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Alajlan N, Carrasco-Labra A, Karabucak B, Lee SM. Systemic Corticosteroid Uses in Endodontics-Part 1: Managing Postoperative Pain. J Endod 2024:S0099-2399(24)00163-8. [PMID: 38490301 DOI: 10.1016/j.joen.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/03/2024] [Accepted: 03/05/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION This study aimed to systematically search and review all available literature regarding systemic (oral or locally injected) corticosteroids in endodontics to assess their effect on postoperative pain. METHODS A search was conducted using PubMed, Cochrane Library, Embase, Scopus, Dentistry & Oral Science, and ProQuest. Randomized controlled trials enrolling participants undergoing endodontic treatment and assessing the presence of pain and pain scores at 6, 12, and 24 hours postoperatively were included. We synthesize the effect measures using risk ratios (RRs), standardized mean differences (SMDs), and their corresponding 95% confidence intervals (CIs). Meta-analysis was performed using the random-effects inverse variance method. The level of significance was set at P < .05. The certainty of the evidence was evaluated using Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS A total of 2303 participants from 29 trials were included. Patients who received corticosteroids were significantly less likely to report pain at 6 hours (RR = 2.5; 95% CI, 1.74-3.61; P < .00001), 12 hours (RR = 2.10; 95% CI, 1.53-2.90; P < .00001), and 24 hours (RR = 1.77; 95% CI, 1.38-2.28; P < .00001) postoperatively. Furthermore, they reported lower pain intensity at 6 hours (SMD = - 0.82; 95% CI, -1.17 to -0.48; P < .00001), 12 hours (SMD = - 0.63; 95% CI, -0.75 to -0.51; P < .00001), and 24 hours (SMD = - 0.68; 95% CI, -0.90 to -0.46; P < .00001) postoperatively. CONCLUSIONS Moderate certainty evidence indicates that the use of systemic corticosteroids likely results in a moderate to large reduction in postoperative endodontic pain.
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Affiliation(s)
- Norah Alajlan
- Department of Restorative Dental Science, College of Dentistry, King Saud University, Riyadh, Saudi Arabia; Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Alonso Carrasco-Labra
- Division of Restorative Dentistry, Department of Preventive and Restorative Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bekir Karabucak
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Su-Min Lee
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Signor B, Poli Kopper PM, Aspesi M, Münchow EA, Scarparo RK. Postoperative pain after single-visit root canal treatment or vital pulp therapy: A systematic review and meta-analysis. J Am Dent Assoc 2024; 155:118-137.e1. [PMID: 38325970 DOI: 10.1016/j.adaj.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/06/2023] [Accepted: 11/05/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND This systematic review aimed to investigate whether vital pulp therapy and root canal treatment (RCT) promote different postoperative pain. STUDIES REVIEWED The authors searched PubMed, Cochrane Library, Embase, and Latin American and Caribbean Health Sciences Literature databases for studies published through June 30, 2022. The authors included randomized clinical trials if they reported on the assessment of postoperative pain after direct pulp capping, partial pulpotomy, pulpotomy, or single-visit RCT. The authors assessed the frequency of no, mild, moderate, and severe postoperative pain. They conducted meta-analyses to compare postoperative pain after full pulpotomy (PULP) and RCT. RESULTS The qualitative synthesis included 57 studies, and the authors conducted meta-analysis of 3. PULP leads to more asymptomatic cases (relative risk [RR], 1.06; 95% CI, 1.01 to 1.11; P < .01; I2 = 67%) and to a lower occurrence of mild (RR, 0.89; 95% CI, 0.79 to 0.99; P < .04; I2 = 37%) and moderate (RR, 0.70; 95% CI, 0.51 to 0.95; P < .02; I2 = 57%) postoperative pain than RCT. The frequency of severe pain was very low for both vital pulp therapy and RCT. Moderate to severe postoperative pain was more common at 48 hours through 72 hours after RCT and up to 36 hours after PULP. Pain intensity after PULP was higher using calcium-enriched material compared with using mineral trioxide aggregate at 12, 18, and 36 hours (P < .001). PRACTICAL IMPLICATIONS PULP showed a significantly higher incidence of no pain and a lower incidence of mild and moderate pain than single-visit RCT. Clinical decisions for RCT or PULP should not be based on differences in postoperative pain. When analgesia is indicated, it probably should be limited to a short time after PULP.
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Elmallawany A, Hussein YF, Ali MM, Montasser K, Aly Y, Sharaf N. Effect of Ultrasonic and Diode Laser Irrigation Activation on Post-operative Pain and Microbial Reduction in Single Visit Endodontic Treatment of Necrotic Mandibular Molars. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
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.
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).
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 < 0.05.
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).
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.
Keywords: Continuous ultrasonic irrigation, diode laser 810, post-operative pain, bacterial reduction, single visit endodontic treatment.
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Kumar G, Sangwan P, Tewari S. Effect of premedication on postoperative pain after root canal therapy in patients with irreversible pulpitis: a systematic review and meta-analysis. J Dent Anesth Pain Med 2021; 21:397-411. [PMID: 34703890 PMCID: PMC8520836 DOI: 10.17245/jdapm.2021.21.5.397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/21/2021] [Accepted: 07/28/2021] [Indexed: 01/14/2023] Open
Abstract
This systematic review aimed to assess the effect of premedication on postoperative pain after root canal treatment in vital teeth. Five electronic databases were searched for randomized clinical trials, and two independent reviewers selected eligible studies, extracted data, and assessed the quality of studies using the Cochrane Risk of Bias tool. Meta-analysis was conducted using the random-effects model, and the pooled effect estimate of the standardized mean difference (SMD) between premedication and placebo was calculated. Subgroup analysis was conducted based on the class and route of the drug. Studies with a high risk of bias were excluded from the sensitivity analysis. Ten trials satisfied the inclusion criteria, of which eight were included in the meta-analysis. Premedication was more effective in reducing postoperative pain than placebo at 6 hours (SMD = −1.00; 95% confidence interval [CI] = −1.33 to −0.66), 12 hours (SMD = −0.80; 95% CI = −1.05 to −0.56), and 24 hours (SMD = −0.72; 95% CI = −1.02 to −0.43). The results of the sensitivity analysis confirmed the findings of the primary analysis. Based on these results, it can be concluded that premedication is effective in reducing postoperative pain in teeth with irreversible pulpitis. However, additional quality studies are required for further validation.
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Affiliation(s)
- Gaurav Kumar
- Post Graduate Institute of Dental Sciences Rohtak, Haryana, India
| | - Pankaj Sangwan
- Post Graduate Institute of Dental Sciences Rohtak, Haryana, India
| | - Sanjay Tewari
- Post Graduate Institute of Dental Sciences Rohtak, Haryana, India
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Almuthhin M, Afify M, Alshammari Y, Alkatheeri N, Altuwaijri SM, Alhussain B, Albaij SMA, Alanazi F, Alsheri Y. The Safety and Efficacy of Pre- and Post-Medication for Postoperative Endo- dontic Pain: A Systematic Review and Network Meta-analysis. Open Dent J 2020. [DOI: 10.2174/1874210602014010563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Postoperative Endodontic Pain is a major concern for dentists and their patients, with pain having been reported to occur in 25%–40% of patients treated. Therefore, the aim of this systematic review and Network Meta-analysis (NMA) was to identify the safety and efficacy of pre- and post-medication for reducing postoperative endodontic pain.
Methods:
A literature search was performed in the SCOPUS, MEDLINE, and ScienceDirect, and Cochrane Central databases until December 2019 with no language restriction. Randomized controlled trials evaluating the efficacy of pre- or post-medications compared with other agents, placebo, or no treatment in adult patients who underwent endodontic surgery for postoperative pain were included. The mean difference of postoperative pain was measured using the Standardized Mean Difference (SMD) with its 95% confidence interval (95% CI).
Results:
This Systematic Review included 62 Articles. Of them, 50 studies were included in the NMA. Among all medications, corticosteroids were ranked as the best treatment for the reduction of postoperative pain at 6 and 12 hours with a significant reduction in postoperative pain scores [SMD= -1.18, 95% CI (-1.51: -0.85)] and [SMD= -1.39, 95% CI (-1.77: -1.02)], respectively. Cyclooxygenase-2 (COX-2) inhibitors were ranked as the best treatment for the reduction of postoperative pain at 8 and 24 hours with a significant reduction in postoperative pain scores [SMD= -2.86, 95% CI (-6.05: -1.66)] and [SMD= -1.27, 95% CI (-2.10: -0.43)], respectively. Non-steroidal anti-inflammatory drugs (NSAIDs) significantly reduced the postoperative pain scores in all durations. For postoperative pain at 6 hours, Indomethacin, Novafen, Naproxen, Prednisolone, Ketorolac, Betamethasone, Dexamethasone, Deflazacort, Rofecoxib, Piroxicam, and Ibuprofen significantly reduced the pain score when compared with a placebo. All of these drugs demonstrated a significant reduction at 12 hours except Ketorolac.
Conclusion:
The current evidence suggests that pre- and post-medication can reduce postoperative pain after nonsurgical root canal treatment. Corticosteroids and COX-2 inhibitors showed significant control of the pain up to 12 hours after administration. However, NSAIDs demonstrated a high efficacy from administration and until two days after treatment. Indomethacin, Novafen, prednisolone, and Naproxen were ranked first in most analyzed durations.
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Nagendrababu V, Duncan HF, Bjørndal L, Kvist T, Priya E, Jayaraman J, Pulikkotil SJ, Dummer PMH. PRIRATE 2020 guidelines for reporting randomized trials in Endodontics: explanation and elaboration. Int Endod J 2020; 53:774-803. [DOI: 10.1111/iej.13304] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 12/11/2022]
Affiliation(s)
- V. Nagendrababu
- Division of Clinical Dentistry School of Dentistry International Medical University Kuala Lumpur Malaysia
| | - H. F. Duncan
- Division of Restorative Dentistry & Periodontology Dublin Dental University Hospital Trinity College Dublin Dublin Ireland
| | - L. Bjørndal
- Cariology and Endodontics Department of Odontology Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - T. Kvist
- Department of Endodontology Institute of Odontology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - E. Priya
- Division of Children and Community Oral Health School of Dentistry International Medical University Kuala Lumpur Malaysia
| | - J. Jayaraman
- Department of Developmental Dentistry University of Texas Health School of Dentistry San Antonio USA
| | - S. J. Pulikkotil
- Division of Clinical Dentistry School of Dentistry International Medical University Kuala Lumpur Malaysia
| | - P. M. H. Dummer
- School of Dentistry College of Biomedical and Life Sciences Cardiff University Cardiff UK
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Bansal R, Jain A. An insight into patient's perceptions regarding root canal treatment: A questionnaire-based survey. J Family Med Prim Care 2020; 9:1020-1027. [PMID: 32318461 PMCID: PMC7114049 DOI: 10.4103/jfmpc.jfmpc_880_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 12/16/2019] [Accepted: 12/27/2019] [Indexed: 12/26/2022] Open
Abstract
Background: A key setback of root canal treatment (RCT) is that most patients lack adequate knowledge about it. Understanding and identifying the factors that hinder or discourage patients from undergoing RCT is necessary to adequately address the issue. The review of literature shows that there is a paucity of data about the awareness and acceptance of RCT among patients in Indian population. Thus, the study was conducted with aim to assess patients’ awareness of RCT among patients reporting in Desh Bhagat Dental College and Hospital, Mandi Gobindgarh. By surveying the patients, a broad patient perspective on the issue was sought. Materials and Methods: This survey was conducted with the help of prestructured questionnaire consisting of 15 questions, distributed to random 450 patients coming to the outpatient department of Conservative dentistry and Endodontics in Desh Bhagat Dental College and Hospital. The completed questionnaires were then analyzed to assess patients’ experiences, concerns, and perceptions about RCT. Results: There is a lack of awareness among patients regarding RCT. Conclusion: It is important to create more awareness among the populace of our country about the significance of maintaining a healthy dentition and attendant sequel if not done so. More patients would consider having endodontic procedures if properly made aware of.
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Affiliation(s)
- Ramta Bansal
- Department of Conservative Dentistry and Endodontics, Desh Bhagat Dental College and Hospital, Mandi Gobindgarh, District Fatehgarh Sahib, India
| | - Aditya Jain
- Department of Physiology, Government Medical College, Patiala, Punjab, India
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Aksoy F, Ege B. The effect of pretreatment submucosal injections of tramadol and dexamethasone on post‐endodontic pain in mandibular molar teeth with symptomatic irreversible pulpitis: a randomized controlled clinical trial. Int Endod J 2019; 53:176-185. [DOI: 10.1111/iej.13246] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 11/06/2019] [Indexed: 11/27/2022]
Affiliation(s)
- F. Aksoy
- Department of EndodonticsFaculty of DentistryAdiyaman University Adiyaman Turkey
| | - B. Ege
- Department of Oral and Maxillofacial Surgery Faculty of Dentistry Adiyaman University Adiyaman Turkey
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Nagendrababu V, Pulikkotil SJ, Jinatongthai P, Veettil SK, Teerawattanapong N, Gutmann JL. Efficacy and Safety of Oral Premedication on Pain after Nonsurgical Root Canal Treatment: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials. J Endod 2019; 45:364-371. [DOI: 10.1016/j.joen.2018.10.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/23/2018] [Accepted: 10/30/2018] [Indexed: 10/27/2022]
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Nath R, Daneshmand A, Sizemore D, Guo J, Enciso R. Efficacy of corticosteroids for postoperative endodontic pain: A systematic review and meta-analysis. J Dent Anesth Pain Med 2018; 18:205-221. [PMID: 30186968 PMCID: PMC6115367 DOI: 10.17245/jdapm.2018.18.4.205] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 07/30/2018] [Accepted: 08/01/2018] [Indexed: 01/22/2023] Open
Abstract
This systematic review aimed to analyze the efficacy of corticosteroid premedication compared to placebo or no treatment to reduce postoperative pain in endodontic patients. Randomized controlled trials (RCTs) assessing corticosteroids via oral, intramuscular, subperiosteal, intraligamentary or intracanal route compared to passive or active placebo, or no treatment were included. Four databases were searched: PubMed, Web of Science, Cochrane Library and Embase up to 2/21/2018. Risk of bias was assessed with Cochrane Risk of bias tool. Fourteen RCTs with 1,462 generally healthy adults in need of endodontic treatment were included. 50% of the studies were at unclear risk and 50% at high risk of bias. Meta-analysis showed Visual Analog Scale (VAS) pain at 4-6 hours after Inferior Alveolar Nerve Block (IANB) was significantly lower by 21 points (0-100 scale) in the corticosteroid group compared to the control group (95% CI -35 to -7; P = 0.003), however this difference was not statistically significant after 24 hours (P = 0.116). The route of administration was oral and intraligament injection. Patients who received corticosteroids prior to IANB were 70.7% more likely to have none or mild pain 4-8 hours after treatment (P = 0.001) and 13.5% more likely 24 hours after IANB (P = 0.013) than patients in the control group. In conclusion, corticosteroid administration (oral or intraligamental) may clinically reduce the level of postoperative pain at 4-8 hours after IANB, however the quality of the evidence was low/moderate due to risk of bias and heterogeneity. Further studies are recommended.
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Affiliation(s)
- Ranjivendra Nath
- Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Ali Daneshmand
- Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Dan Sizemore
- Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Jing Guo
- Department of Endodontics, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA.,Department of Endodontics, School of Dentistry, Loma Linda University, Loma Linda, CA, USA
| | - Reyes Enciso
- Division of Dental Public Health and Pediatric Dentistry, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
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