Maintaining Apical Patency Does Not Increase Postoperative Pain in Molars with Necrotic Pulp and Apical Periodontitis: A Randomized Controlled Trial

Yaylali, Ibrahim Ethem; Kurnaz, Safa; Tunca, Yaşar Meriç

doi:10.1016/j.joen.2017.11.013

Cited by 25 publications

(47 citation statements)

References 21 publications

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“…In our study, mean rank of postoperative pain scores was higher in apical patency group than nonpatency group in 1 st , 2 nd and 7 th day follow up with statistically signi cant difference. The result is in contrast to other studies (14,15,16,17,18,19,20). Arias et al (14), Garg et al (16) and Sharaan et al (17) reported maintaining apical patency did not increase post-operative pain whereas Arora et.…”

Section: Discussionmentioning

confidence: 69%

“…Yaylali et.al (18) found decrease in post-operative pain when patency was maintained. Even systematic review (19) and meta-analysis (20) also concluded that maintaining apical patency did not increase postoperative pain.…”

Section: Discussionmentioning

confidence: 96%

“…Pain is a subjective sign, so it is di cult to assess accurately and quantify in any statistical analysis (21) so it is crucial to select proper pain assessment tool. VAS scale was used in many studies (16,17,18) as pain assessment tool for postoperative pain when patency was maintained whereas NRS-11 scale was used in our study as it has high reliability and validity (22). A systematic review in 2011, authors found that even though the studies were inconclusive regarding preference for a particular tool, the NRS was considered superior in 11 studies and the VAS (Visual Analogue Scale) was recommended in only four studies (23).…”

Section: Discussionmentioning

confidence: 96%

“…In addition to this, the variation of results might be due to difference in ling technique, le system and difference in pain perception by different population. In most of the studies shaping and cleaning was done with rotary instruments (15,16,17,18) whereas shaping and cleaning in our study was done by manual K les with step back technique which requires more frequent number of ling and recapitulations increasing the possibility of greater extrusion and peri-apical injury thereby increasing the chance for more post-operative pain in an attempt to maintain apical patency.…”

Section: Discussionmentioning

confidence: 97%

“…There are only few published researches evaluating postoperative pain after maintenance and nonmaintenance of apical patency (14,15,16,17,18,19,20). Some of these literatures showed superiority of apical patency group (15,18), however some studies (14,16,17,19,20) showed no difference. Hence, the study hypothesizes that there is no difference in post-operative pain between apical patency and nonapical patency group.…”

Section: Introductionmentioning

confidence: 99%

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Influence of maintaining apical patency in post-endodontic pain

Shubham

Nepal

Mishra

et al. 2020

Preprint

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BackgroundThe concept of instrumentation beyond the apical foramen by small flexible file to prevent apical blockage is apical patency. However, this procedure might endow postoperative pain, thus to maintain apical patency or not is the matter of dilemma. Hence, the primary objective of this study was to compare postoperative pain between apical patency and non-patency groups and secondary objective was to evaluate the influence of number of visits, vitality of teeth, group of teeth and preoperative pain on post-operative pain.MethodsOne hundred sixty patients were included in the study. Patients were randomly divided into: Group A (n = 80) contained apical patency maintained and Group B (n = 80) contained those treated without apical patency. Each group was subdivided into equal number of patients treated in single visit (n = 40) and multiple visits (n = 40), including vital (n=20) and non-vital teeth (n=20) and single- rooted (n=10) and multiple-rooted teeth (n=10). Apical patency was maintained with a size 10 K-file during conventional hand filing step-back shaping procedure. Intensity of pain was recorded before treatment and on days 1, 2, and 7 after treatment using a Numerical Rating Scale (NRS-11). Statistical analysis was done using Mann -Whitney U test, Spearman correlation and Multiple linear regression analysis.ResultsThe primary outcome of this study showed statistically significant difference (p<0.05) in postoperative pain scores between patency and non-patency groups with higher pain scores in patency group on 1st, 2nd and 7th day follow up. The secondary outcome showed postoperative pain in patency maintained group was influenced by status of the pulp and preoperative pain only. Vital teeth of patency-maintained group treated in multiple visits showed statistically significant (p=0.02) post-operative pain in day 1 follow up. Pre-operative pain showed positive correlation with postoperative pain with statistically significant difference.ConclusionsOur study concluded that maintenance of apical patency increased postoperative pain. Evaluation of influence of number of visits, status of pulp, group of tooth and preoperative pain revealed status of pulp and preoperative pain as influencing factors for postoperative pain in patency group.

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