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Abstracts - 20

1. Postoperative pain after 1- and 2-visit root canal therapy
2. The relationship of intracanal medicaments to postoperative pain in endodontics.
Relationship of intracanal medicaments to endodontic flare-ups.
4 Endodontic interappointment flare-ups: a prospective study of incidence and related factors.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002 May;93(5):605-10.
Postoperative pain after 1- and 2-visit root canal therapy
DiRenzo A,
Gresla T,
Johnson BR,
Rogers M,
Tucker D,
BeGole EA.
University of Illinois at Chicago, Chicago, Ill 60612, USA. bjohnson@uic.edu

OBJECTIVES: The factors that influence postoperative pain after root canal treatment are not completely understood. The purpose of this prospective clinical study was to evaluate postoperative pain after root canal therapy performed in 1 appointment versus 2 appointments.

STUDY DESIGN: Seventy-two patients requiring root canal therapy on permanent molars were included in this study. Patients were randomly assigned to either the 1-appointment or the 2-appointment group. Both vital and nonvital teeth were included. The standardized protocol for all teeth involved local anesthesia, isolation and access, engine-driven rotary nickel-titanium canal instrumentation to a minimum size #5 (.028 mm).04 taper Profile with step-back flaring, and irrigation with 2.5% NaOCl. Teeth in group 1 (n = 39) were obturated at the first appointment by using laterally condensed gutta-percha and Roth 811 sealer. Teeth in group 2 (n = 33) were closed with a sterile dry cotton pellet and Cavit restoration and were obturated at a second appointment 7 to 14 days later. A modified Visual Analogue Scale was used to measure preoperative pain and pain at 6, 12, 24, and 48 hours after the first appointment. Statistical analysis was performed to compare groups at each interval by using an independent-samples t test with Bonferroni adjustment.

RESULTS: There was no statistically significant difference between groups at preoperative intervals or at any of the 4 postoperative intervals (P <.01).

CONCLUSIONS: There was no difference in postoperative pain between patients treated in 1 appointment and patients treated in 2 appointments. The majority of patients in both groups reported no pain or only minimal pain within 24 to 48 hours of treatment.

Int Endod J. 2003 Dec;36(12):868-75.
The relationship of intracanal medicaments to postoperative pain in endodontics
Ehrmann EH,
Messer HH,
Adams GG.
School of Dental Science, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, 711 Elizabeth Street, Melbourne, Victoria, 3000, Australia. eehrmann@melbpc.org.au

AIM: To investigate the relationship of postoperative pain to three different medicaments placed in the root canal after a complete biomechanical debridement of the root canal system in patients presenting for emergency relief of pain.

METHODOLOGY: Two hundred and twenty-three teeth belonging to 221 patients presenting as emergencies to the Royal Dental Hospital of Melbourne were included in the study. Inclusion was limited to patients with a diagnosis of pulp necrosis and acute apical periodontitis. All teeth underwent conventional root canal treatment, which involved the instrumentation to the apices of each canal at the first visit. Canals were instrumented using a stepback technique and hand-files along with irrigants using Milton's (1% sodium hypochlorite) solution followed by 15% EDTAC. The canals were dried and one of the following three medicaments was inserted into the canal in random sequence: Group 1: Ledermix paste (Lederle Pharmaceuticals, Division of Cyanamid, Wolfratshausen, Germany); Group 2: calcium hydroxide paste (Calcipulpe, Septodont, France); and Group 3: no dressing. Before dismissal, the preoperative pain experienced on the previous night was recorded using a visual analogue pain scale. Patients were then instructed to record the degree of pain experienced 4 h after treatment and daily for a further 4 days.

commenced. After 4 days, the pain score for Group 2 was 10, for Group 3 was 7 and for Group 1 was 4. Mean preoperative pain level was 44.4 (of a maximum 100) for all groups, and declined by 50% (to 22.1) after 24 h. Patients in Group 1 (Ledermix) experienced significantly less (P = 0.04) postoperative pain than those in the other two groups. There was no significant difference between Group 2 (calcium hydroxide) and Group 3 (no dressing).

CONCLUSION: Under the conditions of this study, painful teeth with acute apical periodontitis that had been dressed with Ledermix paste gave rise to less pain than that experienced by patients who had a dressing of calcium hydroxide or no dressing at all. Ledermix is an effective intracanal medicament for the control of postoperative pain associated with acute apical periodontitis, with a rapid onset of pain reduction.

Endod Dent Traumatol. 1990 Oct;6(5):226-9.
Relationship of intracanal medicaments to endodontic flare-ups
Trope M. Department of Endodontology, Temple University School of Dentistry, Philadelphia.
The purpose of the study was to compare the effect of three intracanal medicaments on the incidence of post-instrumentation flare-ups. All teeth were instrumented to a predetermined minimum size using a 0.5% solution of sodium hypochlorite as the irrigant. Formocresol, Ledermix, and calcium hydroxide were placed in strict sequence irrespective of the presence or absence of symptoms or radiographic signs of apical periodontitis. The patients were given written post-operative instructions and a prescription for 600 mg ibuprofen to be taken if mild to moderate pain developed. If severe pain and/or swelling developed the patient was instructed to call the office immediately and was considered to have had a flare-up. Twelve flare-ups occurred in teeth with radiographic signs of apical periodontitis; none in teeth without periapical radiolucencies. Six of the twelve flare-ups occurred in retreatment cases and the other six occurred in teeth without previous endodontic treatment. No significant difference was found in the flare-up rate among the three intracanal medicaments.

J Endod. 1992 Apr;18(4):172-7.
Endodontic interappointment flare-ups: a prospective study of incidence and related factors
Walton R,
Fouad A.
University of Iowa College of Dentistry, Iowa City.

Severe pain and/or swelling following a root canal treatment appointment are serious sequelae. Information varies or is incomplete as to the incidence of these conditions and related factors. In this study, data were collected at root canal treatment appointments on demographics, pulp/periapical diagnoses, presenting symptoms, treatment procedures, and number of appointments. Patients that then experienced a flare-up (a severe problem requiring an unscheduled visit and treatment) had the correlating factors examined. Statistical determinations were by chi-square analysis with significance at 0.05 or less. Nine hundred forty-six visits resulted in an incidence of 3.17% flare-ups. Flare-ups were positively correlated with more severe presenting symptoms, pulp necrosis with painful apical pathosis, and patients on analgesics. Fewer flare-ups occurred in undergraduate patients and following obturation procedures. There was no correlation between patient demographics or systemic conditions, number of appointments, treatment procedures, or taking antibiotics.
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