The effect of solution and gel forms of sodium hypochlorite on postoperative pain: a randomized clinical trial

Abstract

The effect of solution and gel forms of sodium hypochlorite on postoperative pain: a randomized clinical trial Objectives: The aim of this study is to evaluate the effect of using gel and solution forms of NaOCI during the chemomechanical preparation of the root canals on postoperative pain at different time intervals. Methodology: 114 patients with mandibular molar teeth and symptomatic irreversible pulpitis were included in the study. All patients were divided into two groups based on the irrigant used during root canal preparation (n=57): Group 1, 5.25% NaOCI, Group 2, 5.25% NaOCI gel. All groups were filled with gutta-percha and AH Plus root canal sealer using single-cone technique. VAS scale (1-10) was used for postoperative pain assessment. After endodontic treatment, all patients were asked to record their postoperative pain levels at the 6th, 24th, 48th, 72nd hours, and 1 week later. The data were analyzed using Chi-Squared, Independent Samples T, Cochran Q and Friedman tests. Results: Statistically significant difference was not found between the distributions of pain levels at different times according to the groups (p>0.050). A statistically significant difference was observed between the distributions of pain levels measured at different times in the solution group (p<0.001). A statistically significant difference was found between the distributions of pain levels measured at different times in the gel group (p<0.001). In both groups, highest postoperative pain levels occurred in the first 6 hours. Pain levels of the gel group as 38,5% mild, 17.3% moderate, 5.8% severe and pain levels of the solution group were obtained as 46.2% mild, 26.9% moderate, 9.6% severe at the 6th hour. Conclusions: The use of the gel form of NaOCI during the chemomechanical preparation of the root canals showed similar postoperative pain when compared to the solution form.

Self-perceived pain levels following irrigation with various concentrations ofsodium hypochlorite solution and gels: A systematic review of randomized clinical studies

“…Studies have shown that the gel form of NaOCl may be advantageous in reducing postoperative pain. However, the effectiveness of gel form in disinfection and smear removal is inconclusive [1]. Previous studies have evaluated the impact of several NaOCl forms on root canal dentin's microhardness.…”

“…Moreover, a study by Karatas et al concluded that the NaOCl gel results in less postoperative pain than the NaOCl solution on day 1 of endodontic treatment [3]. Another survey by Ozlek et al showed that using the NaOCI gel form during root canal irrigation resulted in postoperative pain similar to that of the solution form [1]. Nonetheless, the comparison between different concentrations and formulations of NaOCl in root canal treatment has not been systematically assessed.…”

“…After reading the titles and abstracts, 11 manuscripts underwent full-text assessment for eligibility, and six articles were excluded (Appendix A). Five RCTs [1,3,17,32,35] were included in the present systematic review for qualitative analysis and processed for data extraction (Figure 1).…”

“…All RCTs included both male and female subjects. Four RCTs [1,3,17,35] reported patient dropouts. The reason for the dropout was either the patient was lost to follow-up or was not reachable by phone.…”

“…Postoperative pain can be experienced following root canal treatment, which can be short or long-lasting, with an overall incidence reported as 39% -65% within the first 24 hours [1,2]. Several factors can affect postoperative endodontic pain, such as preoperative pain level [3,4], the number of appointments [3,5], the method of determination of the working length [3,6], type of tooth [3,7], type of the instrument [3,8], movement kinematic of the device [3,9], extrusion of root canal filling material and sealer [3,10], apically extruded debris [3,11], occlusal reduction [12], and method of irrigation [3,13].…”