Effect of final irrigation with sodium hypochlorite at different temperatures on postoperative pain level and antibacterial activity: a randomized controlled clinical study

Abstract

Objective: To evaluate the effect of final irrigation of root canals with NaOCl solution at different temperatures on postoperative pain level and antimicrobial activity. Methodology: 45 patients were randomly divided into three groups using a web program according to the irrigation selected: NaOCl 2ºC, NaOCl 25ºC and NaOCl 45ºC. First root canal samples were collected before treatment (S1). After chemo-mechanical preparation, final irrigation was performed with the selected irrigant (NaOCl 2ºC, NaOCl 25ºC and NaOCl 45ºC) and second samples were collected (S2). Samples were subjected to quantitative real-time polymerase chain reaction to evaluate the levels of total bacteria. The root canal treatments were completed and the participants were given instructions to record postoperative pain levels at 24, 48 and 72 hours, 5 days and 1 week after treatment using a visual analog scale (VAS). Results: The reduction in the number of total bacterial cell equivalents from S1 to S2 was statistically significant in all groups (p<0.001). The NaOCl 2˚C group reported significantly less postoperative pain than the NaOCl 45˚C group (p<0.05). Postoperative analgesic intake was significantly higher in the NaOCl 45˚C group than in the NaOCl 2˚C group (p<0.05). Conclusion: We conclude that final irrigation with NaOCl at different temperatures results in similar antibacterial effectiveness. Final irrigation with cold NaOCl (2˚C) is better than NaOCl 45˚C when comparing postoperative pain levels.

Is Intracanal Cryotherapy Effective in Reducing Postoperative Endodontic Pain? An Updated Systematic Review and Meta-Analysis of Randomized Clinical Trials

“…Seventeen articles were eliminated due to the following causes: ten studies were still ongoing [26][27][28][29][30][31][32][33][34][35], two studies were in vitro [36,37], two studies were critical appraisals [38,39], one paper was a letter to the editor [40], one was an editorial paper [41], and one study had no control group [42]. Therefore, 16 studies were involved in the systematic review [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58]. Seven of the sixteen studies documented their results as percentages, which were excluded from the meta-analysis [43,44,47,50,52,55,56].…”

“…Seven of the sixteen studies documented their results as percentages, which were excluded from the meta-analysis [43,44,47,50,52,55,56]. Nine studies involving 878 participants were included in the meta-analysis [45,46,48,49,51,53,54,57,58]. The main features of the sixteen included articles are summarized in Table 1.…”

“…Eight of the sixteen articles consisted of two parallel groups [44,45,47,48,50,53,54,57], four studies had three parallel groups [43,49,51,58], three studies had four parallel groups [46,52,56], and one study had five parallel groups [55]. The number of participants in these studies ranged from 30 to 240 with ages ranging from 18 to 70 years diagnosed with irreversible pulpitis in 11 studies [43][44][45][46][47]49,50,52,53,55,57], necrotic pulp in 3 studies [48,54,58], and pulpal and periradicular pathosis or normal periradicular tissues in 12 studies [44][45][46][47][48][49][53][54][55][56][57][58]. The assessment of postoperative pain ranged from day 1 to day 7 and it was measured using a visual analogue scale (VAS, 0-10 cm) in 12 studies [43][44][45]…”

“…The assessment of postoperative pain ranged from day 1 to day 7 and it was measured using a visual analogue scale (VAS, 0-10 cm) in 12 studies [43][44][45][47][48][49][50][51][52][53][54]56]. Three studies used the VAS (0-100) [46,55,58], one study used the Heft-Parker scale [57], and all of the scales were converted into a 0-10 cm VAS for statistical calculation standardization. Preoperative pain was evaluated in 13 studies [43][44][45][46][47][48][49]51,[53][54][55][56][57] ranging from no pain in 2 studies [49,51] to mild pain in 2 studies [43,44], moderate pain in 2 studies [53,54], and severe pain in 6 studies [45][46][47][48]55,56].…”

“…One study had fourteen patients with mild pain, twelve patients with moderate pain and fourteen patients with severe pain [57]. Three studies did not clearly describe the preoperative pain assessment [50,52,58]. The final cold irrigant used was either saline in most of the studies [43][44][45][46][47][48][49][50][51][52]55,57] or sodium hypochlorite (NaOCl) [53,54,56,58].…”