Intracanal medications versus placebo in reducing postoperative endodontic pain – a double – blind randomized clinical trial

Abstract

This prospective randomized, double-blind factorial study aimed to compare the efficacy of three different intracanal medicaments with the placebo in controlling the postoperative pain after complete root canal preparation. The study was performed on 64 mandibular molars of 64 patients with diagnosis of pulp necrosis and acute apical periodontitis. After chemomechanical procedures using the stepback technique and 1% sodium hypochlorite, the teeth were randomized into four treatment groups (n=16). In group I, canals were filled with calcium hydroxide paste mixed with 2% chlorhexidine gel, group II received 2% chlorhexidine gel, group III was treated with calcium hydroxide paste, and group IV received no dressing (control). Before dismissal, preoperative pain experience was recorded using a visual analog pain scale. Patients were then instructed to quantify the degree of pain experienced 4h after treatment and daily for a further 24, 48, 72 and 96h. Two-way repeated measures ANOVA test and post hoc Tukey's HSD test revealed that at each time interval groups I and II were significantly more effective in reducing the postoperative pain values than groups III and IV (p<0.05). Dunnett's test showed that groups I and II differed significantly from control whereas difference between group III and control was not significant (p>0.05). Patients with pulp necrosis and acute apical periodontitis that had been dressed with chlorhexidine alone and calcium hydroxide plus chlorhexidine gave rise to less pain than that experienced by patients who had a calcium hydroxide dressing alone or no dressing at all.

Comparative evaluation of postoperative pain intensity after single-visit and multiple-visit retreatment cases: a prospective randomized clinical trial

“…Therefore, an antimicrobial intracanal dressing helps reduce postoperative pain and flare-ups [21]. CaOH 2 is still a commonly used root canal dressing material for multiple-visit root canal treatments [3,4,7] because of its high-alkalinity antibacterial activity and its ability to create an appropriate environment for hard tissue deposition and apical repair.…”

“…There have been some studies discussing the relationship between intracanal medicaments for postoperative pain in endodontics [4,17,[19][20][21]23] and the incidence of pain after endodontic treatments being performed in single or multiple visits [1,29,32], but these studies were not about retreatment. Therefore, it would not be accurate to compare the results.…”

“…The elimination of these microorganisms is very important for the success of endodontic therapy and reducing postoperative pain, especially in retreated infected root canals [3]. Thus, in addition to the antibacterial effects of the chemo-mechanical preparation and irrigation procedures, intracanal dressing has been recommended for long-lasting effects against the microorganisms in the root canal [4]. Calcium hydroxide (CaOH2) has been used for this treatment for many years [4,5], and its many advantages, such as a high pH, antibacterial effects, hard tissue stimulation, and reduced cytotoxicity to the periapical tissues, are the main reasons why it is so popular as an intracanal medicament [6].…”

“…Thus, in addition to the antibacterial effects of the chemo-mechanical preparation and irrigation procedures, intracanal dressing has been recommended for long-lasting effects against the microorganisms in the root canal [4]. Calcium hydroxide (CaOH2) has been used for this treatment for many years [4,5], and its many advantages, such as a high pH, antibacterial effects, hard tissue stimulation, and reduced cytotoxicity to the periapical tissues, are the main reasons why it is so popular as an intracanal medicament [6]. Because of its high-pH and antibacterial activity, CaOH 2 is still commonly used as a root canal dressing material in multiple-visit root canal treatments [7].…”

Autotransplantation of a Mandibular Third Molar: A Case Report with 5 Years of Follow-up

“…The use of calcium hydroxide as an intracanal dressing is required as part of the endodontic treatment because the high pH and antimicrobial properties of this compound may contribute to the prevention of root resorption and stimulation of the healing process (9,10,13,17). In this case, a calcium hydroxide dressing was used in addition to the already described properties to stimulate the process of apical closure.…”