The impact of two root canal treatment protocols on the oral health‐related quality of life: a randomized controlled pragmatic clinical trial

Abstract

Aim To assess the impact of two root canal treatment protocols on the oral health‐related quality of life (OHRQoL) of patients in need of root canal treatment on their anterior teeth. Methodology The sample consisted of 120 participants (mean age: 34 years) enrolled in a pragmatic randomized clinical trial evaluating two root canal treatment protocols. Anterior teeth with nonvital pulps were allocated for root canal preparation with either hand files and filled with lateral compaction of gutta‐percha (manual protocol) or canal preparation with a single file in a reciprocating movement and filled with a single cone technique (Reciproc protocol). OHRQoL data were assessed using the Oral Health Impact Profile instrument (OHIP‐14), which was administered before the root canal intervention (baseline), and 6 and 12 months after treatment. Demographic and clinical characteristics of participants were collected at baseline. Data were analysed using bivariate analyses, Poisson univariate and multiple regression (α = 0.05). Results The drop‐out rate from baseline was 27% and 28% at 6 and 12 months after treatment, respectively. Both root canal protocols significantly enhanced patients' OHRQoL, regardless of the follow‐up time (P < 0.001). After 6 months, patients treated with the Reciproc protocol had significantly lower OHIP‐14 overall scores (P = 0.030), as well as significantly lower scores for psychological discomfort (P = 0.031) and social disability (P = 0.013). After 12 months, no significant difference was observed between the two root canal protocols for OHIP‐14 overall scores (P = 0.174). Either large or moderate effect sizes were observed for all domains and overall scores at both evaluation times, irrespective of the protocol. Low‐income persons (RR = 2.03) and the Reciproc protocol (RR = 1.52) had a higher likelihood of a positive impact on OHRQoL 12 months after root canal treatment. Conclusions The two root canal protocols improved the OHRQoL and differences in scores were observed only after 6 months with poorer OHRQoL for the manual protocol. After 12 months, patients with low‐income status and treated with Reciproc were associated with a greater improvement in OHRQoL scores.

PROMs Following Root Canal Treatment and Surgical Endodontic Treatment

“… 61 In terms of surgical endodontics, the use of microsurgical protocols, 53 peizosurgery instruments, 46 papilla-based flap designs, 48 low-level laser therapy, 56 and autologous platelet concentrates have also been evaluated in the context of PROMs. Except for the study by Diniz-de-Figueiredo et al, 65 the period of evaluation was relatively short, spanning 2 weeks at most. Again, short evaluation times may be insufficient to thoroughly assess OHRQoL beyond patients’ initial recovery.…”

“…A decrease in pain was associated with an increased in OHRQoL (POQoL scores). Diniz-de-Figueiredo et al 2020 65 Randomised controlled trial; Brazil 88 patients at 6 months (46 manual group, 42 reciprocating group); 87 patients at 12 months (42 manual group, 45 reciprocating group) Reciprocating instrumentation and single cone obturation vs hand file instrumentation and lateral compaction obturation Prior to treatment and 6 and 12 months after treatment OHIP-14 Brazilian version Yes OHRQoL improved (OHIP-14 scores decreased) significantly after root canal treatment with moderate to large effect sizes. At 6 months, the manual protocol was associated with poorer OHIP-14 scores.…”

“…However, significant variation exists in regard to the evaluation periods. Whilst several studies have applied extended evaluation periods, for example, 1 year 54 , 65 to 2 years, 66 , 67 others reported postoperative assessments of only up to 7 days, sometimes without any preoperative baseline measurement. 46 , 47 , 48 , 49 , 50 , 51 , 52 It has been suggested that limited time frames, for example, 6 months or less, are insufficient to evaluate changes in OHRQoL as they are limited to describing the initial posttreatment recovery.…”

“…Multiple clinical studies have investigated how various procedural aspects of root canal treatment may impact OHRQoL. This includes local infiltration of corticosteroids, 59 different instrumentation protocols, 58 , 65 , 73 , 74 obturation techniques, 65 and extent of foraminal enlargement. 61 In terms of surgical endodontics, the use of microsurgical protocols, 53 peizosurgery instruments, 46 papilla-based flap designs, 48 low-level laser therapy, 56 and autologous platelet concentrates have also been evaluated in the context of PROMs.…”

Present status and future directions: Canal shaping

“…A lower incidence of postoperative pain has also been reported when using rotary than manual shaping (Arias et al, 2015 ), and a poorer oral health–related quality of life 6 months after the manual shaping of anterior teeth compared with a reciprocating preparation, although with no differences after 12 months (Diniz‐de‐Figueiredo et al, 2020 ). Root canal preparation time was also lower for rotary shaping when compared with manual preparation in a clinical study that also demonstrated a comparable flare‐up incidence with both (Makanjuola et al, 2018 ).…”