Evaluation of postoperative pain in infected root canals after using double antibiotic paste versus calcium hydroxide as intra-canal medication: A randomized controlled trial

Abstract

Background: Postoperative pain is defined as pain of any degree after initiation of endodontic treatment either intra-appointment or post-obturation and is considered an undesirable occurrence for both patient and dentist. It was suggested that bacterial injury is probably the major cause of pain. Intra-canal medicaments are widely used to kill any bacteria surviving after instrumentation and irrigation. The aim of this study was to assess the ability of double antibiotic paste versus calcium hydroxide used as intra-canal medication in reducing postoperative pain. Methods: 36 patients with single rooted necrotic premolars with apical periodontitis were randomly assigned into two groups according to the intra-canal medication used: calcium hydroxide group (CH) and double antibiotic paste group (DAP). Preoperative pain was recorded using numerical rating scale. After isolation, access cavity was performed followed by chemico-mechanical preparation using rotary Race files with 2.5% sodium hypochlorite irrigation. Subsequently, intra-canal medication was placed and postoperative pain was recorded at 6, 12, 24 and 48 hours postoperatively. Results: There was no statistically significant difference between both groups. Both groups resulted in an increase in median pain value from preoperative to 6 hours postoperative, followed by gradual decrease from 6 hours to 12, 24, 48 hours postoperatively with statistically significant difference. When comparing both groups, DAP group showed lower postoperative pain values than CH group at 12 and 24 hours, but this was not statistically significant. Conclusion: The use of intra-canal medication in necrotic teeth with apical periodontitis was efficient in reducing postoperative pain regardless of type of intra-canal medication used. Trial registration: PACTR201605001482394 (Date: 22 nd February 2016).

Reduction of Pain and Bacterial Presence by using Double and Triple Antibiotic Pastes in Symptomatic Apical Periodontitis

“…Contrary to our results one study noticed no advantage of DAP medication over CH, but they used canal dressings for 48 hours only 16 . With contrast to our findings Narang K 2018 20 found no difference between antibiotic pastes and CH in apical periodontitis in their case reports.…”

“…Sabbagh S 2018 11 also found symptom free patient when they applied DAP as intracanal medication in their case report. Contrary to our results Abouelenien SS 2018 16 in their study found less post operative pain in apical periodontitis with DAP group than CH after only 24 hours, while we evaluated postoperative pain after 7 days.…”

Calcium hydroxide intracanal medication effects on pain and flare-up: a systematic review and meta-analysis

“…Twenty-six articles were excluded for different reasons ( Supplementary Table 4 ). Sixteen articles from 15 studies [ 4 5 10 11 12 20 21 22 23 24 25 26 27 28 29 30 ] were included in the qualitative analysis ( Tables 1 and 2 ).…”

“…Thirteen articles [ 4 5 10 11 12 20 21 24 25 26 27 29 30 ] assessed postoperative pain in terms of incidence and/or intensity using different scales. Five articles reported flare-up incidence [ 20 22 23 25 28 ].…”

“…One study [24] showed no difference between CH and DAP in pain risk at the ≤ 1-day interval (RR, 1.11; 95% CI, 0.60 to 2.07; 36 teeth, Low RoB) or the > 1-day-till-3-days (RR, 0.57; 95% CI, 0.20 to 1.62) intervals.…”