Evaluation of Post-operative Pain After Total Pulpotomy and Root Canal Treatment
Condition: Post-operative Pain; Pulpitis - Irreversible
MeSH terms: Pulpitis; Pain, Postoperative
Study type: Interventional

Summary: 
      The aim of this study was to compare post-operative pain following total pulpotomy (TP) and
      root canal treatment (RCT) in mature molar teeth with severe symptoms indicative of
      irreversible pulpitis. To compare the traditional pulpitis classification with the Wolters
      system in evaluating post-operative pain.

      Materials and Methods: Sixty-four mature mandibular molar with symptomatic vital pulps in
      patients aged 18-60 years were included and were classified according to the Wolters
      (moderate/severe pulpitis) and the traditional pulpitis classification
      (reversible/irreversible pulpitis). The teeth randomly divided into 2 groups. RCT was
      performed, using standardized protocols. TP was performed to the level of the canal orifices,
      and haemostasis was achieved with 2.5% NaOCl. 3 mm layer of MTA was placed as the pulpotomy
      agent. The treated teeth were restored with glass ionomer cement followed by composite. Pain
      was recorded 6, 12, 24, 48, 72 hours and 7 days after treatment. The data collected were
      statistically analyzed
    

Detailed description: 
      The literature does not contain any studies comparing the effects of TP and RCT procedures on
      post-operative pain in mature molar teeth diagnosed with irreversible pulpitis and severe
      symptoms. Therefore, this study evaluated the effect of pre-operative and intra-operative
      variables and the treatment method on post-operative pain.

      Patient evaluation and treatment procedure

      As a result of clinical and radiographic examination, the teeth were classified both
      according to American Association of Endodontists (AAE) and as proposed by Wolters. The
      presence/absence of percussion was noted. Pre-operative pain levels were determined according
      to the Heft-Parker Visual Analog Scale (HP VAS), which consisted of a 10 mm long horizontal
      line where numerical values were divided into visual categories. Patients were instructed to
      score their pain with a value on the HP VAS. The presence or absence of pain was classified
      according to 4 categories:

      No pain (level 1, 0), Mild pain (level 2, 1-3 mm), Moderate pain (level 3, 4-6mm), Severe
      pain (level 4, 7-10 mm). After inferior alveolar nerve block anesthesia was performed with
      local anesthetic (adrenaline 4% Articaine, 1:100,000), the tooth was isolated with a rubber
      dam. The isolated area was cleaned using a cotton pellet wetted first with 3% hydrogen
      peroxide and then 2% chlorhexidine. The entire caries was removed non-selectively using a
      high-speed diamond bur under water coolant followed by a sterile round steel bur in a slow
      handpiece. After the pulp exposure was clinically confirmed, the patient was assigned to the
      TP or RCT group. Randomization was performed using online software with a four-block size
      block randomization technique to ensure even distribution between the groups
      (www.randomizer.org). The clinician could not be blinded due to the stages of treatment.

      Both patients were prescribed 400 mg of ibuprofen following treatment and asked to use it if
      necessary. They were informed to consult the clinic in case of severe post-operative pain
      that was not relieved by analgesics. All participants were administered a questionnaire form
      based on HP VAS, which could show their pain and analgesic intake after 6 hours, 12 hours, 24
      hours, 48 hours, 72 hours, and seven days. Patients were asked to fill in the form. Patients
      were invited for clinical examination one week after treatment, and follow-up appointments
      were scheduled for three months, six months, and one year for patients who were observed to
      be asymptomatic.
    

Intervention name(s): Total pulpotomy; Root canal treatment
Intervention type(s): Procedure; Procedure
Intervention description(s): Total pulpotomy procedures explained in arm descriptions.; Root canal treatment procedures explained in arm descriptions.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: irreversibl pulpitis; mineral trioxide aggregate; post-operative pain; total pulpotomy