Can instrumentation kinematics affect postoperative pain and substance P levels? A randomized controlled trial

BACKGROUND

This study aimed to assess the influence of continuous rotation and reciprocation kinematics on postoperative pain (POP) levels and substance P (SP) levels in patients diagnosed with irreversible pulpitis and symptomatic apical periodontitis (SAP).

MATERIALS AND SUBJECTS

A total of twenty patients were randomly assigned into two groups: Continuous Rotation Group (CRG) (n = 10), subjected to mechanical preparation with the EdgeEndox7 rotary system (Albuquerque, NM, USA), and Reciprocation Group (RG) (n = 10), treated with the EdgeOne Fire reciprocating system (Albuquerque, NM, USA). Apical fluid (AF) samples were collected, and SP levels were quantified through radioimmunoassay. POP was assessed using the Numerical Rating Scale (NRS) at various time intervals (preoperatively, 6 h, 12 h, 24 h, 48 h, and 72 h). Data were statistically analyzed utilizing the independent t-test, Mann-Whitney U test, Friedman's test, and Nemenyi post hoc test.

RESULTS

There was a significant increase in SP levels in the reciprocating group compared to the continuous rotation group (P ≤ 0.05). Additionally, patients in the reciprocating group reported significantly higher POP levels (P ≤ 0.05) at all measured intervals (6 h, 12 h, 24 h, and 48 h), with both groups exhibiting similar pain level reductions at the 72-hour mark.

CONCLUSION

Our findings suggest that continuous rotation kinematics in root canal preparation leads to a considerable reduction in SP expression and POP.

TRIAL REGISTRATION

The study protocol was retrospectively registered on the www.

CLINICALTRIALS

gov database (NCT06081335) at (13/10/2023) after the approval of the Ethics Committee, Faculty of Dentistry, Ain Shams University (FDASU-RecIM012135).

The effect of different irrigation and disinfection methods on post-operative pain in mandibular molars: a randomised clinical trial

BACKGROUND

To examine post-operative pain (PP) after conventional irrigation and sonic activation methods, with and without laser disinfection in mandibular molars.

METHODS

Eighty patients with symptomatic apical periodontitis were included in this randomized clinical study. There were four study groups. In group 1, conventional irrigation only was applied. In group 2, a sonic irrigation activation system (EDDY (VDW, Munich, Germany)), was applied. In groups 3 and 4, irradiation with a 980-nm diode laser was performed, following irrigation with the conventional method and sonic irrigation activation system, respectively. The patients were instructed to record their PP and analgesic intake using a numerical rating scale 8, 24, 48 h and 7 days post-procedure. A chi-square test, Fisher's exact chi-square test and Fisher-Freeman-Halton exact test were used to assess qualitative data. Inter-group and intra-group parameters were assessed using the Kruskal-Wallis test and Wilcoxon's test at a significance level of p < 0.05.

RESULTS

There was no statistically significant difference among the groups in terms of age, sex, pre-operative pain, PP and analgesic intake (p > 0.05).

CONCLUSIONS

The use of sonic irrigation activation system in the final irrigation protocol and irradiation with the 980-nm diode laser did not significantly reduce PP levels and analgesic intake.

Effect of Photodynamic Therapy on Postoperative Pain in Posterior Teeth with Symptomatic Apical Periodontitis

This study aimed to evaluate the impact of photodynamic therapy (PDT) after root canal preparation on pain relief in posterior teeth presenting with symptomatic apical periodontitis (SAP). A visual analog scale (VAS) was completed by the patients which registered their pain perception as none (0), mild (1-3), moderate (4-7), or severe (8-10). Only patients who registered moderate or severe pain were included. Seventy patients were allocated to two groups (n=35): a control group (CG) without the PDT application and an intervention group with PDT application (PG). The same chemo-mechanical preparation was achieved in both groups. In the PG, 150 µM methylene blue (MB)Please remove the underline was placed inside the canal for 2 minutes and a 660 nm wavelength laser was applied through a fiber for 3 minutes (100 mW, 600 J/cm², total 18J). The patients were asked to register their pain perception in the VAS document after 24-h, 72-h, and 1-week intervals. The number of tablets taken for pain relief was also recorded. The Mann-Whitney, Students T-test and Fisher´s exact tests were used for statistical analysis (P < .05). After 1 week, 32 patients in the CG and 33 in the PG returned their VAS cards. The PG resulted in lower pain levels after the 24-hour interval (median 0) than the CG (median 2); there was no difference between both groups at 72-h and 1-week intervals. The decrease in pain was higher in the PG at all time-intervals when compared to the CG. There was no difference in the mean number of tablets taken for pain relief (P > .05). Within the limitations of this study, it can be concluded that PDT was efficient in decreasing pain in teeth presenting with SAP. There was no difference observed after 72 hours and there was no impact on the intake of pain relief medication.

An Evaluation of Ibuprofen Versus Ibuprofen/Acetaminophen for Postoperative Endodontic Pain in Patients With Symptomatic Irreversible Pulpitis and Symptomatic Apical Periodontitis

The purpose of this investigation was to compare ibuprofen versus an ibuprofen/acetaminophen combination for postoperative pain control in a patient model specific to teeth diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis. One hundred and two patients presenting with moderate to severe pain from a maxillary or mandibular posterior tooth diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis were included. Following local anesthetic administration, complete endodontic cleaning and shaping was performed. Patients were randomly assigned to receive identically appearing tablets of ibuprofen 200 mg or a combination of ibuprofen 200 mg/acetaminophen 216.7 mg with instructions to take 3 tablets every 6 hours as needed for pain. Patients were also given a prescription for an escape medication to take if the study medications did not adequately control their pain. A 4-day diary was used to record pain ratings and medication use. Moderate to severe pain was experienced by 59-61% of the patients on postoperative day 1 and 50-57% of the patients on day 2, with the pain ratings decreasing over the next 2 days. There were no statistically significant differences between the 2 groups in postoperative pain, percussion pain, or medication use. There was no difference between ibuprofen and the combination of ibuprofen/acetaminophen in the reduction of postoperative pain following endodontic debridement in patients with symptomatic irreversible pulpitis and symptomatic apical periodontitis.