Predictive models of pain following root canal treatment: a prospective clinical study

Abstract

Arias A, de la Macorra JC, Hidalgo JJ, Azabal M.Predictive models of pain following root canal treatment: a prospective clinical study. International Endodontic Journal, 46, 784-793, 2013. Aim To determine the probability of the incidence, intensity, duration and triggering of post-endodontic pain, considering factors related to the patient (age, gender, medical evaluation) and to the affected tooth (group, location, number of canals, pulp vitality, preoperative pain, periapical radiolucencies, previous emergency access, presence of occlusal contacts with antagonist). Methodology A total of 500 one-visit root canal treatments (RCTs) were performed on patients referred to an endodontist. Shaping of root canals was performed manually with Gates-Glidden drills and K-Flexofiles, and apical patency was maintained with a size 10 file. A 5% NaOCl solution was used for irrigation, and canals were filled with lateral compaction and AH-Plus sealer. Independent factors were recorded during the treatment, and characteristics of post-endodontic pain (incidence, intensity, type and duration) were later surveyed through questionnaires. Of the 500 questionnaires, 374 were properly returned and split in two groups for two different statistical purposes: 316 cases were used to adjust the logistic regression models to predict each characteristic of post-endodontic pain using predictive factors, and the remaining 58 cases were used to test the validity of each model. Results The predictive models showed that the incidence of post-endodontic pain was significantly lower when the treated tooth was not a molar (P = 0.003), demonstrated periapical radiolucencies (P = 0.003), had no history of previous pain (P = 0.006) or emergency endodontic treatment (P = 0.045) and had no occlusal contact (P < 0.0001). The probability of experiencing moderate or severe pain was higher with increasing age (P = 0.09) and in mandibular teeth (P = 0.045). The probability of pain lasting more than 2 days was increased with age (P = 0.1) and decreased in males (P = 0.007) and when a radiolucent lesion was present on radiographs (P = 0.1). Conclusions Predictive formulae for the incidence, the intensity and the duration of post-endodontic pain were generated and validated taking account of the interrelation of multiple concomitant clinical factors. A predictive model for triggering post-endodontic pain could not be established.

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

“…This was relatively similar to the results of postoperative pain after applying five-hundred single-visit root canal treatments, reporting intense in 9.6% of the cases, moderate in 45.8%, and mild in 43.5% [31]. However, in Arias et al's study [31], the cases included single-visit root canal treatments, not retreatments, so it is difficult to compare their results with those of our study.…”

“…This was relatively similar to the results of postoperative pain after applying five-hundred single-visit root canal treatments, reporting intense in 9.6% of the cases, moderate in 45.8%, and mild in 43.5% [31]. However, in Arias et al's study [31], the cases included single-visit root canal treatments, not retreatments, so it is difficult to compare their results with those of our study. In contrast, Yoldas et al [3] investigated two-hundred and eighteen single-visit and multiple-visit retreatment cases and reported "none pain" in 73.9%, mild pain in 17.8%, moderate pain in 2.7%, and severe pain in 5.4% of the single-visit asymptomatic group.…”

The Outcome of Preoperative Administration of Single-Dose Ketorolac, Ibuprofen 400mg and Placebo on Postoperative Pain in Teeth with Irreversible Pulpitis and Apical Periodontitis

“…The occurrence of postoperative pain of mild intensity is not an occasional event even when endodontic treatment has followed suitable standards [3]. This usually involves acute pain, meaning the correct treatment can be rapidly applied.…”

“…Post-endodontic pain, especially after primary endodontic therapy, should ideally be eliminated by the treatment; however, analgesics are frequently required to reduce pain [2]. There is a solid association among pulp status and postoperative pain, influencing the capability of pain, which may undermine the patient's confidence in the procedure and the clinician [3]. Ketorolac is an excellent acting analgesic used widely in surgery and medicine [22].…”

The Effect of Preoperative Administration of Antihistamine, Analgesic and Placebo on Postoperative Pain in Teeth with Symptomatic Apical Periodontitis: A Randomized Controlled Trial

“…Extrusion of microorganisms or debris during endodontic treatment results in inflammatory response (1)(2)(3)(4). A recent systematic review showed that between 3% and 58% of patients were reported to have experienced endodontic postoperative pain (5).…”