Postoperative pain after root canal filling with different endodontic sealers: a randomized clinical trial

Abstract

The aim of this randomized clinical trial was to compare the occurrence and intensity of postoperative pain and analgesic intake after root canal treatment, using different root canal sealers. Sixty single-rooted teeth diagnosed with asymptomatic necrosis and apical periodontitis were randomly assigned to 3 experimental groups (n=20), according to the root canal sealer: AH Plus, Endofill or MTA Fillapex. Endodontic treatment was performed in two sessions, and calcium hydroxide was used as the intracanal dressing. Patients were instructed to record pain intensity as none, slight, moderate and severe. Scores from 1 to 4 were attributed to each level of pain after 24 h, 48 h and 7 days. The need for analgesic intake was also recorded. Differences in the incidence of postoperative pain and the need for an analgesic were analyzed using the chi-square test. Differences in pain intensity after treatment were analyzed using the ordinal (linear) chi-square test. No significant differences were detected among the groups in terms of either incidence or intensity of postoperative pain, or need for analgesic intake, at any timepoint (p>0.05). No pain was reported after 7 days. AH Plus, Endofill and MTA Fillapex used for filling root canals resulted in the same rate of postoperative pain and need for analgesic medication.

Postoperative Pain following Root Canal Filling with Bioceramic vs. Traditional Filling Techniques: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Only one study managed an endodontic treatment without local anesthesia [ 31 ]. Furthermore, three studies assessed POP in anterior single-rooted teeth only [ 31 , 32 , 33 ].…”

“…Pooled POP data (mean ± standard deviation [SD]) experienced by patients 24 h and 48 h after RCF with BCS or RBS are presented in Figure 2 and Figure 3 , respectively. Six studies did not report the mean POP ± SD 48 h after RCF and these were not included in the respective forest plot [ 28 , 30 , 33 , 34 , 35 , 36 ]. Since in the study by Graunaite et al 2018 [ 31 ] asymptomatic patients were treated, as opposed to all the other studies in which patients were symptomatic, the sensitivity analysis was performed in all analyses where that study was considered, to see if the results changed with the exclusion of asymptomatic subjects.…”

“…The analgesic intake did not significantly differ between the BCS and RBS groups 24 h after RCF (RR = 0.46; P = 0.14; Figure 4 ). Five studies were not included in this forest plot due to a lack of available data [ 11 , 12 , 13 , 33 , 36 ]. The incidence of flare-up was also not significantly different between the BCS and RBS groups (OR = 0.32; P = 0.24; Supplementary Materials Figure S1 ).…”

“…In this analysis, we found that BCS was non-significantly correlated with reduced analgesic intake vs. RBS, an observation that was also reported by one of the included studies [ 35 ] using the warm-obturator filling technique. However, two of the other included RCTs [ 32 , 33 ] demonstrated comparable analgesic intake in the control and experimental groups after RCF using SCT.…”

“…However, only three studies included teeth that needed retreatment [28][29][30]. Four studies included teeth that were asymptomatic pre-operatively [30][31][32][33], two studies only included symptomatic teeth [28,34], and three studies examined asymptomatic and symptomatic teeth [29,35,36]. Only one study managed an endodontic treatment without local anesthesia [31].…”