Intra-canal medication containing silver nanoparticle versus calcium hydroxide in reducing postoperative pain: A randomized clinical trial

Abstract

Background: Pain of endodontic origin can be annoying for patients and endodontist. Pain relief is more important to the patient than treatment success. Numerous factors such as over instrumentation, over filling, debris extrusion can cause postoperative pain. However, bacteria found in the root canal space is the most important factor. Therefore mechanical preparation is an important step in elimination of micro-organisms from the root canal. It has been reported that micro-organisms can still survive inside the root canal even after mechanical preparation. Hence, the use of intra-canal medicaments in between visits for reduction of bacteria inside the root canal space has been recommended. The aim of this study was to assess the ability of silver nanoparticles versus calcium hydroxide used as intra-canal medication in reducing pain in necrotic teeth with apical periodontitis. Methods: Thirty-four participants were randomly divided into 2 groups, 17 in each group according to intra-canal medication used silver nanoparticles and calcium hydroxide (AgNPs and Ca(OH)2). Each patient was given pain scale chart numerical rating scale (NRS) in order to record his/her pain level before any intervention followed by placement of intra-canal medicament for 1 week. Postoperative pain was recorded at 4, 12, 24, 48 hours. Results: Pre-operatively; there was no statistically significant difference between mean pain scores in the two groups. After 4, 12 as well as 24 hours, Ca(OH)2 group showed statistically significantly higher mean pain score than AgNPs group. After 48 hours; there was no statistically significant difference between mean pain scores in the two groups. Conclusions: There was a statistically significant difference in postoperative pain following 4, 12, and 24 hours where AgNPs group resulted in reduction of pain more than Ca(OH)2 group. At 48 hours, there was no statistically significant difference. Trial registration: PACTR PACTR201602001444180 26/01/2016

Post-operative Pain and Antibacterial Efficacy of Silver Nanoparticles Formulations Intracanal Medication: A Randomized Controlled Clinical Study

“…Both Ca(OH) 2 or AgNPs groups showed statistically significantly lower median pain scores with no statistically significant difference between them. This came in contradiction with an earlier study that found significantly lower pain scores in the AgNPs group at 4, 12, and 24 h in comparison to Ca(OH) 2 , while at 48 h postoperatively, there was no statistically significant difference [9]. A possible explanation may be due to the presence of pre-operative pain at the start of the study mentioned above, which can affect the levels of post-operative pain [32].…”

“…Lately, silver nanoparticles (AgNPs) have gained much attention due to their unique characteristics, which lead to being incorporated in various dental materials [7]. AgNPs seem to be potential antibacterial agents due to their large surface-to-volume ratios and surface structure which can be a valuable additive to endodontic materials [8], and specifically as an intracanal medication alone [9] or in combination with Ca(OH) 2 . This combination has shown noticeable ability to reduce the bacterial count in root canals contaminated with Enterococcus faecalis [10], [11], [12].…”

Silver Nanoparticles as an Intracanal Medicament: A Scoping Review

“…Of the 24 included studies, nineteen were in vitro [ 1 , 9 , 10 , 12 , 19 – 23 , 26 – 29 , 31 – 36 ], three ex vivo [ 3 , 4 , 25 ], and two in vivo [ 24 , 30 ]. About 16 studies evaluated the antibacterial efficacy of AgNPs as an intracanal medicament [ 1 , 3 , 4 , 9 , 10 , 19 , 21 – 30 ].…”

Silver Nanoparticles and Their Therapeutic Applications in Endodontics: A Narrative Review

“…A study on the efficacy of AgNPs as an intracanal medicament to mitigate postoperative pain in necrotic teeth with apical periodontitis after 4, 12, and 24 h showed that they were significantly more effective than Ca(OH) 2 ; however, no significant difference was observed after 48 h [ 135 ]. Another randomized controlled clinical trial evaluated the effect of using Ca(OH) 2 /AgNPs (0.03 μg/mL concentration) in 2:1 ratio or Ca(OH) 2 individually as an intracanal medicament in reducing postoperative pain and intracanal bacterial count, and showed that Ca(OH) 2 /AgNPs decreased the count of intracanal bacteria more than each one alone, although this difference was not significant for aerobic intracanal bacteria.…”