Incidence of Postoperative Pain After Intracanal Procedures Based on an Antimicrobial Strategy

Abstract

The purpose of this prospective study was to evaluate the incidence of postoperative pain after intracanal procedures based on an antimicrobial strategy. Data were examined from 627 teeth that had necrotic pulps or required retreatment. Information was obtained for each patient treated with regard to presence of preoperative pain. Occurrence of periradicular bone destruction detected by radiographs was also recorded. The operators consisted of undergraduate students, who were in their first year of clinical training. Root canals were instrumented and then medicated with a calcium hydroxide/camphorated paramonochlorophenol paste. No systemic medication was prescribed. Approximately 1 week after the initial appointment, patients were asked about the occurrence of postoperative pain and the level of discomfort was rated as no pain, mild pain, moderate pain, or severe pain. Data were statistically analyzed using the Chi-square test. Mild pain occurred in 10% of the cases, moderate in 3.3%, and severe (flare-up) in 1.9%. Postoperative pain was significantly associated with the treatment of previously symptomatic teeth without periradicular lesions (p < 0.01). No other correlations were detected between the occurrence of postoperative discomfort and other clinical conditions. There was also no difference regarding the incidence of postoperative pain between treatment and retreatment (p > 0.01). The intracanal procedures used in this study to control root canal infections showed a small incidence of postoperative pain, particularly flare-ups, even performed by inexperienced undergraduate dental students.

Influence of serum and necrotic soft tissue on the antimicrobial effects of intracanal medicaments

“…Although CPMC exhibits high toxicity when used alone, satisfactory biocompatibility results have been observed for its association with CH in animal studies (17,18). Clinical studies evaluating the incidence of postoperative pain (19), antibacterial activity (3) and treatment outcome (20) have demonstrated excellent results when using an antibacterial protocol for treatment that includes a 7-day interappointment medication with CHPG.…”

Apical Extrusion of Debris and Irrigant using Novel Preparation Systems

“…This has led to the hypothesis that engine-driven instruments produce less debris than hand filing techniques, as they have a tendency to pull the debris into their flutes, thus leading the debris out of the root canal in a coronal direction. 3,4 Vande Visse and Brilliant (1975) 5 were the first to quantify the amount of apically extruded debris during instrumentation. When instrumentation is coupled with irrigation, it tends to generate a significantly greater amount of debris than when irrigation is omitted.…”

Exacerbación Apical Posterior a Tratamiento Endodóntico

“…8 A partir de 1987, la incidencia de agudizaciones alcanza un 20% al tener en cuenta la inflamación como base, después de tratar pulpas necróticas y presentándose el paciente antes del tratamiento asintomá-tico con una imagen radiolúcida al final. 3,[9][10][11] No existen diferencias en términos de éxito radiológico entre tratamientos de conductos radiculares de visita única y de visitas múltiples.…”

“…Las probabilidades disminuyen en los casos de pulpas necróticas asintomáticas, el factor más importante relacionado con la incidencia de agudizaciones ha sido la presencia de dolor preoperatorio severo, el cual ocasiona el 19% de incidencia. 8,13,[17][18][19] Técnicas de instrumentación: ninguna técnica es efectiva en prevenir la extrusión de restos a través del foramen apical, pero sí se ha reportado que es mayor la cantidad de los mismos cuando se utiliza la técnica de paso atrás. 14,[20][21][22] Número de citas: no se encuentran diferencias en la incidencia de dolor postoperatorio existente entre los tratamientos endodónticos en varias citas y aquellos realizados en una sola cita.…”