Restorative Dentistry and Endodontics

The Korean Academy of Conservative Dentistry (대한치과보존학회)
권호 표지
DOI QR코드

DOI QR Code

Postoperative pain after endodontic treatment of necrotic teeth with large intentional foraminal enlargement

  • Ricardo Machado (Department of Endodontics, School of Health and Bioscience, Pontifical Catholic University of Parana – PUC/PR) ;
  • Daniel Comparin (Department of Endodontics, School of Dentistry, Paranaense University – UNIPAR) ;
  • Sergio Aparecido Ignacio (Department of Statistics, School of Health and Bioscience, Pontifical Catholic University of Parana – PUC/PR) ;
  • Ulisses Xavier da Silva Neto (Department of Statistics, School of Health and Bioscience, Pontifical Catholic University of Parana – PUC/PR)
  • Received : 2020.07.13
  • Accepted : 2020.12.31
  • Published : 2021.08.31
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives: To evaluate postoperative pain after endodontic treatment of necrotic teeth using large intentional foraminal enlargement (LIFE). Materials and Methods: The sample included 60 asymptomatic necrotic teeth (with or without chronic apical periodontitis), and a periodontal probing depth of 3 mm, previously accessed and referred to perform endodontic treatment. After previous procedures, the position and approximate size of the apical foramen (AF) were determined by using an apex locator and K flexo-files, respectively. The chemomechanical preparation was performed with Profile 04 files 2 mm beyond the AF to achieve the LIFE, using 2.5 mL of 2.5% NaOCl at each file change. The filling was performed by Tagger's hybrid technique and EndoFill sealer. Phone calls were made to all the patients at 24, 48 and 72 hours after treatment, to classify postoperative pain. Statistical analysis was performed by different tests with a significance level of 5%. Results: Age, gender, periradicular status and tooth type did not influence postoperative pain (p > 0.05). Only 1 patient (1.66%) reported severe pain after 72 hours. Moderate pain was reported by 7, 4 and 3 patients after 24, 48 and 72 hours, respectively (p = 0.0001). However, paired analyses showed a statistically significant difference only between 24 and 72 hours (p = 0.04). Sealer extrusion did not influence the postoperative pain (p > 0.05). Conclusions: Acute or moderate postoperative pain was uncommon after endodontic treatment of necrotic teeth with LIFE.

Keywords

References

  1. Schilder H. Filling root canals in three dimensions. Dent Clin North Am 1967;723-744.
  2. Schilder H. Cleaning and shaping the root canal. Dent Clin North Am 1974;18:269-296. https://doi.org/10.1016/S0011-8532(22)00677-2
  3. ureyen Kaya B, Erik CE, Sesli Cetin E, Kole M, Maden M. Mechanical reduction in intracanal Enterococcus faecalis when using three different single-file systems: an ex vivo comparative study. Int Endod J 2019;52:77-85. https://doi.org/10.1111/iej.12984
  4. Martinho FC, Gomes CC, Nascimento GG, Gomes AP, Leite FR. Clinical comparison of the effectiveness of 7- and 14-day intracanal medications in root canal disinfection and inflammatory cytokines. Clin Oral Investig 2018;22:523-530.
  5. Chavez de Paz LE. Redefining the persistent infection in root canals: possible role of biofilm communities. J Endod 2007;33:652-662. https://doi.org/10.1016/j.joen.2006.11.004
  6. Wang J, Chen W, Jiang Y, Liang J. Imaging of extraradicular biofilm using combined scanning electron microscopy and stereomicroscopy. Microsc Res Tech 2013;76:979-983. https://doi.org/10.1002/jemt.22257
  7. Wang J, Jiang Y, Chen W, Zhu C, Liang J. Bacterial flora and extraradicular biofilm associated with the apical segment of teeth with post-treatment apical periodontitis. J Endod 2012;38:954-959. https://doi.org/10.1016/j.joen.2012.03.004
  8. Brandao PM, de Figueiredo JA, Morgental RD, Scarparo RK, Hartmann RC, Waltrick SB, Souza RA. Influence of foraminal enlargement on the healing of periapical lesions in rat molars. Clin Oral Investig 2019;23:1985-1991. https://doi.org/10.1007/s00784-018-2628-2
  9. Borlina SC, de Souza V, Holland R, Murata SS, Gomes-Filho JE, Dezan Junior E, Marion JJ, Neto DA. Influence of apical foramen widening and sealer on the healing of chronic periapical lesions induced in dogs' teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:932-940. https://doi.org/10.1016/j.tripleo.2010.01.028
  10. de Souza Filho FJ, Benatti O, de Almeida OP. Influence of the enlargement of the apical foramen in periapical repair of contaminated teeth of dog. Oral Surg Oral Med Oral Pathol 1987;64:480-484. https://doi.org/10.1016/0030-4220(87)90157-5
  11. Tinaz AC, Alacam T, Uzun O, Maden M, Kayaoglu G. The effect of disruption of apical constriction on periapical extrusion. J Endod 2005;31:533-535. https://doi.org/10.1097/01.don.0000152294.35507.35
  12. Mostafa MEHAA, El-Shrief YAI, Anous WIO, Hassan MW, Salamah FTA, El Boghdadi RM, El-Bayoumi MAA, Seyam RM, Abd-El-Kader KG, Amin SAW. Postoperative pain following endodontic irrigation using 1.3% versus 5.25% sodium hypochlorite in mandibular molars with necrotic pulps: a randomized doubleblind clinical trial. Int Endod J 2020;53:154-166. https://doi.org/10.1111/iej.13222
  13. Nagendrababu V, Gutmann JL. Factors associated with postobturation pain following single-visit nonsurgical root canal treatment: a systematic review. Quintessence Int 2017;48:193-208.
  14. Yaylali IE, Teke A, Tunca YM. The effect of foraminal enlargement of necrotic teeth with a continuous rotary system on postoperative pain: a randomized controlled trial. J Endod 2017;43:359-363. https://doi.org/10.1016/j.joen.2016.11.009
  15. Cruz Junior JA, Coelho MS, Kato AS, Vivacqua-Gomes N, Fontana CE, Rocha DG, da Silveira Bueno CE. The effect of foraminal enlargement of necrotic teeth with the reciproc system on postoperative pain: a prospective and randomized clinical trial. J Endod 2016;42:8-11. https://doi.org/10.1016/j.joen.2015.09.018
  16. Silva EJ, Menaged K, Ajuz N, Monteiro MR, Coutinho-Filho TS. Postoperative pain after foraminal enlargement in anterior teeth with necrosis and apical periodontitis: a prospective and randomized clinical trial. J Endod 2013;39:173-176. https://doi.org/10.1016/j.joen.2012.11.013
  17. Kuttler Y. Microscopic investigation of root apexes. J Am Dent Assoc 1955;50:544-552. https://doi.org/10.14219/jada.archive.1955.0099
  18. Ponce EH, Vilar Fernandez JA. The cemento-dentino-canal junction, the apical foramen, and the apical constriction: evaluation by optical microscopy. J Endod 2003;29:214-219. https://doi.org/10.1097/00004770-200303000-00013
  19. Dummer PM, McGinn JH, Rees DG. The position and topography of the apical canal constriction and apical foramen. Int Endod J 1984;17:192-198. https://doi.org/10.1111/j.1365-2591.1984.tb00404.x
  20. Aminoshariae A, Kulild JC. Master apical file size - smaller or larger: a systematic review of healing outcomes. Int Endod J 2015;48:639-647. https://doi.org/10.1111/iej.12370
  21. Pasqualini D, Mollo L, Scotti N, Cantatore G, Castellucci A, Migliaretti G, Berutti E. Postoperative pain after manual and mechanical glide path: a randomized clinical trial. J Endod 2012;38:32-36. https://doi.org/10.1016/j.joen.2011.09.017
  22. Cailleteau JG, Mullaney TP. Prevalence of teaching apical patency and various instrumentation and obturation techniques in United States dental schools. J Endod 1997;23:394-396. https://doi.org/10.1016/S0099-2399(97)80191-4
  23. Kherlakian D, Cunha RS, Ehrhardt IC, Zuolo ML, Kishen A, da Silveira Bueno CE. Comparison of the incidence of postoperative pain after using 2 reciprocating systems and a continuous rotary system: a prospective randomized clinical trial. J Endod 2016;42:171-176. https://doi.org/10.1016/j.joen.2015.10.011
  24. Arias A, de la Macorra JC, Azabal M, Hidalgo JJ, Peters OA. Prospective case controlled clinical study of post-endodontic pain after rotary root canal preparation performed by a single operator. J Dent 2015;43:389-395.
  25. 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;46:784-793. https://doi.org/10.1111/iej.12059
  26. Sun C, Sun J, Tan M, Hu B, Gao X, Song J. Pain after root canal treatment with different instruments: a systematic review and meta-analysis. Oral Dis 2018;24:908-919. https://doi.org/10.1111/odi.12854
  27. Ali A, Olivieri JG, Duran-Sindreu F, Abella F, Roig M, Garcia-Font M. Influence of preoperative pain intensity on postoperative pain after root canal treatment: A prospective clinical study. J Dent 2016;45:39-42. https://doi.org/10.1016/j.jdent.2015.12.002
  28. Sadaf D, Ahmad MZ. Factors associated with postoperative pain in endodontic therapy. Int J Biomed Sci 2014;10:243-247. https://doi.org/10.59566/IJBS.2014.10243
  29. Patil AA, Joshi SB, Bhagwat SV, Patil SA. Incidence of postoperative pain after single visit and two visit root canal therapy: a randomized controlled trial. J Clin Diagn Res 2016;10:ZC09-ZC12.
  30. El Mubarak AH, Abu-bakr NH, Ibrahim YE. Postoperative pain in multiple-visit and single-visit root canal treatment. J Endod 2010;36:36-39. https://doi.org/10.1016/j.joen.2009.09.003
  31. Paredes-Vieyra J, Enriquez FJ. Success rate of single- versus two-visit root canal treatment of teeth with apical periodontitis: a randomized controlled trial. J Endod 2012;38:1164-1169. https://doi.org/10.1016/j.joen.2012.05.021
  32. Garcia-Font M, Duran-Sindreu F, Calvo C, Basilio J, Abella F, Ali A, Roig M, Olivieri JG. Comparison of postoperative pain after root canal treatment using reciprocating instruments based on operator's experience: a prospective clinical study. J Clin Exp Dent 2017;9:e869-e874.
  33. Graunaite I, Skucaite N, Lodiene G, Agentiene I, Machiulskiene V. Effect of resin-based and bioceramic root canal sealers on postoperative pain: a split-mouth randomized controlled trial. J Endod 2018;44:689-693. https://doi.org/10.1016/j.joen.2018.02.010
  34. Al-Negrish AR, Habahbeh R. Flare up rate related to root canal treatment of asymptomatic pulpally necrotic central incisor teeth in patients attending a military hospital. J Dent 2006;34:635-640. https://doi.org/10.1016/j.jdent.2005.12.007
  35. Relvas JB, Bastos MM, Marques AA, Garrido AD, Sponchiado EC Jr. Assessment of postoperative pain after reciprocating or rotary NiTi instrumentation of root canals: a randomized, controlled clinical trial. Clin Oral Investig 2016;20:1987-1993. https://doi.org/10.1007/s00784-015-1692-0
  36. Cicek E, Kocak MM, Kocak S, Saglam BC, Turker SA. Postoperative pain intensity after using different instrumentation techniques: a randomized clinical study. J Appl Oral Sci 2017;25:20-26. https://doi.org/10.1590/1678-77572016-0138
  37. Farzaneh S, Parirokh M, Nakhaee N, Abbott PV. Effect of two different concentrations of sodium hypochlorite on postoperative pain following single-visit root canal treatment: a triple-blind randomized clinical trial. Int Endod J 2018;51 Suppl 1:e2-e11.
  38. Attar S, Bowles WR, Baisden MK, Hodges JS, McClanahan SB. Evaluation of pretreatment analgesia and endodontic treatment for postoperative endodontic pain. J Endod 2008;34:652-655. https://doi.org/10.1016/j.joen.2008.02.017
  39. Arias A, Azabal M, Hidalgo JJ, de la Macorra JC. Relationship between postendodontic pain, tooth diagnostic factors, and apical patency. J Endod 2009;35:189-192.
  40. Ali SG, Mulay S, Palekar A, Sejpal D, Joshi A, Gufran H. Prevalence of and factors affecting postobturation pain following single visit root canal treatment in Indian population: a prospective, randomized clinical trial. Contemp Clin Dent 2012;3:459-463. https://doi.org/10.4103/0976-237X.107440
  41. Ng YL, Glennon JP, Setchell DJ, Gulabivala K. Prevalence of and factors affecting post-obturation pain in patients undergoing root canal treatment. Int Endod J 2004;37:381-391. https://doi.org/10.1111/j.1365-2591.2004.00820.x
  42. Polycarpou N, Ng YL, Canavan D, Moles DR, Gulabivala K. Prevalence of persistent pain after endodontic treatment and factors affecting its occurrence in cases with complete radiographic healing. Int Endod J 2005;38:169-178. https://doi.org/10.1111/j.1365-2591.2004.00923.x
  43. Unruh AM. Gender variations in clinical pain experience. Pain 1996;65:123-167. https://doi.org/10.1016/0304-3959(95)00214-6
  44. Fillingim RB, Maixner W. Gender differences in the responses to noxious stimuli. Pain Forum 1995;4:209-221.
  45. Vier FV, Figueiredo JA. Prevalence of different periapical lesions associated with human teeth and their correlation with the presence and extension of apical external root resorption. Int Endod J 2002;35:710-719. https://doi.org/10.1046/j.1365-2591.2002.00554.x
  46. Marshall JG, Liesinger AW. Factors associated with endodontic posttreatment pain. J Endod 1993;19:573-575. https://doi.org/10.1016/S0099-2399(06)81290-2
  47. Genet JM, Hart AA, Wesselink PR, Thoden van Velzen SK. Preoperative and operative factors associated with pain after the first endodontic visit. Int Endod J 1987;20:53-64. https://doi.org/10.1111/j.1365-2591.1987.tb00590.x
  48. Estrela C, Bueno MR, Leles CR, Azevedo B, Azevedo JR. Accuracy of cone beam computed tomography and panoramic and periapical radiography for detection of apical periodontitis. J Endod 2008;34:273-279. https://doi.org/10.1016/j.joen.2007.11.023
  49. Bender IB, Seltzer S. Roentgenographic and direct observation of experimental lesions in bone: II. 1961. J Endod 2003;29:707-712.
  50. Bender IB, Seltzer S. Roentgenographic and direct observation of experimental lesions in bone: I. 1961. J Endod 2003;29:702-706.
  51. Halse A, Molven O, Fristad I. Diagnosing periapical lesions--disagreement and borderline cases. Int Endod J 2002;35:703-709.
  52. Yesilsoy C, Koren LZ, Morse DR, Rankow H, Bolanos OR, Furst ML. Post-endodontic obturation pain: a comparative evaluation. Quintessence Int 1988;19:431-438.
  53. Liddell A, Locker D. Gender and age differences in attitudes to dental pain and dental control. Community Dent Oral Epidemiol 1997;25:314-318. https://doi.org/10.1111/j.1600-0528.1997.tb00945.x
  54. Shokraneh A, Ajami M, Farhadi N, Hosseini M, Rohani B. Postoperative endodontic pain of three different instrumentation techniques in asymptomatic necrotic mandibular molars with periapical lesion: a prospective, randomized, double-blind clinical trial. Clin Oral Investig 2017;21:413-418. https://doi.org/10.1007/s00784-016-1807-2
  55. Pak JG, White SN. Pain prevalence and severity before, during, and after root canal treatment: a systematic review. J Endod 2011;37:429-438. https://doi.org/10.1016/j.joen.2010.12.016
  56. Hackel D, Pflucke D, Neumann A, Viebahn J, Mousa S, Wischmeyer E, Roewer N, Brack A, Rittner HL. The connection of monocytes and reactive oxygen species in pain. PLoS One 2013;8:e63564.
  57. Vengerfeldt V, Mandar R, Saag M, Piir A, Kullisaar T. Oxidative stress in patients with endodontic pathologies. J Pain Res 2017;10:2031-2040. https://doi.org/10.2147/JPR.S141366
  58. Camargo CH, Camargo SE, Valera MC, Hiller KA, Schmalz G, Schweikl H. The induction of cytotoxicity, oxidative stress, and genotoxicity by root canal sealers in mammalian cells. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;108:952-960. https://doi.org/10.1016/j.tripleo.2009.07.015
  59. Cintra LT, Benetti F, de Azevedo Queiroz IO, Ferreira LL, Massunari L, Bueno CR, de Oliveira SH, GomesFilho JE. Evaluation of the cytotoxicity and biocompatibility of new resin epoxy-based endodontic sealer containing calcium hydroxide. J Endod 2017;43:2088-2092. https://doi.org/10.1016/j.joen.2017.07.016
  60. Morgental RD, Vier-Pelisser FV, Oliveira SD, Antunes FC, Cogo DM, Kopper PM. Antibacterial activity of two MTA-based root canal sealers. Int Endod J 2011;44:1128-1133. https://doi.org/10.1111/j.1365-2591.2011.01931.x