Comparison of postoperative pain with and without apical patency technique in asymptomatic necrotic teeth: a randomized control trial
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Abstract
Objective: To evaluate the incidence and severity of post-operative pain in patients with asymptomatic necrotic pulp and apical periodontitis treated with or without the apical patency technique, and to assess the corresponding use of analgesics.
Methods: This single-blinded, prospective randomized clinical trial was conducted from October 2022 to February 2023 at Peshawar Dental College, Peshawar-Pakistan. Sixty patients aged 18–60 years with maxillary or mandibular premolars and molars diagnosed with asymptomatic necrotic pulp and apical periodontitis were randomly assigned (1:1) to either the apical patency (AP) group or non-apical patency (NAP) group. Standardized root canal treatments were performed under local anesthesia with rubber dam isolation. In the AP group, a #10 K-file was extended 1 mm beyond the working length during instrumentation, while recapitulation in the NAP group was confined to the working length. Post-operative pain was self-assessed on a 0–10 numerical scale at 24 hours and daily for 7 days, with Ibuprofen 400 mg provided as rescue analgesia.
Results: Demographic characteristics were comparable between groups. Overall, 21 (35%) patients experienced post-operative pain, with similar incidence between AP (n=11, 36.6%) and NAP (n=10; 33.3%) groups (p=0.787). Overall, the AP group exhibited significantly higher mean pain scores during the first five days (P<0.05), with a greater proportion of patients requiring analgesics (16.7% vs. 10%) compared to the NAP group.
Conclusion: While the overall incidence of post-operative pain was similar, the apical patency technique was associated with increased early pain severity and higher analgesic consumption, warranting further studies to optimize its clinical application.
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References
1. Yaylali IE, Kurnaz S, Tunca YM. Maintaining apical patency does not increase postoperative pain in molars with necrotic pulp and apical periodontitis: a randomized controlled trial. J Endod 2018;44(3):335-40. https://doi.org/10.1016/j.joen.2017.11.013
2. Yaylali IE, Demirci GK, Kurnaz S, Celik G, Kaya BU, Tunca YM. Does maintaining apical patency during instrumentation increase postoperative pain or flare-up rate after nonsurgical root canal treatment? a systematic review of randomized controlled trials. J Endod 2018;44(8):1228-36. https://doi.org/10.1016/j.joen.2018.05.002
3. Arias A, Azabal M, Hidalgo JJ, De La Macorra JC. Relationship between postendodontic pain, tooth diagnostic factors, and apical patency. J Endod 2009;35(2):189-92. https://doi.org/10.1016/j.joen.2008.11.014
4. Abdelsalam N, Hashem N. Impact of apical patency on accuracy of electronic apex locators: in vitro study. J Endod 2020;46(4):509-14. https://doi.org/10.1016/j.joen.2020.01.010
5. Vera J, Hernandez EM, Romero M, Arias A, Van der Sluis LW. Effect of maintaining apical patency on irrigant penetration into the apical two millimeters of large root canals: an in vivo study. J Endod 2012;38(10):1340-3. https://doi.org/10.1016/j.joen.2012.06.005
6. Vera J, Arias A, Romero M. Dynamic movement of intracanal gas bubbles during cleaning and shaping procedures: the effect of maintaining apical patency on their presence in the middle and cervical thirds of human root canals-an in vivo study. J Endod 2012;38(2):200-3. https://doi.org/10.1016/j.joen.2011.10.026
7. Abdulrab S, Rodrigues JC, Al-Maweri SA, Halboub E, Alqutaibi AY, Alhadainy H. Effect of apical patency on postoperative pain: a meta-analysis. J Endod 2018;44(10):1467-73. https://doi.org/10.1016/j.joen.2018.07.011
8. Arslan H, Doğanay YE, Topçuoğlu HS, Tepecik E, Ayaz N. Success of maintaining apical patency in teeth with periapical lesion: a randomized clinical study. Quintessence Int 2019;50(9):686-93. https://doi.org/10.3290/j.qi.a43047
9. Oliveira PS, da Costa KNB, Carvalho CN, Ferreira MC. Impact of root canal preparation performed by protaper next or reciproc on the quality of life of patients: a randomized clinical trial. Int Endod J 2019;52:139-48. https://doi.org/10.1111/iej.12990
10. Arora M, Sangwan P, Tewari S, Duhan J. Effect of maintaining apical patency on endodontic pain in posterior teeth with pulp necrosis and apical periodontitis: a randomized controlled trial. Int Endod J 2016;49(4):317-24. https://doi.org/10.1111/iej.12457
11. Mostafa M, El-shrief Y, Anous W, Hassan M, Salamah F, El Boghdadi R, et al. Postoperative pain following endodontic irrigation using 1.3% versus 5.25% sodium hypochlorite in mandibular molars with necrotic pulps: a randomized double-blind clinical trial. Int Endod J 2020;53(2):154-66. https://doi.org/10.1111/iej.13222
12. Iandolo A, Amato A, Martina S, Abdel Latif D, Pantaleo G. Management of severe curvatures in root canal treatment with the new generation of rotating files using a safe and predictable protocol. Open Dent J 2021; 14:421-5. https://doi.org/10.2174/1874210602014010421
13. Manker A, Solanki M, Tripathi A, Jain M. Biomechanical preparation in primary molars using manual and three niti instruments: a cone-beam-computed tomographic in vitro study. Eur Arch Paediatr Dent 2019;21(2):203-13. https://doi.org/10.1007/s40368-019-00474-0
14. Konark, Singh A, Kumar A, Nazeer J, Singh R, Singh S. Incidence of postoperative flare-ups after single-visit and multiple-visit endodontic therapy in permanent teeth. J Indian Soc Pedod Prev Dent 2020;38(1):79-83. https://doi.org/10.4103/jisppd.jisppd_354_19
15. Blicher B, Lucier Pryles R. Endodontic pain management: preoperative, perioperative, and postoperative strategies. Compend Contin Educ Dent 2020;41:242-3.
16. Arias A, de la Macorra JC, Hidalgo JJ, Azabal M. Predictive models of pain following root canal treatment: a prospective clinical study. Int Endod J 2013;46(8):784-93. https://doi.org/10.1111/iej.12059
17. Shubham S, Nepal M, Mishra R, Dutta K. Influence of maintaining apical patency in post-endodontic pain. BMC Oral Health 2021;21(1):284. https://doi.org/10.1186/s12903-021-01632-x
18. Yousaf A, Ali F, Bhangar F, Alam M. Effect of apical patency on postoperative pain after single-visit endodontic treatment in necrotic teeth with asymptomatic apical periodontitis: a randomised control trial. J Coll Physicians Surg Pak 2021;31(10):1154-8. https://doi.org/10.29271/jcpsp.2021.10.1154
19. Gambarini G, Testarelli L, de Luca M, Milana V, Plotino G, Grande NM, et al. The influence of three different instrumentation techniques on the incidence of postoperative pain after endodontic treatment. Ann Stomatol (Roma) 2013;4(1):152-5. https://doi.org/10.11138/ads.0152
20. Mohammadi Z, Jafarzadeh H, Shalavi S, Kinoshita JI. Establishing apical patency: to be or not to be? J Contemp Dent Pract 2017;18(4):326-9. https://doi.org/10.5005/jp-journals-10024-2040
21. Keskin C, Sivas Yilmaz O, Inan U, Özdemir Ö. Postoperative pain after glide path preparation using manual, reciprocating and continuous rotary instruments: a randomized clinical trial. Int Endod J 2019;52:579-82. https://doi.org/10.1111/iej.13053