Single-visit Endodontic Treatment Research Articles

Postoperative pain of single-visit endodontic treatment with gutta-percha versus MTA filling: a randomized superiority trial

BackgroundPostoperative pain has remained a challenge for clinicians. This randomized superiority trial compared the levels of postoperative pain following the use of gutta-percha (GP) and sealer or mineral trioxide aggregate (MTA) as root canal filling materials in teeth with asymptomatic apical periodontitis.MethodsA total of 119 patients were initially evaluated in this two-arm, parallel-group, single-blind, superiority randomized trial. The inclusion criteria were participants aged 18–65 years with single-canal premolars diagnosed with asymptomatic apical periodontitis. The participants were finally divided into two groups using the permuted block randomization method. In the GP group (N = 46), the cleaned and shaped root canals were filled with gutta-percha and AH Plus sealer, while in the MTA group (N = 48), the cleaned and shaped root canals were filled with an MTA apical filling and a coronal gutta-percha and sealer. Patient pain level was measured 6, 12, 24, 48, and 72 h postoperatively using a 10-point visual analog scale (VAS). The data were analyzed by the chi-square, independent t, Friedman, and Mann-Whitney U tests.ResultsThe mean of VAS scores decreased significantly over time in both groups (P < 0.001). The mean VAS scores were significantly lower in the MTA filling group than in the other group (P < 0.05). Female patients reported higher VAS scores at 6- and 12-hour periods in both groups (P < 0.05).ConclusionMTA as a root canal filling material might be a valuable option for clinicians due to its low postoperative pain.Trial registrationThe trial protocol was registered at the Registry of Clinical Trials (IRCT20191104045331N1).

Effect of Continuous Ultrasonic Irrigation on Postoperative Pain in Cases in Symptomatic Apical Periodontitis After Single Visit Endodontic Treatment

Objective: To examine and evaluate the efficacy of Continuous Ultrasonic Irrigation (CUI) in comparison to Syringe Irrigation (SI) with regards to the reduction of postoperative pain. : The clinical investigation was carried out at the Department of Operative Dentistry, Liaquat University of Medical and Health Sciences, Jamshoro, for a period of six months, starting from January 2021 and ending in June 2021. The study involved a total of 90 patients, and its objective was to assess pain levels experienced by the participants 24 hours and seven days after the surgical procedure. The Heft Parker Visual-Analogue Scale was utilized as the tool for pain measurement. Results: CUI yielded superior outcomes in terms of statistically significant postoperative pain reduction at the 24-hour when compared to syringe irrigation. Nevertheless, it was shown that syringe irrigation demonstrated more efficacy in mitigating postoperative discomfort on the seventh day. The findings also revealed statistically significant disparities in pain intensity between the two cohorts at the 24-hour mark and on the seventh day, with notable variations in pain levels based on gender.Conclusion: The efficacy of continuous ultrasonic irrigation in lowering postoperative pain was shown to be higher at the 24-hour mark, whereas syringe irrigation demonstrated greater effectiveness at the 7-day postoperative period.

Comparative evaluation of post-operative pain &amp; analgesic intake after root canal treatment using three bioceramic sealers- An In-vivo study

To evaluate the occurrence and intensity of post-operative pain &amp; number of analgesic tablets intake after single visit endodontic treatment using three different Bioceramic sealers.45 single rooted teeth diagnosed with asymptomatic irreversible pulpits requiring endodontic treatment were randomly assigned to three groups (n=15) according to sealer used during obturation. To avoid bias in post-operative pain perception, each sealer is evaluated in three different single rooted teeth of the same patient. The different groups are Group 1-MTA-Fillapex, Group –II Ceraseal RCS, Group-III BioRoot RCS. Single visit Endodontic treatment was performed and teeth were obturated using cold lateral compaction and different root canal sealers with no radiographic material extrusion beyond the apex. Severity of post obturation pain was assessed by Visual Analog Scale (VAS) with score ranging from 0 to 10 at 6hrs, 12hrs, 24hrs and 48hrs intervals. The need for analgesic (Tab. Aceclofenac 100 mg) intake was also recorded. Differences in incidence of postoperative pain were analyzed using the Kruskal Wallis test followed by Mann Whitneys Post Hoc to compare the mean VAS score &amp; number of analgesics taken between three groups at different time intervals (p&amp;#60;0.05).MTA Fillapex shows statistically significant difference in mean VAS score (more pain) at 6hrs, 12hrs (p value &amp;#60; 0.001) &amp; at 24hrs (p&amp;#60;0.005) than Ceraseal RCS and BioRoot RCS. There is statistically significant difference in the no. of analgesic intake for MTA Fillapex i.e., more tablets taken by the patient to relive pain (p&amp;#60;0.001) as compared to Ceraseal RCS and BioRoot RCS. The decrease in pain was statistically significant for each time intervals from 6hrs to 48hrs for all the three groups.The teeth of the patients where MTA Fillapex sealer was used as a sealer in the obturation showed significantly more pain at 6hrs &amp; 12hrs and needed to take more analgesics than teeth obturated with other two sealers. This probably could be due to leaching out of resin constituents from MTA Fillapex.

Single versus multiple visits endodontic therapy on healing rate of periapical lesions: A systematic review and meta-analysis

The choice of one or more sessions for the endodontic treatment of teeth with pulp necrosis and apical periodontitis is controversial. The purpose of this systematic review was to compare the radiographic healing of necrotic teeth with pre-existing periapical lesions after at least 1 year of follow-up period between two therapy groups: 1. single visit endodontic treatment, 2. multiple visits endodontic treatment with calcium hydroxide as intracanal medicament. It was made a literature search of only Randomized Controlled Trials (RCTs) on PubMed database. 5 RCTs met the inclusion and exclusion criteria and were included in this review, with a total sample size of 513 cases. Complete radiographic healing was observed in 226 (83.4%) of 271 cases treated in one visit and 198 (81.8%) of 242 cases treated in more than one visit. A meta-analysis was performed, showing no significant difference in the healing rate between the two therapy groups (fixed effect model, RR: 1.025; 95% Cl: 0.950 - 1.107). Based on the results of this study, endodontic treatment of teeth with pulp necrosis and radiographic evidence of apical periodontitis in one or more appointments showed similar radiographic healing rate.

Incidence of postoperative pain after using single continuous, single reciprocating, and full sequence continuous rotary file system: a prospective randomized clinical trial.

Extrusion of debris is a major factor that results in postoperative pain during root canal treatment with various instruments and instrumentation techniques. Therefore, instrumentation techniques that extrude minimal debris into the periapical area while reducing pain are desirable. This study aimed to compare the incidence of postoperative pain and intake of analgesic medication (frequency and quantity) after endodontic treatment of mandibular posterior teeth using two single files and full-sequence continuous rotary systems with different kinematic motions. Thirty-five of 105 patients were assigned equally to three groups according to the instrumentation system used: ProTaper Next (PN) X2, 25/06 (Dentsply, Maillefer, Ballaigues, Switzerland), One Shape (OS), #0.25/06 (Micro Mega, Besancon, France), and Wave One Gold (WG), Red - #0.25, 0.07 (Dentsply, Maillefer, Ballaigues, Switzerland). Five specialists were included in this study design; each professional prepared 21 teeth, and randomly selected 7 per instrument system. The VAS sheet ranging from 0 to 10 was used to record the initial and postoperative pains at 24, 48, and 72 h, and 7th day after single visit endodontic treatment in mandibular premolars and molars with a diagnosis of asymptomatic irreversible pulpitis with or without apical periodontitis. Postoperatively, an analgesic, ibuprofen 400 mg was administered for intolerable pain at a dose of 1 tablet for 6 h. The patients were asked over the telephone regarding postoperative pain at intervals of 24, 48, and 72 h, and 7th day using a visual analogue scale. There were no statistically significant differences among the PN, OS, and WG systems (P > 0.05) with regard to the incidence of postoperative pain at any of the four time points assessed. The intensity of postoperative pain, frequency, and analgesic intake were similar across all three types of instrument systems; however, the reciprocating single file (WG) was associated with less postoperative pain than the full sequence continuous rotary file.

Comparable Analysis of the Influence of Rotary File System with Reciprocating File System on Postobturation Pain after Single-sitting Endodontics: A Randomized Clinical Study

Abstract Aim: The objective of this study was to determine the influence of various factors (sex, class, and arch of tooth) on postoperative pain (PP) after use of Rotary ProTaper Gold (PTG) and Reciprocating WaveOne Gold (WOG) file system following single-visit endodontic treatment. Materials and Methods: One hundred and twenty patients requiring endodontic therapy were assessed for the study. Permanent posterior teeth with acute irreversible pulpitis and vital pulp were selected. Patients were blindly grouped and analyzed based on the files employed for single-visit endodontic treatment: “Group 1” (n = 60) was treated using PTG and “Group 2” (n = 60) in which WOG was used during biomechanical preparation. Patients selected were instructed to record the before and after treatment pain incidence using a Modified Verbal Descriptive Scale at 12, 24, and 48 h. Chi-square and Fisher’s exact tests were used for the data analysis (P ≤ 0.05). Results: Postobturation pain (PP) after single-visit root canal treatment using PTG and WOG showed a higher proclivity for females with a greater predilection for maxillary posteriors mainly premolars. Comparing PTG with WOG, the latter showed significantly less PP after 12 h (P = 0.559), 24 h (P = 0.559), and 48 h (P = 0.556), although the difference between the two was insignificant (P &gt; 0.05). Conclusion: Postobturation pain incidence was higher when canals were instrumented with PTG than WOG file system following single-visit endodontics.

Comparative Evaluation of Periapical Healing Outcome Following Non Surgical Endodontic Treatment in Single-visit versus Multiplevisit in Type 2 Diabetes Mellitus Patients: A Randomised Clinical Study

Introduction: Apical periodontitis is very common in those with diabetes mellitus. Diabetes alters immunity, which impacts how periapical tissue heals. The decision between one-visit and multiple-visit root canal therapy is currently up for debate. Aim: To compare periapical healing following single-visit endodontic therapy and multiple-visit endodontic therapy in type 2 diabetic patients by clinical assessment. Materials and Methods: The present randomised singleblinded clinical trial was conducted in the Department of Conservative Dentistry and Endodontics, KM Shah Dental College and Hospital, Vadodara, Gujarat, India, from December 2017 to October 2019. A total of 46 patients having type 2 diabetes, indicated for root canal treatment participated in the study and were randomly split into two groups: group I: Single-visit endodontic treatment and group II: Multiple-visit endodontic treatment. Thereafter, endodontic treatment was carried out on all the patients and the patients were recalled for evaluation at 1-week, 3-month and 6-month time intervals. The clinical assessment was done based on the absence of pain, swelling and sinus tract formation. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) software version 20.0. Results: Results showed that the success rate based on clinical assessment at one week for a single-visit and multi-visit group was 56.52% for both the groups and at three months 90.47% and 86.36%, respectively. At six months, the single-visit group reported 100% success, while the multi-visit group reported 95% success. However, the difference between the groups was not statistically significant. Conclusion: Within the limitation of the study, it was concluded that clinically, a higher success rate was found after six months in patients having type 2 diabetes mellitus who were treated in a single-visit, which was not statistically significant.

Comparative evaluation of postoperative pain after single-visit endodontic treatment using protaper gold and hyflex electrical discharge machining rotary file system

Background: Endodontics has a widened range due to its increase in success rate and increase in lifespan of individuals. As of today, extracting the tooth has become a rare situation, and endodontic intrusion has become a custom. Although after having detailed knowledge about the internal anatomy of tooth, it is a must to know about the upcoming evolution of instruments as well as materials and complete knowledge regarding techniques of treatment modalities. Postoperative pain could leave a significant control on the quality of life, which will begin after completion of endodontic treatment having a range of 3%–58% cases. Materials and Methods: Twenty-six patients with irreversible pulpitis were selected for single-visit endodontics. The teeth were blindly assigned to two groups based on the instrumentation systems used: Group A (Protaper Gold) and Group B (Electrical Discharge Machining [EDM] Hyflex). Participants were asked to note the incidence of preand postoperative pain on the Visual Analog Scale at different time intervals. Results: The greatest mean pain in both Group A and B was found to be maximum in the first 24 h, with a significant reduction in pain at the subsequent observation time points of 48 h, 72 h, and 7 days. The least painful group was Group A, followed by Group B. Conclusion: In single-visit endodontics, both Protaper Gold and EDM Hyflex both may prove to be a better system, but according to statistics Protaper gold being slightly superior as it produces minimal postoperative pain, thus improving the overall acceptance of endodontic treatment.

Incidence of Postoperative Pain after Single Visit Root Canal Treatment using XP-endo Shaper, 2Shape and ProTaper Gold Rotary Systems: A Prospective Randomized Clinical Trial.

To evaluate the incidence of postoperative pain, treatment time and analgesic intake after single visit endodontic treatment of mandibular molars using XP-endo Shaper, 2Shape and ProTaper Gold rotary systems. 150 patients with irreversible pulpitis were scheduled for single visit root canal treatment. Teeth were randomly assigned to one of the three groups: ProTaper Gold (PTG; Dentsply Tulsa Dental Specialties, Johnson City, TN), 2Shape (2S; Micro-Mega, Besancon, Cedex, France) and XP-endo Shaper (XPES; FKG Dentaire, La Chaux-de-Fonds, Switzerland). Preoperative and postoperative pain was rated by the patients at the beginning of treatment and after 24, 48, 72 hours and 7 days on Heft Parker's visual analog scale (HP-VAS). Highest mean postoperative pain score was recorded in PTG (P<0.05), followed by 2S and XPES respectively at all time intervals. XPES exhibited maximum reduction from preoperative pain at 24 (48.67%) and 48 hours (96.90 %) with no pain at 72 hours. Treatment time was significantly least in XPES (P<0.05) followed by 2S and PTG; but no significant difference in analgesic intake was noted. XPES exhibited least postoperative pain at all time intervals and treatment time, followed by 2S and PTG rotary systems respectively. (EEJ-2022-04-053).

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

Evaluation of Postoperative Pain Following Sonic and Ultrasonic Root Canal Irrigation Activation Protocols in Patients with Non-vital Teeth Associated with Apical Periodontitis (Randomized Clinical Trial

Aim: Evaluate the degree of postoperative pain in patients with necrotic teeth with symptomatic apical periodontitis in mandibular first molar teeth at 6, 12, 24, 48 and 72 hrs time interval after using different irrigation activation techniques in single-visit endodontic treatment. Material and Methods: Seventy-eight patients diagnosed with necrotic mandibular first molar with symptomatic apical periodontitis were randomly allocated into 1 of 3 separate groups (n=26); Navitip group (control), EndoUltra group, or Eddy group. After a single visit root canal treatment and a specific method of agitation, depending on each group, the patients were given a questionnaire on which the patient would mark the degree of pain in a scale from 0 to 10 at 6, 12, 24, 48, 72 hours and 7 days post-obturation. Data were statistically analyzed with a significance level of P≤0.05. Results: EndoUltra ultrasonic agitation and Eddy sonic agitation as a final irrigation protocol showed significantly lower pain values than the control group, but there was no significant difference in pain values between the experimental groups. Conclusion: There was significantly less pain associated with EndoUltra ultrasonic and Eddy sonic agitation compared to Navitip irrigation

Comparison of Post-Operative Pain Frequency After Single visit and Multiple visit Root Canal Treatment in Non-Vital Teeth

OBJECTIVES: Root canal treatment (RCT) is performed to get rid of pain resulting from the infection in the tooth. It is a safe procedure with high success rate. One of the main issues with root canal treatment is post-operative pain. There are many factors which can cause pain and distress to patients. If the clinician follows the guidelines properly and use the anxiety reduction protocol, then the procedure is not painful. RCT can be performed in multiple visits or it can be done in single visit. Present research was conducted to compare the single visit versus multiple visits endodontic treatment in teeth with pulpal necrosis in terms of post-operative pain frequency. METHODOLOGY: This study was a randomized controlled trial conducted at Department of Operative Dentistry, Fatima Memorial Hospital, Lahore, over a period of six months. Total number of participants was 302 and the teeth were lower and upper first and second molars with pulp necrosis and they were were equally assigned in two groups of 151with equal number of men and women. Single visit RCT was done in Group A patients, in which the endodontic procedure was performed in one day and multiple visit RCT was done in Group B, in which endodontic treatment was done in two or more visits. RESULTS: In necrosed teeth single visit endodontic treatment 20.5(%) resulted in less frequent post-operative pain than in multiple visit endodontic treatment (26.5%). CONCLUSION: Single visit endodontic treatment is a better technique in terms of pain control as compared to multiple visit in teeth with pulp necrosis. KEYWORDS: Endodontics, Non-vital teeth, Post-operative pain, single visit root canal treatment, multiple visit root canal treatment.

Evaluation of Single Visit Endodontic Treatment Outcome in Teeth with Asymptomatic Necrotic Pulp and Apical Periodontitis Using EndoVac Irrigation Device: Randomized Controlled Clinical Trial

Evaluation of Single Visit Endodontic Treatment Outcome in Teeth with Asymptomatic Necrotic Pulp and Apical Periodontitis Using EndoVac Irrigation Device: Randomized Controlled Clinical Trial

Effect of Ultrasonic and Diode Laser Irrigation Activation on Post-operative Pain and Microbial Reduction in Single Visit Endodontic Treatment of Necrotic Mandibular Molars

Aim: To clinically evaluate the effect of continuous ultrasonic and diode laser 810 wave length irrigation activation techniques on postoperative pain and bacterial reduction in single visit endodontic treatment of mandibular molars.&#x0D; Material and methods: Forty patients requiring root canal treatment therapy for necrotic mandibular molars teeth were included in this study with age ranges between 20 and 45 years. In all cases, single visit endodontic treatment was carried out using Revo-S rotary file system in crown down sequence. NaOCl 2.5% irrigation solution was used during treatment. Patients were randomly and equally assigned into two groups according to irrigation technique. Group (1): conventional syringe irrigation and group (2): continuous ultrasonic irrigation. Each group was subdivided into two sub groups (n = 10); subgroup 1A (conventional syringe irrigation with no laser), subgroup 1B (conventional syringe irrigation with diode laser), subgroup 2A (continuous ultrasonic irrigation with no laser) and subgroup 2B (continuous ultrasonic irrigation with diode laser).&#x0D; Postoperative pain evaluation was done using Visual Analogue Scale (VAS) at 6, 12, 24, 36, 48 hours and 7 days postoperatively. Microbiological detection of bacterial reduction was done by taking Samples (S1 and S2) for bacterial cultures. S1 after finishing access cavity and before mechanical preparation and S2 after finishing mechanical preparation and irrigation activation and before obturation. Samples were cultured on blood agar and determined as colony forming units (CFU/mL). Microbiological bacterial reduction was calculated accordingly. Statistical analyses were analyzed using the Mann-Whitney U test. The significance level was set at p &lt; 0.05.&#x0D; Results: In all sub groups, postoperative pain decreased by time in all time intervals but pain was significantly lower in subgroup (2B) (continuous ultrasonic irrigation with diode laser) than subgroup (1A) (conventional syringe irrigation with no laser) in all time interval. Microbiological results showed the highest bacterial reduction was in subgroup (2B) (continuous ultrasonic irrigation with diode laser) and least bacterial reduction was in subgroup (1A) (conventional syringe irrigation with no laser).&#x0D; Conclusion: Using diode laser and continuous ultrasonic irrigation activation techniques as adjunctive methods showed improvement in postoperative pain records and enhanced bacterial reduction in root canal therapy.&#x0D; Keywords: Continuous ultrasonic irrigation, diode laser 810, post-operative pain, bacterial reduction, single visit endodontic treatment.

Comprehensive assessment of post operative pain in single versus multiple visit endodontic treatment attempted in maxillary lateral incisors

Aim: This incidence based study was conducted to comprehensively assess the incidence of post-operative pain in single and multiple visit endodontic treatment attempted in maxillary lateral incisors.&#x0D; Materials &amp; Methods: This study was designed to conduct on the treated patient of department OPD. Patients were firstly explained about the study and asked to voluntarily participate in this study. Total 40 patients (both males and females) were selected and assessed for their reactions. Single rooted maxillary lateral incisors were included in the study. For ease of study, all participants were separated into two major study groups of 20 each. Group one has all participants wherein root canal treatment was completed in one visit. Group two has all participants wherein root canal treatment was completed in more than one visit (multiple). Estimation of pain in post-treatment visits was conducted by Visual Analogue Scale. Patients were explained about user instructions of this scale. They requested to make responses on VAS scale with prefixed values. Pain was observed on VAS scale in follow up stages of 12, 24 and 36 hours.

Assessment of Post-operative Pain after using EdgeFile X7 and Protaper Next Rotary Systems in Patients with Symptomatic Pulpitis in Mandibular Molars: A Randomized Controlled Clinical Trial

AIM: The aim of the study was to evaluate the incidence of post-operative pain and analgesics intake after single-visit endodontic treatment using Edge File X7 and ProTaper Next (PTN) rotary files in mandibular molars having symptomatic pulpitis. METHODS: The study included 60 patients complaining of symptomatic pulpitis in mandibular molar teeth. After confirming the diagnosis clinically and radiographically, patients were assigned into two equal groups; Group (I): Instrumentation was done with Edge File X7 (EF) rotary files and Group (II): Instrumentation was done with PTN rotary files. The patients underwent standardized single visit endodontic treatment procedures using 2.5% sodium hypochlorite for irrigation. Modified visual analogue scale was used to access pain preoperatively, and then postoperatively after 6, 12, 24, 48, and 72 h. An analgesic (ibuprofen 400 mg) was prescribed to the patient who suffered from persistent pain. The incidence and/or number of analgesic tablets intake were recorded. Data of pain score were compared using Mann–Whitney U test for intergroup comparisons and Freidman’s test followed by Dunn’s post hoc test for intragroup comparisons. RESULTS: No statistically significant difference was detected between EF and PTN groups regarding the incidence and intensity of pain at different time intervals (p &gt; 0.05). There was a significant reduction in the mean VAS score through the follow-up periods in both groups (p &lt; 0.001). The incidence of analgesic intake was not significant in both groups. CONCLUSION: The incidence of post-operative pain and the analgesic intake in terms of frequency and quantity were found to be similar with both rotary systems for all the post-operative time points.

The Effect of Premedication with Curcumin on Post-operative Pain in Single Visit Endodontic Treatment of Acute Pulpitis in Mandibular Molars: A Randomized Controlled Trial

The Effect of Premedication with Curcumin on Post-operative Pain in Single Visit Endodontic Treatment of Acute Pulpitis in Mandibular Molars: A Randomized Controlled Trial

The Effect of Premedication with Curcumin on Post-Operative Pain in Single Visit Endodontic Treatment of Acute Pulpitis in Mandibular Molars: A Randomized Controlled Trial

Objective: The purpose of this randomized double-blind clinical trial was to compare the effect of a single pretreatment dose of Curcumin and placebo on post-operative pain for patients diagnosed with symptomatic irreversible pulpitis in mandibular molars treated in single visit. Methods: Forty-four patients with severe to moderate pain randomly received either Curcumin (400mg +20 mg pepper) or placebo (420 mg Starch) one hour before starting root canal treatment (n = 22 per group). Participants rated their pain using visual analogue pain scale (VAS): preoperatively and at 5 time points: immediately post-operative, 8, 12, 24 and 48 hours postoperative. Patients also stated emergency analgesic intake. The need for supplemental anesthesia during treatment was recorded. Mann-Whitney U-test compared the two groups at each time point, while Repeated-Measure ANOVA and Wilcoxon Signed Rank test compared time points within each group. A p-value &lt;0.05 was considered statistically significant. Results: Baseline characteristics of both groups showed non-significant differences (P &gt; 05). Curcumin group at 8, 12 and 24 hours revealed statistically significantly less VAS values (44.2, 26.7, 19.1) than the placebo (58.5, 43.3, 30.3), respectively, (P &gt; 05). All patients in Curcumin group did not need emergency analgesics. Curcumin group revealed statistically significantly lower percentages for the need of supplemental anesthesia (27.3%) compared to placebo (68.2%), (P &lt; 05). Conclusion: Single preoperative oral dose of Curcumin proved to be an effective premedication that reduced post-operative pain as well as the need of supplemental anesthesia for patients diagnosed with symptomatic irreversible pulpitis of mandibular molars.

Assessment of Antimicrobial Efficacy of Nano Chitosan, Chlorhexidine, Chlorhexidine/Nano Chitosan Combination versus Sodium Hypochlorite Irrigation in Patients with Necrotic Mandibular Premolars: A Randomized Clinical Trial

AIM: The study was done to assess the antimicrobial effectiveness of Chitosan Nanoparticles (CNPs), Chlorhexidine (CHX), and their combination (CHX/CNPs) versus that of Sodium hypochlorite (NaOCl) in patients with mandibular necrotic premolars and to evaluate their effects on post-operative pain after single-visit endodontic treatment. MATERIALS AND METHODS: Sixty patients with necrotic mandibular premolars were divided randomly to four groups (n = 15) according to the used irrigating solution. Instrumentation was done using rotary ProTaper files. During instrumentation, irrigation was done using 2.5% NaOCl; afterward, canals were flushed with sterile saline. A final flush with the study irrigants was done as follows: 3% CNPs for Group A, 2% CHX for Group B, CHX/CNPs for Group C, and 5.25% NaOCl for Group D. Samples were collected from root canals before and after canal preparation then cultured to assess the number of colony-forming units/ml. All patients were instructed to record their pre- and post-operative pain levels on a numerical rating scale. RESULTS: CNPs and CHX/CNPs were significantly more effective than either CHX or NaOCl; however, there was no significant difference between them against anaerobic bacteria. All tested irrigants were similarly effective against aerobic bacteria. CNPs and CHX/CNPs were associated with significantly lower post-operative pain levels in the first 24 h after treatment. CONCLUSIONS: CNPs and its combination with CHX are significantly more effective than both CHX and NaOCl against anaerobic bacteria isolated from necrotic mandibular premolars. Post-operative pain intensity was significantly lower with CNPs and CNPs/CHX combination than with either NaOCl or CHX.

Effect of Apical Patency on Postoperative Pain after Single-visit Endodontic Treatment in Necrotic Teeth with Asymptomatic Apical Periodontitis: A Randomised Control Trial.

To find out the effect of apical patency on postoperative pain after single-visit endodontic treatment in necrotic teeth with asymptomatic apical periodontitis. Single blind randomised clinical trial. Department of Operative Dentistry, Armed Forces Institute of Dentistry, Rawalpindi, Pakistan, from June to December 2020. A total of 240 patients with good general health presenting with asymptomatic apical periodontitis in their mandibular first molar teeth were selected and randomly divided into two equal groups with the help of scientific number table. Endodontic therapy was initiated and root canals were prepared with ProTaper Next system. In the Patency group, a size 10 K-file was used as patency file and carried 01mm beyond working length between successive files. In the non-patency group, the file was carried till the working length. Obturation was done with cold lateral condensation using Pro Taper Next GP points, and permanent restoration was done with composite. The patients were informed to record pain scores after 24 and 48 hours and bring the VAS after one week. The data was analysed using SPSS version 22. There were 137 (57.08%) female and 103 (42.92%) male patients; 78 (65%) of patients in Patency group and 67 (55.83%) in Non-patency group, had no pain after 24 hours (p=0.345). In Patency group, 101 (84.17%) patients had no pain after 48 hours as compared to 98 (81.67%) patients of Non-patency group (p = 0.649). So apical patency reduced pain, but not in statistically significant proportion. Maintaining apical patency in necrosed teeth with asymptomatic apical periodontitis does not significantly reduce postoperative pain after single visit endodontic treatment. Key Words: Apical patency, Postoperative pain, Asymptomatic apical periodontitis.