Occlusal Reduction and Postoperative Pain
Condition: Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      The purpose of this randomized clinical study was to evaluate the impact of occlusal
      reduction on the incidences of post-instrumentation and post-obturation pain. Forty four
      patients were included in this study. Inclusion criteria were posterior mandibular teeth
      having symptomatic irreversible pulpitis and symptomatic apical periodontitis. Patients were
      randomized into two equal groups. In the intervention group the functional and nonfunctional
      cusps were reduced until absence of contact was confirmed, while in the control group the
      occlusal surfaces were left intact. Standard endodontic treatment was performed in two visits
      using rotary nickel titanium files for shaping, 2.5% sodium hypochlorite for cleaning and
      lateral condensation technique with resin sealer for obturation. Pain was assessed
      preoperatively, then after 6, 12, 24 and 48 hours following instrumentation, then after 6 and
      12 hours following obturation. Visual Analogue Scale (VAS) was used as the primary outcome
      measure. Patients were given a placebo to be administrated in case of severe pain and
      ibuprofen 400mg was prescribed in case of persistent pain.
    

Detailed description: 
      Recruitment of the study participants was done from the outpatient clinic of the Endodontic
      Department of the Faculty of Oral and Dental Medicine, Cairo University.

      Randomization was done to assign participants to the study groups by chance and not choice.
      44 numbers were generated and randomly allocated to either intervention or control group on a
      table using Microsoft Office Excel 2010. Each participant was given a number from 1 to 44
      according to his turn in enrollment in the study.

      Root canal treatment was completed in two visits. Before treatment, each patient was given
      pain scale chart and was asked to record their pain level. The tooth was anesthetized using
      inferior alveolar nerve block technique by local anesthesia of 1.8 - 3.6 ml of 2% Mepivacaine
      HCl. The access cavity preparation was performed using round carbide bur and Endo-z bur.
      After access cavity in the intervention group, all occlusal contacts on the functional and
      non-functional cusps as well as on the marginal ridges were reduced using a wheel diamond
      bur. Absence of contact was confirmed using an articulating paper. In the control group, all
      occlusal contacts were left intact. The tooth was then properly isolated with rubber dam. The
      patency of the root canals was confirmed using stainless steel hand K-files size #10 and #15.
      Working length was determined using an electronic apex locator and confirmed radiographically
      to be 1 mm shorter than radiographic apex. Mechanical preparation was done by crown-down
      technique using rotary Revo-S instruments and Ethylene Diamine Tetra Aceticacid gel as a
      lubricant. The canals were thoroughly irrigated using 3ml of 2.5% sodium hypochlorite
      following each instrument. After dryness of the canals using paper points, a cotton pellet
      was placed in the pulp chamber and the access cavity was sealed with a temporary filling.
      After 7 days, the root canals were obturated with lateral condensation technique using 0.04
      taper gutta-percha and AdSeal resin-based root canal sealer.

      Degree of postoperative pain was measured using visual analogue scale (VAS) after 6, 12, 24
      and 48 hours after instrumentation then at 6 and 12 hours after obturation. The VAS consists
      of a 10-cm line anchored by two extremes "No pain" and "pain as bad as could be". The
      patients were asked to choose the mark that represents their level of pain. Pain level was
      assigned to one of four categorical scores: 1, None(0); 2,Mild(1-3); 3,Moderate(4-6);
      4,Severe(7-10) 10.

      In case of moderate to severe postoperative pain, the patients were instructed to take a
      capsule of placebo given to him/her at the end of each visit. In case of persistent pain,
      patients were allowed to take Ibuprofen 400mg. The incidence of placebo intake and number of
      analgesic tablets taken were recorded by the patients.
    

Intervention name(s): occlusal reduction
Intervention type(s): Other
Intervention description(s): relief of occlusion following endodontic treatment
Other intervention name(s): occlusal relief
Intervention MeSH terms: Salicylic Acid
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Prevention