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Nosrat A, Valancius M, Mehrzad S, Dianat O, Verma P, Aminoshariae A, Fouad AF. Flare-ups After Nonsurgical Retreatments: Incidence, Associated Factors, and Prediction. J Endod 2023; 49:1299-1307.e1. [PMID: 37451334 DOI: 10.1016/j.joen.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/28/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION The aims of this study were to determine the incidence, associated factors, and predictability of flare-ups after nonsurgical retreatments (NSRetx). METHODS All patients (n = 3,666) who received NSRetx by 3 endodontists in 2 endodontic offices during a period of 6 years (2016-2022) were included. Demographic, diagnostic, and procedural data were collected. A flare-up was defined as moderate-severe pain with/without swelling that took place within 14 days of initiation of NSRetx and resulted in an unscheduled appointment. Bivariate analyses on the entire cohort and multivariable analyses on cases with complete dataset (n = 2,846) were performed to identify significant associations. A Random Forest algorithm was used to make a prediction model. RESULTS Incidence of flare-ups was 3.95% (n = 145). Increased risk of flare-ups was associated with diabetes (adjusted odds ratio [AOR] = 2.01; 95% confidence interval [CI], 1.01-3.97), mandibular teeth (AOR = 1.67; 95% CI, 1.11-2.52), moderate-severe preoperative pain on percussion (AOR = 2.13; 95% CI, 1.31-3.50), and pain on palpation (AOR = 1.63; 95% CI, 1.01-2.64). Lower risk of flare-up was associated with high blood pressure (AOR = 0.44; 95% CI, 0.21-0.82) (P < .05). The prediction model was not able to predict flare-ups with sufficient confidence (precision = 0.13). CONCLUSIONS Incidence of flare-ups following NSRetx was low (∼4%) and had a weak but significant association with the history of diabetes. Moderate-severe pain on percussion, pain on palpation (any intensity), and mandibular teeth had a significant association with flare-ups. The history of high blood pressure was associated with lower risk of flare-ups. Flare-ups were difficult to predict in this clinical setting.
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Affiliation(s)
- Ali Nosrat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland; Private Practice, Centreville Endodontics, Centreville, Virginia.
| | - Michael Valancius
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Sahar Mehrzad
- Bernard J. Dunn School of Pharmacy, Shenandoah University, Fairfax, Virginia
| | - Omid Dianat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland; Private Practice, Centreville Endodontics, Centreville, Virginia
| | - Prashant Verma
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland; Private Practice, Centreville Endodontics, Centreville, Virginia; Private Practice, Capitol Endodontics, Washington, District of Columbia
| | - Anita Aminoshariae
- Department of Endodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Ashraf F Fouad
- Department of Endodontics, School of Dentistry, The University of Alabama at Birmingham, Birmingham, Alabama
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Kandemir Demirci G, Miçooğulları Kurt S, Serefoglu B, Kaval ME, Çalışkan MK. The influence of different NiTi instrumentation techniques on postoperative pain after single-visit root canal treatment. AUST ENDOD J 2021; 47:559-568. [PMID: 34278665 DOI: 10.1111/aej.12547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/27/2021] [Accepted: 07/04/2021] [Indexed: 11/30/2022]
Abstract
This study aimed to evaluate the effect of multi-file rotary (Protaper Universal) and reciprocating single-file (Reciproc Blue) root canal preparation techniques on the occurrence of postoperative pain in asymptomatic mandibular molar teeth with large periapical lesions in single-visit root canal treatment (RCT). A hundred and twenty teeth were randomly assigned to two groups: Protaper Universal (PTU) or Reciproc Blue (RB) instruments. Postoperative pain at 6, 12, 24, 48, 72 h and 7 days after obturation was measured. Mann-Whitney U-test was performed to compare the pain scores between the groups and to assess the relation of pain with patients' age and gender. Spearman's rank correlation was utilized to correlate the pain intensity and analgesic intake at different time points. There was no significant difference between the instrumentation techniques regarding postoperative pain at any time points evaluated (P > 0.05). There was a correlation between analgesic intake and intensity of pain (P < 0.05). No statistically significant difference was found among the groups assessed in the study in terms of analgesic intake (P > 0.05).
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Affiliation(s)
| | | | - Burcu Serefoglu
- Department of Endodontology, School of Dentistry, Ege University, Izmir, Turkey
| | - Mehmet E Kaval
- Department of Endodontology, School of Dentistry, Ege University, Izmir, Turkey
| | - Mehmet K Çalışkan
- Department of Endodontology, School of Dentistry, Ege University, Izmir, Turkey
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Shabbir J, Khurshid Z, Qazi F, Sarwar H, Afaq H, Salman S, Adanir N. Effect of Different Host-Related Factors on Postoperative Endodontic Pain in Necrotic Teeth Dressed with Interappointment Intracanal Medicaments: A Multicomparison Study. Eur J Dent 2021; 15:152-157. [PMID: 33511602 PMCID: PMC7902120 DOI: 10.1055/s-0040-1721909] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objectives
The current study aimed to assess the impact of factors such as age, gender, and the tooth type on postoperative endodontic pain in necrotic teeth with symptomatic periapical periodontitis and radiolucency dressed randomly with either calcium hydroxide or propolis paste.
Materials and Methods
The standard chemomechanical root canal preparation of 80 teeth was performed by the primary investigator. The intracanal medicaments were inserted by the secondary operator. Patients self-recorded their postoperative endodontic pain intensity with the help of visual analog scale at 4, 12, 24 (day 2), 48 (day 3), and 72 (day 4) hours. During analysis, patients (68/80) were grouped according to gender, age, and the tooth type.
Statistical Analysis
Mann–Whitney’s
U
test was applied for mean pain score comparison between genders and between tooth type. Kruskal–Wallis’ test was applied for mean pain score comparison between the age groups.
Results
No significant difference (
p
> 0.05) in pain scores was found between the age groups and between the tooth types. Males had significantly higher pain scores as compared with females at days 2 (
p
= 0.035), 3 (
p
= 0.023), and 4 (
p
= 0.020).
Conclusion
The results suggested that there was no impact of age and tooth types on postoperative endodontic pain.
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Affiliation(s)
- Juzer Shabbir
- Department of Operative Dentistry and Endodontics, Dow International Dental College, Dow University of Health Sciences, Karachi, Pakistan.,Department of Operative Dentistry and Endodontics, Liaquat College of Medicine and Dentistry, Karachi, Pakistan
| | - Zohaib Khurshid
- Department of Prosthodontics and Dental Implantology, College of Dentistry, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Fazal Qazi
- Department of Operative Dentistry and Endodontics, Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan
| | - Huma Sarwar
- Department of Operative Dentistry and Endodontics, Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan
| | - Hasan Afaq
- Department of Operative Dentistry and Endodontics, Baqai Medical University, Karachi, Pakistan
| | - Saima Salman
- Department of Operative Dentistry and Endodontics, Hamdard University Dental Hospital, Karachi, Pakistan
| | - Necdet Adanir
- Department of Restorative Dentistry, College of Dentistry, King Faisal University, Al Ahsa, Saudi Arabia
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Nosrat A, Dianat O, Verma P, Nixdorf DR, Law AS. Postoperative Pain: An Analysis on Evolution of Research in Half-Century. J Endod 2020; 47:358-365. [PMID: 33271179 DOI: 10.1016/j.joen.2020.11.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/23/2020] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Examining the evolution of research parameters helps scientists to discover the well-developed and neglected aspects of knowledge. Pain after root canal treatment is a health problem affecting millions of patients. Research in this field has a meaningful impact on quality of lives. The aim of this study was to analyze the evolution of research on postoperative pain over the past 50 years. METHODS Electronic searches were performed in Scopus and MEDLINE databases to identify studies on pain after nonsurgical root canal treatments/retreatments. The full texts of eligible articles were reviewed to determine the study category and to extract and analyze the methodological variables. A series of statistical analyses were performed to determine the trend of publications based on the variable of interest over time. RESULTS Four hundred twenty-four articles were included. There was a positive trend for systematic reviews, studies with sample size <200, studies on single-visit treatment, and clinical trials on instrumentation and adjunct treatments (P < .05). There was a negative trend for the use of numeric rating scales, studies on multiple-visit treatments, clinical trials on medication/medicament, and studies on pain in maxillary incisors (P < .05). No trend was observed based on pulpal diagnosis or for studies with longer observation periods (>8 weeks) (P > .05). CONCLUSIONS A paradigm shift is needed toward clinical studies with larger sample sizes, longer observation periods, and more focus on pulpal diagnoses associated with higher rates of postoperative pain. There is a need to view postoperative pain as an important patient-centered outcome and to develop and disseminate standard reporting guidelines for future studies.
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Affiliation(s)
- Ali Nosrat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Maryland; Private Practice, Centreville Endodontics, Centreville, Virginia.
| | - Omid Dianat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Maryland
| | - Prashant Verma
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Maryland; Private Practice, Centreville Endodontics, Centreville, Virginia; Private Practice, Capitol Endodontics, Washington, DC
| | - Donald R Nixdorf
- Division of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, Minneapolis, Minnesota; Department of Neurology, Medical School, University of Minnesota, Minneapolis, Minnesota; HealthPartners Institute for Education and Research, Bloomington, Minnesota
| | - Alan S Law
- Private Practice, The Dental Specialists, Lake Elmo, Minnesota; Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, Minnesota
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Villa-Machado PA, Restrepo-Patiño DM, Calvo-Trejos JP, Restrepo-Restrepo FA, Tobón-Arroyave SI, Provenzano JC, Siqueira JF, Alves FRF. Cone-beam Computed Tomographic and Micro-computed Tomographic Evaluations of the Root Apexes of Teeth with Posttreatment Apical Periodontitis. J Endod 2020; 46:1695-1701. [PMID: 32682792 DOI: 10.1016/j.joen.2020.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/05/2020] [Indexed: 01/06/2023]
Abstract
INTRODUCTION This study evaluated the association of different variables that may influence the outcome of root canal treatment through cone-beam computed tomographic (CBCT) and micro-computed tomography (micro-CT) assessments of root apexes obtained by endodontic microsurgery of teeth with posttreatment apical periodontitis (AP), the agreement between CBCT and micro-CT findings, and the association of these variables with symptoms or lesion size. METHODS Clinical and CBCT records and root apexes obtained by endodontic microsurgery from 11 cases of symptomatic AP and 22 cases of asymptomatic AP were available. Apical root specimens were further scanned using micro-CT imaging. CBCT parameters included periapical radiolucency size, apical extent/density of root canal filling, and occurrence of procedural errors. Micro-CT images evaluated the same parameters plus the presence of filling material in lateral canals and ramifications, the volume of the filled/nonfilled apical root canal, and the percentage of the nonfilled canal space. The agreement between CBCT/micro-CT observations was evaluated. RESULTS Mandibular teeth, a lesion size <5 mm, a nonfilled volume <0.04 mm3, and the decreased percentage of the nonfilled canal volume were significantly associated with symptomatic AP. Maxillary teeth and inadequate apical filling density were significantly associated with larger lesions. Agreement between CBCT/micro-CT scores varied from fair (procedural errors) to satisfactory (extent/density of filling). CONCLUSIONS Tooth location, lesion size, the nonfilled apical canal volume, and the percentage of the nonfilled apical canal volume were associated with symptomatic AP. In addition, lesion size was significantly associated with tooth location and apical root canal filling density. CBCT imaging may not provide a reliable evaluation of procedural errors associated with posttreatment disease.
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Affiliation(s)
- Paula A Villa-Machado
- POPCAD Research Group, Laboratory of Immunodetection and Bioanalysis, Faculty of Dentistry, University of Antioquia, Medellín, Colombia
| | - Diana M Restrepo-Patiño
- POPCAD Research Group, Laboratory of Immunodetection and Bioanalysis, Faculty of Dentistry, University of Antioquia, Medellín, Colombia
| | - Juliana P Calvo-Trejos
- POPCAD Research Group, Laboratory of Immunodetection and Bioanalysis, Faculty of Dentistry, University of Antioquia, Medellín, Colombia
| | - Felipe A Restrepo-Restrepo
- POPCAD Research Group, Laboratory of Immunodetection and Bioanalysis, Faculty of Dentistry, University of Antioquia, Medellín, Colombia
| | - Sergio I Tobón-Arroyave
- POPCAD Research Group, Laboratory of Immunodetection and Bioanalysis, Faculty of Dentistry, University of Antioquia, Medellín, Colombia.
| | - José C Provenzano
- Department of Endodontics and Dental Research Group, Iguaçu University, Nova Iguaçu, Rio de Janeiro, Brazil
| | - José F Siqueira
- Department of Endodontics and Dental Research Group, Iguaçu University, Nova Iguaçu, Rio de Janeiro, Brazil; Postgraduate Program in Dentistry, University of Grande Rio, Duque de Caxias, Rio de Janeiro, Brazil
| | - Flávio R F Alves
- Department of Endodontics and Dental Research Group, Iguaçu University, Nova Iguaçu, Rio de Janeiro, Brazil; Postgraduate Program in Dentistry, University of Grande Rio, Duque de Caxias, Rio de Janeiro, Brazil
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Emara RS, Abou El Nasr HM, El Boghdadi RM. Evaluation of postoperative pain intensity following occlusal reduction in teeth associated with symptomatic irreversible pulpitis and symptomatic apical periodontitis: a randomized clinical study. Int Endod J 2018; 52:288-296. [DOI: 10.1111/iej.13012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/28/2018] [Indexed: 01/17/2023]
Affiliation(s)
- R. S. Emara
- Department of Endodontics Faculty of Oral and Dental Medicine Cairo University Cairo Egypt
| | - H. M. Abou El Nasr
- Department of Endodontics Faculty of Oral and Dental Medicine Cairo University Cairo Egypt
| | - R. M. El Boghdadi
- Department of Endodontics Faculty of Oral and Dental Medicine Cairo University Cairo Egypt
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7
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Saumya-Rajesh P, Krithikadatta J, Velmurugan N, Sooriaprakas C. Post-instrumentation pain after the use of either Mtwo or the SAF system: a randomized controlled clinical trial. Int Endod J 2016; 50:750-760. [DOI: 10.1111/iej.12702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 09/19/2016] [Indexed: 12/14/2022]
Affiliation(s)
- P. Saumya-Rajesh
- Department of Conservative Dentistry and Endodontics; Meenakshi Ammal Dental College and Hospital; Meenakshi University; Chennai Tamil Nadu India
| | - J. Krithikadatta
- Department of Conservative Dentistry and Endodontics; Meenakshi Ammal Dental College and Hospital; Meenakshi University; Chennai Tamil Nadu India
| | - N. Velmurugan
- Department of Conservative Dentistry and Endodontics; Meenakshi Ammal Dental College and Hospital; Meenakshi University; Chennai Tamil Nadu India
| | - C. Sooriaprakas
- Department of Conservative Dentistry and Endodontics; Meenakshi Ammal Dental College and Hospital; Meenakshi University; Chennai Tamil Nadu India
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8
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Onay EO, Ungor M, Yazici AC. The evaluation of endodontic flare-ups and their relationship to various risk factors. BMC Oral Health 2015; 15:142. [PMID: 26577095 PMCID: PMC4647657 DOI: 10.1186/s12903-015-0135-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 11/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the incidence of flare-ups and identify the risk factors including age, gender, tooth type, number of root canals, initial diagnosis, the type of irrigation regimen, treatment modality and the number of visits, in patients who received root canal treatment from January 2002 to January 2008. METHODS Records of 1819 teeth belonging to 1410 patients treated by 1 endodontics specialist during 6-year period were kept. Patient, tooth, and treatment characteristics were evaluated and the relationships between these characteristics and flare-ups were studied. Statistical analysis was carried out by using Pearson Chi-square test, Fisher's Exact test, and Binary Logistic regression analyses. RESULTS The incidence of flare-ups was 59 (3.2 %) out of 1819 teeth that received endodontic therapy. Pulpal necrosis without periapical pathosis was the most common indication for flare-up (6 %) (p < 0.01). Teeth undergoing multiple visits had a higher risk of developing flare-ups compared to those with single appointments (OR: 3.14, CI: 1.414-7.009, p < 0.01). There were also no statistically significant differences in the incidence of flare-ups regarding to age, gender, tooth type, number of root canals, treatment modality, and the irrigation solutions that used during the treatment. CONCLUSIONS The incidence of flare-up is minimal when teeth are treated in one visit. Absence of a periapical lesion in necrotic teeth is a significant risk factor for flare-ups.
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Affiliation(s)
- Emel Olga Onay
- Department of Endodontics, Baskent University, School of Dentistry, 82 sok No 26, 06490, Bahcelievler, Ankara, Turkey.
| | - Mete Ungor
- Department of Endodontics, Baskent University, School of Dentistry, 82 sok No 26, 06490, Bahcelievler, Ankara, Turkey.
| | - A Canan Yazici
- Department of Biostatistics, Baskent University, School of Medicine, Ankara, Turkey.
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Wong AWY, Zhang S, Li SKY, Zhu X, Zhang C, Chu CH. Incidence of post-obturation pain after single-visit versus multiple-visit non-surgical endodontic treatments. BMC Oral Health 2015; 15:96. [PMID: 26272704 PMCID: PMC4536791 DOI: 10.1186/s12903-015-0082-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 08/07/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Post-obturation pain is frustrating to both patients and dentists. Its incidence may change with the use of contemporary endodontic techniques. This randomised clinical trial aims to compare the incidence of post-obturation pain at one and seven days after single-visit and multiple-visit non-surgical endodontic treatments. METHODS Patients who required primary endodontic treatment in the two clinical trial centres in Hong Kong (HK) and in Beijing (PK) were recruited. Three HK dentists and three PK dentists performed endodontic treatments on 567 teeth using the same procedures and materials, either in a single visit or over multiple visits, using either core carrier or cold lateral condensation for obturation. RESULTS The attrition rate was 5.1%, and a total of 538 teeth were evaluated. Among these teeth, 232 (43%) were operated in HK, 275 (51%) were treated in a single visit, and 234 (43%) were treated using core carrier obturation. Logistic regression analysis showed that teeth with apical periodontitis (OR = 0.35, 95% CI = 0.21-0.57, p < 0.01) and less pre-operative pain (OR = 1.10, 95% CI = 1.03-1.18, p < 0.01) had lower incidences of post-obturation pain after one day. The incidences of post-obturation pain after one day for single-visit and multiple-visit treatments were 24.7% (68 of 275) and 33.5% (88 of 263), respectively (p = 0.50). The incidences of post-obturation pain after seven days for single-visit and multiple-visit treatments were 4.0% (11 of 275) and 5.3% (14 of 263), respectively (p = 0.47). CONCLUSIONS There was no significant difference in the incidences of post-obturation pain after one day and seven days with single-visit or multiple-visit endodontic treatments. TRIAL REGISTRATION ChiCTR-IOR-15005989.
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Affiliation(s)
- Amy Wai-Yee Wong
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.
| | - Shinan Zhang
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.
| | | | - Xiaofei Zhu
- VIP Dental Service & Geriatric Dentistry, School and Hospital of Stomatology, Peking University, Beijing, China.
| | - Chengfei Zhang
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.
| | - Chun-Hung Chu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.
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Akbar I. Efficacy of Prophylactic use of Antibiotics to Avoid Flare up During Root Canal Treatment of Nonvital Teeth: A Randomized Clinical Trial. J Clin Diagn Res 2015; 9:ZC08-11. [PMID: 25954695 DOI: 10.7860/jcdr/2015/12046.5620] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 01/22/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Flare-up during root canal treatment of non vital teeth is a common clinical incident. The aim of the present study was to assess the effect of prophylactic use of antibiotics to avoid flare up during root canal treatment of the teeth having asymptomatic necrotic pulp. MATERIALS AND METHODS A randomized double blind clinical trial with parallel design was conducted on 100 subjects with asymptomatic non vital teeth. They were randomly divided into two groups. The first group (50 participants) was given two gram amoxicillin one hour before the first visit of root canal treatment; the second group (50 participants) did not receive any treatment (control group). In both groups, root canal treatment was performed in two visits. The flare up was assessed by the pain visual analogue scale and based on the swelling criteria. The data were processed and analyzed using SPSS statistical software 17. A p-value of 0.05 or less was considered statistically significant. RESULTS A total of 80% of participants in the experimental group had flare up while 12% of participants had flare up in the control group. Prophylactic Amoxicillin had no effect on inter-appointment flare up (p > 0.05). There was no relationship between flare up and patient's age, gender and tooth type (p > 0.05). CONCLUSION Prophylactic use of Amoxicillin in asymptomatic non vital teeth before root canal treatment had no effect on the incidence of flare-up.
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Affiliation(s)
- Iftikhar Akbar
- Assistant Professor, Department of Conservative Dentistry, College of Dentistry, Aljouf University , Sakaka, Saudi Arabia
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11
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Pamboo J, Hans MK, Kumaraswamy BN, Chander S, Bhaskaran S. Incidence and factors associated with flare-ups in a post graduate programme in the indian population. J Clin Exp Dent 2014; 6:e514-9. [PMID: 25674318 PMCID: PMC4312678 DOI: 10.4317/jced.51578] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 07/17/2014] [Indexed: 11/28/2022] Open
Abstract
Objectives: The study had twin objectives: to assess the incidence of flare-ups (a severe problem requiring an unscheduled visit and treatment) among patients who received endodontic treatment in the Department of Conservative Dentistry and Endodontics in Vyas Dental college and hospital, Jodhpur during a period of one year, and also to examine the correlation with pre-operative and operative variables.
Material and Methods: Data was collected from 1023 teeth from 916 patients who had received endodontic treatment over a 12- month period. Information was obtained for each patient treated, including pulp and peri-radicular diagnosis for the tooth, presence of pre-operatory pain, type of medication being used, type of instrumentation technique used and number of appointments needed to complete the root canal treatment.
Results: The results showed an incidence of 2.35% for flare-ups from 1023 endodontically treated teeth. Statistical analysis was done using the chi-square test.
Conclusions: Flare-ups were found to be affected significantly by gender of patient, presence of radiolucent lesions, patients taking pre-operative analgesic or anti-inflammatory drugs and on type of instrumentation technique. In contrast, there was no correlation between flare-ups and age, different arch/tooth groups and single or multiple visit endodontics.
Key words:Anti-inflammatory, flare-ups, instrumentation, prospective.
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Affiliation(s)
- Jaya Pamboo
- Post Graduate Student. Department of Conservative Dentistry and Endodontics, Vyas Dental College and Hospital, Jodhpur, Rajasthan, India
| | - Manoj-Kumar Hans
- Reader. Department of Conservative Dentistry and Endodontics, Vyas Dental College and Hospital, Jodhpur, Rajasthan, India
| | - Bangalore-Niranjan Kumaraswamy
- Professor. Department of Conservative Dentistry and Endodontics, Vyas Dental College and Hospital, Jodhpur, Rajasthan, India
| | - Subhash Chander
- Assistant Professor. Department of Conservative Dentistry and Endodontics, Vyas Dental College and Hospital, Jodhpur, Rajasthan, India
| | - Sajeev Bhaskaran
- Professor and Head. Department of Conservative Dentistry and Endodontics, Vyas Dental College and Hospital, Jodhpur, Rajasthan, India
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12
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Demirbuga S, Tuncay O, Cantekin K, Cayabatmaz M, Dincer AN, Kilinc Hİ, Sekerci AE. Frequency and distribution of early tooth loss and endodontic treatment needs of permanent first molars in a Turkish pediatric population. Eur J Dent 2014; 7:S099-S104. [PMID: 24966738 PMCID: PMC4054089 DOI: 10.4103/1305-7456.119085] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives: The objective of this study is to evaluate the frequency and distribution of early tooth loss and endodontic treatment needs of permanent first molars in a Turkish pediatric population. Materials and Methods: A total of 7,895 panoramic radiographs taken for routine dental examination at the Department of Oral Maxillofacial Radiology between 2008 and 2012 years were investigated. Two independent specialists evaluated early tooth loss and endodontic treatment needs of permanent first molars using panoramic radiography and patient anamnesis forms. The teeth were classified according to the following data: (a) Missing teeth, (b) teeth requiring extraction, (c) endodontically treated teeth (ETT), (d) teeth requiring endodontic therapy. The data also classified according to four factors: Age group (6-12 and 13-16), gender (boy and girl), jaw (mandible and maxilla) and side (right and left). A Chi-square test was used for statistical analyses. Results: A total of 19,488 and 12,092 teeth were evaluated in the child group and adolescent group respectively. All data were higher in adolescents than children (P < 0.001). For gender factor, only ETT was higher in girls than it was in boys (P < 0.001). For the jaw factor, all data were higher (P < 0.001) in mandible than in the maxilla. For the side factor, no statistical difference existed between right and left. Conclusions: Early tooth loss and endodontic treatment needs of permanent first molars showed variability according to age groups and jaws. When the results were compared according to the side and gender factors, no statistical difference was found (P > 0.05) except with the data of ETT in gender groups.
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Affiliation(s)
- Sezer Demirbuga
- Department of Restorative Dentistry, Faculty of Dentistry, Erciyes University, Kayseri, Turkiye
| | - Oznur Tuncay
- Department of Endodontics, Faculty of Dentistry, Erciyes University, Kayseri, Turkiye
| | - Kenan Cantekin
- Department of Pediatric Dentistry, Faculty of Dentistry, Erciyes University, Kayseri, Turkiye
| | - Muhammed Cayabatmaz
- Department of Restorative Dentistry, Faculty of Dentistry, Erciyes University, Kayseri, Turkiye
| | - Asiye Nur Dincer
- Department of Endodontics, Faculty of Dentistry, Erciyes University, Kayseri, Turkiye
| | - Halil İbrahim Kilinc
- Department of Prosthetic Dentistry, Faculty of Dentistry, Erciyes University, Kayseri, Turkiye
| | - Ahmet Ercan Sekerci
- Department of Oral Radiology, Faculty of Dentistry, Erciyes University, Kayseri, Turkiye
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13
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Al-Kahtani A. Effect of long acting local anesthetic on postoperative pain in teeth with irreversible pulpitis: Randomized clinical trial. Saudi Pharm J 2014; 22:39-42. [PMID: 24493972 DOI: 10.1016/j.jsps.2013.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 01/10/2013] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The objective of this study was to compare the effect of long acting anesthetics on postoperative pain in teeth with irreversible pulpitis. METHODOLOGY Forty patients were randomly assigned into two groups of twenty patients each. Each patient who fit the inclusion criteria was administered local anesthesia before undergoing root canal treatment. The anesthetic solution was either 2% lidocaine with 1:80,000 epinephrine or 0.5% bupivacaine with 1:200,000 epinephrine. Patients were instructed to complete a VAS pain score at 6, 12, 24 h after single visit root canal treatment. Data were analyzed by Mann-Whitney, Cochrane Q analysis and t test to compare qualitative and quantitative data between the groups. RESULTS The results showed the levels of pain of the patients who received lidocaine as the anesthetic agent and had significantly more postoperative pain after root canal treatment (P < 0.05) but had significantly decreased pain by 24 h compared to the bupivacaine group patients who had significantly lower postoperative pain levels at 6 and 12 h. CONCLUSION The use of long acting local anesthetic can significantly reduce the postoperative pain in teeth with irreversible pulpitis.
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Affiliation(s)
- Ahmed Al-Kahtani
- Department of Restorative Dental Sciences, College of Dentistry, King Saud University, P.O. Box 60169, Riyadh 11545, Saudi Arabia
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14
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Akbar I, Iqbal A, Al-Omiri MK. Flare-up rate in molars with periapical radiolucency in one-visit vs two-visit endodontic treatment. J Contemp Dent Pract 2013; 14:414-8. [PMID: 24171982 DOI: 10.5005/jp-journals-10024-1337] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE The objective of this study was to compare postobturation flare-ups following single and two-visit endodontic treatment of molar teeth with periapical radiolucency. MATERIALS AND METHODS A total of 100 patients with asymptomatic molar teeth with periapical radiolucency were selected. They were randomly allocated into two groups. Fifty patients received complete endodontic treatment in one-visit. Fifty patients received treatment by debridement and instrumentation at the first visit followed by obturation at the second visit. RESULTS 10% of patients had flare-ups in the single visit group and 8% of patients had flare-ups in the two-visit group. Number of visits did not affect the success of endodontic treatment (p>0.05). Age, gender and tooth type had no effects on the occurrence of flare-ups regardless the number of visits (p>0.05). CONCLUSION One-visit endodontic treatment was as successful as two-visit endodontic treatment as evaluated by rate of flareups in asymptomatic molar teeth with periapical radiolucency.
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Affiliation(s)
- Iftikhar Akbar
- Reader, Department of Periodontics, GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India, Phone: 9949109930 08912840395, e-mail:
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15
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Arias A, de la Macorra JC, Hidalgo JJ, Azabal M. Predictive models of pain following root canal treatment: a prospective clinical study. Int Endod J 2013; 46:784-93. [DOI: 10.1111/iej.12059] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 12/14/2012] [Indexed: 11/29/2022]
Affiliation(s)
- A. Arias
- Conservative Dentistry Department; School of Dentistry, Complutense University of Madrid; Madrid; Spain
| | - J. C. de la Macorra
- Conservative Dentistry Department; School of Dentistry, Complutense University of Madrid; Madrid; Spain
| | - J. J. Hidalgo
- Conservative Dentistry Department; School of Dentistry, Complutense University of Madrid; Madrid; Spain
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16
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Parirokh M, Yosefi MH, Nakhaee N, Manochehrifar H, Abbott PV, Reza Forghani F. Effect of bupivacaine on postoperative pain for inferior alveolar nerve block anesthesia after single-visit root canal treatment in teeth with irreversible pulpitis. J Endod 2012; 38:1035-9. [PMID: 22794202 DOI: 10.1016/j.joen.2012.04.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 04/17/2012] [Accepted: 04/27/2012] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Pain control after root canal treatment is of great importance in endodontic practice. The aim of the present study was to investigate the effect of a long-acting anesthetic (bupivacaine) on postoperative pain and the use of analgesics after root canal treatment. METHODS In a randomized double-blinded clinical trial, 60 patients (30 per group) having first or second mandibular molars with irreversible pulpitis randomly received either 0.5% bupivacaine with 1:200,000 epinephrine or 2% lidocaine with 1:80,000 epinephrine as the anesthetic solutions for inferior alveolar nerve blocks. After single-visit root canal treatment, each patient recorded their pain score on a visual analogue scale at 6, 12, 24, 36, 48, and 72 hours after treatment. Data were analyzed by Mann-Whitney, χ(2), Cochrane Q, and t tests as well as Pearson correlation analysis. RESULTS The results indicate that patients who received bupivacaine had significantly lower pain scores at 6 and 12 hours after root canal treatment compared with the patients who received lidocaine (P < .05). The use of analgesics in the bupivacaine patients was significantly lower than in the lidocaine group (P < .05). CONCLUSIONS Patients who received bupivacaine as the anesthetic agent for single-visit endodontic treatment of irreversible pulpitis in mandibular molars had significantly less early postoperative pain and used fewer analgesics than those who had lidocaine as the anesthetic.
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Affiliation(s)
- Masoud Parirokh
- Oral and Dental Diseases Research Center, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran.
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17
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Gambarini G, Al Sudani D, Di Carlo S, Pompa G, Pacifici A, Pacifici L, Testarelli L. Incidence and Intensivity of Postoperative Pain and Periapical Inflammation after Endodontic Treatment with Two Different Instrumentation Techniques. EUR J INFLAMM 2012. [DOI: 10.1177/1721727x1201000111] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Apical extrusion of infected debris to the periradicular tissues is considered one of the possible factors related to the occurrence of postoperative pain and inflammation. The goal of the present study is to evaluate and compare the incidence and intensity of postoperative pain using two different nickel-titanium instrumentation techniques: a rotary crown-down technique using TF instruments (SybronEndo, Orange, Ca, USA) and a reciprocating single-file technique using Reciproc instruments (VDW, Munich, Germany). Sixty patients requiring endodontic treatment on permanent premolar and molar teeth with non-vital pulps preoperatively were included in the study. The patients were divided into two groups of 30 patients each, trying to make the groups very similar, concerning the number of root canals, presence of initial pain and periapical lesions. The teeth in group 1 (n = 30) were treated with a crown-down technique using TF instruments whilst those in group 2 (n = 30) were treated with, a single-file technique using Reciproc 08 25. All canals were shaped, cleaned and obturated in a single-visit. The assessment of postoperative pain was carried out at 3 days by using a visual analogue scale. CAi-square tests and independent-sample t-tests to compare the incidence and intensity of postoperative pain of two groups were carried out. A statistically significant difference was found between the two techniques. When comparing patients who developed no pain, the TF instrumentation technique showed significantly better results ( chi-square = 4.059 P = 0.039). When evaluating patients experiencing severe pain the incidence of symptoms was significantly higher with the Reciproc technique ( chi-square = 7.246 P = 0.023). Since the incidence of preoperative pain, the type of tooth and the pulp and periodontal pathology were quite similar between the two tested groups, and all the other variables (operator, irrigation, and obturation) were identical, the difference in postoperative pain can be mainly related to the different instrumentation technique
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Affiliation(s)
- G. Gambarini
- Sapienza University of Rome, Department of Oral and Maxillofacial Science, Rome, Italy
| | | | - S. Di Carlo
- Sapienza University of Rome, Department of Oral and Maxillofacial Science, Rome, Italy
| | - G. Pompa
- Sapienza University of Rome, Department of Oral and Maxillofacial Science, Rome, Italy
| | - A. Pacifici
- Sapienza University of Rome, Department of Oral and Maxillofacial Science, Rome, Italy
| | - L. Pacifici
- Sapienza University of Rome, Department of Oral and Maxillofacial Science, Rome, Italy
| | - L. Testarelli
- Sapienza University of Rome, Department of Oral and Maxillofacial Science, Rome, Italy
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18
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Iqbal M, Kurtz E, Kohli M. Incidence and factors related to flare-ups in a graduate endodontic programme. Int Endod J 2009; 42:99-104. [PMID: 19134037 DOI: 10.1111/j.1365-2591.2008.01461.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To investigate the incidence and factors related to endodontic flare-ups in nonsurgical root canal treatment (NSRCT) cases completed by graduate endodontic residents at University of Pennsylvania, USA. METHODOLOGY Residents at University of Pennsylvania enter all clinical patient records into an electronic database called PennEndo database. Analysis of records of 6580 patients treated from September 2000 to July 2005 revealed a total of 26 patients with flare-ups (0.39%). Patients were categorized to have undergone flare-up when they attended for an unscheduled visit and active treatment, and when they suffered from severe pain and or swelling after initiation or continuation of NSRCT. SAS software was used to develop a logistic regression model with flare-up as a dependent variable. Independent variables included in the model were: history of previous pain, one vs. two visit NSRCT, periapical diagnosis, tooth type, rotary versus hand instrumentation, and lateral versus vertical compaction of gutta-percha. RESULTS The odds for developing a flare-up in teeth with a periapical radiolucency were 9.64 times greater than teeth without a periapical radiolucency (P = 0.0090). There was no statistically significant difference in flare-ups between one and two visits NSRCT. The odds of developing a flare-up increased 40 fold when NSRCT was completed in three or more visits. However, this result may have been confounded by addition of an unscheduled visit in patients suffering from flare-ups. Other independent variables did not have any statistically significant correlations. CONCLUSIONS A low percentage of patients experienced flare-ups during NSRCT procedures. The presence of a periapical lesion was the single most important predictor of flare-ups during NSRCT.
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Affiliation(s)
- M Iqbal
- Department of Endodontics, University of Pennsylvania, School of Dental Medicine, Robert Schattner Centre, PA 19104-6030, USA.
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19
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Tsesis I, Faivishevsky V, Fuss Z, Zukerman O. Flare-ups after Endodontic Treatment: A Meta-analysis of Literature. J Endod 2008; 34:1177-81. [DOI: 10.1016/j.joen.2008.07.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Revised: 07/06/2008] [Accepted: 07/16/2008] [Indexed: 10/21/2022]
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Ehrmann EH, Messer HH, Clark RM. Flare-ups in endodontics and their relationship to various medicaments. AUST ENDOD J 2008; 33:119-30. [PMID: 18076580 DOI: 10.1111/j.1747-4477.2007.00087.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this research is to investigate the frequency of endodontic flare-ups using a visual analogue scale. Definitions of flare-ups vary widely as does their reported frequency. A flare-up was defined as an increase of 20 or more points on the visual analogue scale for a given tooth, within the periods of 4 h and 24 h after the initial treatment appointment. The data from a previous study were used to determine the incidence of flare-ups after using three modalities (Ledermix, calcium hydroxide and no medication) to manage patients presenting for relief of pain of endodontic origin. A statistical analysis showed that there were no significant differences in flare-up rates at both the 4-h and 24-h periods between the three modalities. Further research is required using the above definition of a flare-up and standardising treatment protocols.
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Affiliation(s)
- Ernest H Ehrmann
- School of Dental Science, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria, Australia.
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21
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Cheng Y, Cheung GSP, Bian Z, Peng B. Incidence and factors associated with endodontic inter-appointment emergency in a dental teaching hospital in China. J Dent 2006; 34:516-21. [PMID: 16414172 DOI: 10.1016/j.jdent.2005.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2005] [Revised: 12/02/2005] [Accepted: 12/06/2005] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To assess the incidence of endodontic inter-appointment emergency (EIE) in a dental teaching hospital in China, and to correlate its occurrence with preoperative and treatment parameters. METHODS Three thousand six hundred and ninety six cases were collected at root canal treatment appointments on demographics, presenting symptoms, treatment procedures and periradicular status. The operators consisted of faculty, undergraduate students and advanced trainees. Root canals were conventionally instrumented and then medicated. No systemic medication was prescribed. In cases EIE developed between appointments, an emergency visit was arranged and active treatment was carried out. The data of EIE cases were statistically analyzed using the chi-square test and a multiple logistic regression model. RESULTS The overall incidence of EIE was 5%, which rate was 5.5% in females and 4.3% in males. Analyses of the potential factors revealed that patient age, tooth location, preoperative percussion pain and pulp status were the most important independent variables. CONCLUSION EIE was significantly associated with some host factors (patient age, tooth location) and presenting factors (preoperative percussion pain, pulp status).
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Affiliation(s)
- Yue Cheng
- Department of Operative Dentistry and Endodontics, School of Stomatology, Wuhan University, China
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22
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Yoldas O, Topuz A, Isçi AS, Oztunc H. Postoperative pain after endodontic retreatment: Single- versus two-visit treatment. ACTA ACUST UNITED AC 2004; 98:483-7. [PMID: 15472665 DOI: 10.1016/j.tripleo.2004.03.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this clinical study was to determine the effect of 1- or 2-visit root canal treatment on the postoperative pain in the retreatment cases. STUDY DESIGN Two hundred eighteen cases that required retreatment were included in the study. Obturated and unfilled canal space and the status of periapical tissues were evaluated according to the PAI index. The patients were subcategorized in regard to the presence or the absence of preoperative pain. Approximately half of each category was treated in 1 appointment. After removing the previous root canal obturation materials and biomechanic preparation of root canals, the teeth in the 1-visit group were obturated at the first appointment by using AH 26 sealer and laterally compacted gutta-percha, and those in the 2-visit group were medicated with calcium hydroxide-chlorhexidine combination and then closed with a temporary filling material. One week after the initial appointment, patients were asked about the occurrence of postoperative pain. The level of discomfort was rated as no pain, mild pain, moderate pain, or severe pain (flare-up). Data were statistically analyzed using the chi-squared and Fischer exact tests. RESULTS Eight patients from the 1-visit group and 2 patients from the 2-visit group had flare-ups. There was a statistical difference between the groups (P <.05). Two-visit root canal treatment was more effective in completely eliminating pain than 1-visit treatment of previously symptomatic teeth (P <.05). CONCLUSIONS Two-visit endodontic treatment with intracanal medication was found to be effective in reducing postoperative pain of previously symptomatic teeth and decreased the number of flare-ups in all retreatment cases.
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Affiliation(s)
- Oguz Yoldas
- Department of Conservative Dentistry and Endodontics, University of Cukurova Faculty of Dentistry, Adana, Turkey.
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Gound TG, Marx D, Schwandt NA. Incidence of Flare-ups and Evaluation of Quality after Retreatment of Resorcinol-Formaldehyde Resin (“Russian Red Cement”) Endodontic Therapy. J Endod 2003; 29:624-6. [PMID: 14606781 DOI: 10.1097/00004770-200310000-00002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this retrospective study was to evaluate the quality of treatment and incidence of flare-ups when teeth with resorcinol-formaldehyde resin are retreated in a postgraduate endodontic clinic. Fifty-eight cases were included in this study. Obturated and unfilled canal space was measured on radiographs. Forty-eight percent of the total canal space was filled before retreatment; 90% was filled after retreatment. After retreatment, obturations were rated as optimal in 59%, improved in 33%, unchanged in 6%, and worse in 2%. Seven patients (12%) had postretreatment flare-ups. Data were statistically analyzed using the Cochran-Armitage Test for Discrete Variables. No statistical difference in the incidence of flare-ups was found in teeth that before treatment had more than half the canal space filled compared to teeth with less than half, cases with pre-existing periradicular radiolucencies compared to cases with normal periradicular appearance, symptomatic cases compared to asymptomatic cases, or cases with optimal fillings after retreatment compared to less than optimal cases. It was concluded that teeth with resorcinol-formaldehyde fillings might be retreated with a good prognosis for improving the radiographic quality, but a higher than normal incidence of flare-ups may occur.
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Affiliation(s)
- Tom G Gound
- University of Nebraska College of Dentistry, Lincoln 68583, USA
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