight hours after irrigation, the EDDY group experienced a statistically significant higher incidence of pain (p=0.041) (52.5%) compared to the manual irrigation group (30%). There was no statistically significant difference between groups regarding the PEP 24 hours (p=0.068) and 48 hours (p=0.433) after RCT. Conclusions: EDDY irrigation during initial RCT is associated with a higher incidence of PEP, mainly in the first 24 hours, compared to manual irrigation. Afterward, the rate of PEP was similar between groups, with a gradual decline in pain intensity.

Post-Endodontic Pain after Root Canal Treatment of Symptomatic Teeth with Mtwo and Safe Sider Multiple File Systems: A Randomized Clinical Trial

Background: Considering the increasing popularity of rotary files among dental clinicians and the emergence of several types of rotary systems, clinical trials are necessary to compare these systems from various aspects. Objectives: This study compared post-endodontic pain following the use of Mtwo and Safe Sider multiple file system. Methods: A total of 150 maxillary and mandibular molars with symptomatic irreversible pulpitis were selected. Their root canals were randomly instrumented with hand files, Mtwo and Safe Sider instruments. The severity of postoperative pain was assessed using a Visual Analog Scale (VAS) at 6, 12, 24, 48 and 72 hours. The data were analyzed using repeated measures ANOVA. P<0.05 was considered statistically significant. Results: The mean postoperative pain score significantly decreased in all three groups over time. The mean pain score at 12 and 24 hours post-treatment was significantly higher in the Safe Sider group compared to the other two groups. At 6, 48 and 72 hours, no significant difference was noted in the severity of pain among the three groups. Conclusions: Postoperative pain is significantly higher at 12 and 24 hours following endodontic treatment with Safe Sider compared to the conventional hand instruments and Mtwo system.

Patient perception who had undergone root canal treatment

Introduction: Root canal treatment (RCT) is generally known as a painful procedure. One of the most significant disadvantages of root canal therapy is that most patients are unaware of it. To effectively address the problem, it is important to understand and recognise the factors that prevent or deter patients from undergoing RCT. According to a review of the literature, there is a scarcity of data on RCT knowledge and acceptance among patients in the Indian population. Aim: The aim of this present study is to assess the patients perception who had undergone root canal treatment. Materials and Methods: 100 participants were involved in the study. A well structured questionnaire containing 15 questions was administered to the participants through an online survey link. The responses were analysed through descriptive statistics using SPSS software. The results are represented through pie charts and association graphs. Results and Discussion: The patients association is not significant. This shows that if patients are not properly educated regarding RCT, they get motivated to undertake the treatment. Patients' confidence can be increased by informing them about potential post endodontic pain and administering drugs to handle it.

Comparison of the Efficacy of Dexamethasone and Methylprednisolone in Infiltration Injection for Postendodontic Pain in Patients with Necrotic Pulp: A Randomized Controlled Clinical Trial.

Purpose Postendodontic pain is one of the problems of root canal therapy. This clinical study aimed to evaluate the effect of infiltration injection of dexamethasone and methylprednisolone on postendodontic pain in patients with necrotic pulp. Methods A total of 80 volunteers with necrotic pulp teeth were included and assigned to two groups (n = 40). After the administration of local anesthesia and before root canal therapy, in group 1, an infiltration injection of 1 ml of dexamethasone was done and in group 2, an infiltration injection of 1 ml of methylprednisolone was done in the buccal vestibule of each tooth. Patients' pain was reported using a visual analogue scale at pretreatment and 6, 12, 24, and 48 hours after treatment. Results There was no significant difference between the two groups receiving dexamethasone and methylprednisolone at pretreatment and 6, 12, 24, and 48 hours after endodontic treatment. Conclusions Infiltration injection of dexamethasone and methylprednisolone had a significant effect in reducing pain after the endodontic treatment in necrotic pulp teeth, but between 6 and 12 hours, methylprednisolone had significantly more effect on pain relief than dexamethasone. Overall, the use of any of these drugs to reduce postendodontic pain is recommended.

Effectiveness of Intracanal Cryotherapy using Different Irrigants on Reduction of Post Endodontic Pain – A Systematic Review and Meta-analysis

Introduction: Recently the non-pharmacological management of post endodontic pain has been extensively studied. The aim of this systematic review was to evaluate the effectiveness of intracanal cryotherapy in reducing postoperative endodontic pain. A comprehensive search was conducted by accessing electronic databases like PubMed, Google Scholar, Google and EBSCO. Articles evaluating the effect of intracanal cryotherapy in reducing postoperative pain using different irrigating agents which were published till November 2020 were included in the study. Risk of bias was assessed using the Cochrane risk of bias criteria. Meta-analysis was performed for ten studies and tested the heterogeneity using I2 index. Qualitative and quantitative analysis was done for thirteen and ten studies respectively. Intracanal cryotherapy was found to be effective in reducing post-operative pain at 6 hours and 24 hours. Within the limitations of the study, it can be concluded that intracanal cryotherapy using cold saline or 17% EDTA at a temperature range of 2.5°C to 6°C as final irrigating agent helps in reducing postoperative pain at 6 hrs and 24 hrs following single-visit or multi visit root canal treatment in teeth diagnosed with irreversible pulpitis with apical periodontitis.

The effect of antibiotic use on endodontic post-operative pain and flare-up rate: a systematic review with meta-analysis.

Aim Antibiotics are widely used to prevent flare-ups after endodontic treatment of non-vital teeth. This systematic review assessed the effect of antibiotic administration on post-endodontic treatment pain and flare-up rate.Methods Five major databases including Web of Science, Cochrane Library, PubMed, Scopus and Embase were searched to identify randomised clinical trials (RCTs) published until September 2020. Retrieved papers were critically appraised using the revised Cochrane risk of bias tool (RoB 2). To reduce the clinical heterogeneity, the included studies were divided into two groups: studies on symptomatic non-vital teeth and studies on asymptomatic non-vital teeth. The primary outcomes were 'post-operative pain' and 'flare-up rate'. The data of included studies were statistically combined through meta-analysis using random-effect model. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of evidence.Results Six RCTs involving two RCTs (N = 61) on symptomatic teeth and four RCTs (N = 310) on asymptomatic teeth were included. In two RCTs on asymptomatic teeth, prophylactic antibiotic had been used, while in the remaining two RCTs, antibiotics had been administered after treatment. Quantitative synthesis of the RCTs showed that antibiotic administration following endodontic treatment of symptomatic non-vital teeth has no effect on pain severity at 24 hours following treatment (weighted mean difference [WMD] = -0.03; 95% confidence interval [CI]: -0.53 to 0.47), and the use of antibiotics before endodontic treatment of asymptomatic non-vital teeth has no effect on flare-up rate (relative risk [RR] = 0.58; 95% CI: 0.22-1.54). The GRADE approach revealed that the overall quality of evidence on the topic is low.Conclusions The antibiotic administration following endodontic treatment of symptomatic non-vital teeth has no effect on pain severity at 24 hours following treatment. Also, prophylactic antibiotics are ineffective in reducing the flare-up rate following treatment of asymptomatic non-vital teeth. However, to evaluate the effect of post-treatment antibiotics on flare-up rate in asymptomatic non-vital teeth, more high-quality RCTs are needed.

Bupivacaine for Root Canal Treatment - Practitioner Behaviors and Patient Perspectives: Survey Studies.

Introduction and ObjectivesLocal anesthesia is essential in dentistry in providing intraoperative analgesia and anesthesia. However, knowledge related to its use for management of post-operative pain is limited. Perioperative pain management is especially important for root canal treatment (ie, endodontic therapy), performed by endodontists. In this study, we sought to better understand endodontists’ attitudes regarding the use of long-lasting anesthetic, namely 0.5% bupivacaine HCl with 1:200,000 epinephrine, for the management of post-endodontic pain. Additionally, we aimed to understand the perspectives of dental patients about receiving longer lasting anesthesia for endodontic therapy and to determine factors that affect their anesthetic preferences within the orofacial region.MethodsAn email invitation to participate in an anonymous online survey was sent to members of the American Association of Endodontists. Also, 82 patients attending an in-person visit to an endodontic clinic were recruited to the study.ResultsData from 474 endodontic practitioners and 82 patients included in analysis. Among practitioners, the majority reported to either never (33.31%) or rarely (34.84%) using bupivacaine. Most chose “I don’t think I need it” (47%) and “patient discomfort because of longer duration of soft tissue anesthesia” (30.81%) as reasons for not preferring the use of bupivacaine. Of the practitioners who reported at least rare use, most chose bupivacaine for post-operative pain management (78.02%). Conversely, 52% of patients reported that they were likely/most likely to request long-lasting anesthetics for post-operative pain control.ConclusionBupivacaine is rarely used as a post-operative pain management strategy for endodontic therapy. Specifically, bupivacaine is not preferred not because of adverse events, toxicity, or slow onset concerns, but rather, because of longer duration of soft tissue anesthesia. However, our data suggest that patients may be willing to receive long-lasting anesthesia. Further patient-centered research should investigate the use of long-lasting anesthetic agents for management of post-endodontic pain.

Effectiveness of Single Dose Premedication of Piroxicam and Prednisolone on Post Endodontic Pain in One Visit Root Canal Treatment: A Randomized Clinical Trial.

The objective of this study was to compare the effectiveness of premedication drugs including single dose Piroxicam and Prednisolone in regard to post endodontic pain at different time intervals (24, 48, 72 and 96 hours) after single visit root canal treatment. This randomized clinical trial (registration no. NCT04124822) was performed in operative dentistry department of a private clinical institute. One hundred twenty patients identified with symptomatic irreversible pulpitis were included in the study. The pain intensity levels were marked through the use of visual analog scale (VAS) before the commencement of treatment. The participants were randomly allocated in three groups, Group I (n=40) received no medication (control), Group II (n=40) received Piroxicam (20 mg) and Group III (n=40) received Prednisolone (20 mg). The drugs were administered thirty minutes before the endodontic procedure was initiated. Root canal treatmentwas carried out followed by placement of provisional restoration in a single appointment. The patients were instructed to continue marking their pain intensity levels after 24, 48, 72 and 96 hours using VAS. All patients were called for follow up after 4 days for clinical evaluation and the placement of permanent restoration. The effectiveness of each drug over different time interval was studied employing ANOVA test. The significance level was set at P≤0.05. The results of the present study revealed that a higher percentage of patients in all 3 groups, reported no post-operative pain at all evaluated time durations (24, 48, 72, and 96 hours). However, the long term effectiveness (96 hours) of both drugs to reduce post-endodontic pain was observed to be statistically insignificant. There was no significant difference in demographic data in terms of age (P=0.14), gender (P=0.12), whilst tooth type (P≤0.05) showed statistically significant value. Pre-medication with either single dose piroxicam or prednisolone was able to prevent post-endodontic pain in patients with symptomatic irreversible pulpitis.

Post-endodontic pain with different engine-driven endodontic instruments in multi-visit root canal therapy: A systematic review and meta-analysis

Aim: Post-endodontic pain during root canal treatment (RCT) is inevitable. Previous meta-analysis reported a lesser post-endodontic pain in using continuous rotation instruments compared with using reciprocating instruments in a single-visit root canal therapy. No evidence has been elucidated to prove the same in multi-visit root canal therapy. The aim of this systematic review was to compare the intensity of post-instrumentation pain on using continuous and reciprocating motion engine-driven systems in multi-visit root endodontic treatment. Materials and Methods: An extensive literature search in PubMed, Cochrane Library, and Google Scholar was performed to identify investigations that evaluated the effect of continuous and reciprocating instrument systems on post-operative pain. The certainty of evidence was assessed using GRADEpro (GRADEpro GDT software, https://gradepro.org). We included two trials in this review, and their risk of bias was found to be low. A fixed-effects model was used to pool the mean post-operative pain as this was found by less heterogeneity. Results: Pooled results showed no difference in the mean post-instrumentation pain measured using a visual analog scale between continuous and reciprocating instrument systems with a mean difference of −0.13 (P = 0.48; I2 = 26%). Also pooled relative risk showed no difference in the risk for post-endodontic pain between continuous and reciprocating instrument systems with a relative risk of 0.53 (P = 0.08; I2 = 34%). Conclusion: The use of both continuous and reciprocating instruments had lower intensity of post-operative pain in patients who received multi-visit RCT with no significant difference between them. Further clinical trials with high quality are needed to understand the effect of continuous and reciprocal engine-driven instrumentation systems in multi-visit RCT.

Comparative evaluation of intracanal cryotherapy and curcumin as a final irrigant in reducing post endodontic pain in primary teeth.

The aim of this study was to evaluate the intracanal effectiveness of cryotherapy, curcumin irrigant, and normal saline as a final irrigant in reducing postendodontic pain in primary teeth. A total of 120 teeth between the ages of 4 and 7 years requiring pulpectomy in primary teeth were included in the study. The teeth were randomly assigned to one of the three treatment groups: intracanal cryotherapy using 2.5°C cold saline, curcumin irrigant, or normal saline. Following completion of chemomechanical preparation, final irrigation with 2.5°C cold saline, curcumin irrigant, and normal saline solution at room temperature were employed in the groups. Participants were asked to rate the severity of their postoperative pain on the Visual Analog Scale before, immediate postoperative after wearing of local anesthetic effect, and 24 h after the procedure. The results were analyzed statistically. The differences in reduction of postendodontic pain between the three irrigating regimens were statistically not significant. Cryotherapy utilizing 2.5°C cold saline or curcumin irrigant can be used instead of normal saline as a final irrigant in pulpectomy of primary teeth. Cryotherapy can be a straightforward, cost-effective, and nontoxic treatment option for the management of postendodontic pain. Curcumin irrigant with its anti-inflammatory properties is also a better alternative as a final irrigant for reducing postoperative pain in primary teeth.