Postoperative Pain after Foraminal Enlargement in Anterior Teeth with Necrosis and Apical Periodontitis: A Prospective and Randomized Clinical Trial

Intraoperative discomfort associated with the use of a rotary or reciprocating system: a prospective randomized clinical trial

“…Postoperative pain related to root canal instrumentation has been reported to vary from low to high incidence 13141516171819. The methodological differences related to preoperative pain, variability in protocols, and differences in the collection of clinical findings may explain this variation.…”

Postoperative Pain after Foraminal Instrumentation with a Reciprocating System and Different Irrigating Solutions

“…None of the patients enrolled in this clinical trial was taking any medication that could alter his/her perception of pain (analgesics or non-steroidal anti-inflammatory drugsNSAIDs). They presented single canal teeth diagnosed with asymptomatic necrosis confirmed by a negative response to heat, cold, percussion and palpation tests, clear radiographic observation of a single canal without any sign of pulp obliteration or calcifications from the pulp chamber to the apex, and evidence of apical periodontitis (8). The heat test was performed using a pre-heated gutta-percha cone placed on the middle third of the buccal surface of the teeth and the cold test was performed with the aid of a cold spray (Endo-Frost; Coltène-Whaledent, Langenau, Germany) placed on a cotton pellet and immediately applied on the middle third of the buccal surface of the candidate tooth.…”

“…After instrumentation, the root canals were dried with absorbent paper points (Denstply Maillefer) and filled with gutta-percha (Odous; Odous De Deus Ltda, Belo Horizonte, MG, Brazil) and AH Plus sealer (Dentsply De Trey, Konstanz, Germany) using warm vertical compaction with the continuous-wave technique (Touch'n Heat; SybronEndo) and gutta-percha backfill. After endodontic treatment, all patients received postoperative instructions for taking analgesics (400 mg ibuprofen) in case they experienced pain (8).…”

“…Pain was recorded as absent, slight, moderate or severe, and scores from 1 to 4 were attributed to each classification of pain (8): no pain (1), the patient feels well; slight pain (2), if the patient is distracted, he/she does not feel the pain and no analgesic is required; moderate pain (3), the patient feels moderate pain even while concentrating on some other activity and analgesic is required; and severe pain (4), the patient is no longer able to perform any type of activity, needs to lie down and seek dentist help (analgesics had little or no effect in relieving the pain). The number of analgesic tablets used was also recorded.…”

“…This maneuver may overcome the limitations of irrigation in the apical area, optimizing root canal disinfection (6,7). A recent study suggested that foraminal instrumentation should be performed for the sake of endodontic treatment predictability without considerably increasing postoperative pain (8). However, up to now, no clinical study has shown whether different irrigants during foraminal instrumentation procedures provide more favorable results in terms of postoperative pain.…”