Effectiveness of Different Obturation Techniques
Condition: Apical Periodontitis; Postoperative Pain; Endodontically Treated Teeth
MeSH terms: Periodontitis; Periapical Periodontitis; Tooth, Nonvital; Pain, Postoperative
Study type: Interventional

Summary: 
      Aim: Evaluation of the effect of different obturation techniques on postoperative pain level
      and radiographic healing on non-surgical endodontic retreatment (NSER) applied in a single
      visit in teeth with single root canal and apical periodontitis (AP).

      Materials and Methods: 63 teeth with single-root canal and AP from 50 systemically healthy
      patients (mean age 34.19±9.75 years; 27 women, 23 men) were included in the study. Residual
      root canal filling materials were removed with retreatment files. All teeth were prepared
      using rotary files . The teeth were randomly divided into three groups according to the
      obturation technique; cold lateral compaction (CLC), continuous wave compaction (CWC), and
      gutta-core (TGC). Restorations are completed using direct composite resin in the same visit.
      In all cases, pain status were evaluated using the Numerical Pain Rating Scale (NRS) at
      preoperative, postoperative, 3rd hour, 24th hour, 48th hour, and 7th day. Periapical index
      (PAI) scores were recorded on preoperative and postoperative 6-month on the periapical
      radiographs for cases. Data were analyzed as statistically. Significance level was determined
      as p < 0.05.
    

Detailed description: 
      All procedures were performed by a endodontist (XX) only in patients who met the inclusion
      criteria. All patients were informed about the risks of the study and alternative treatment
      options before participating. Anaesthesia was achieved with 4% articaine hydrochloride
      containing 1:100,000 adrenalin. None of the patients required additional anaesthesia. After
      rubber dam isolation, previous caries and restorations were removed with high and low speed
      sterile burs under water cooling. The previous root canal obturation of all teeth included in
      the study was removed with a similar treatment protocol. All files were used with a
      torque-controlled endodontic motor based on the appropriate torque and rpm values specified
      by the manufacturer. After determining the canal length with an electronic apex locator the
      apical patency was checked with a #10 K hand file. During the procedure, the canal was
      continuously irrigated with 5.25% sodium hypochlorite. In all irrigation procedures, a
      27-gauge side-vented irrigation needle was used, which was set to be 2 mm shorter than the
      working length. No solvent was used during the NSER protocol. The literature has found that
      there is no definite consensus on the final apical diameter of the root canal when applying
      NSER. However, it has been reported that in primary endodontic treatment, the preparation
      should be completed with a larger file than the file used for apical region preparation. In
      this study, the final preparation was completed by using a case-specific file that was chosen
      to be larger than the apically compressed file while making the final preparation. The root
      canal was prepared with rotary files. For the final irrigation procedure is 2 mL of 5.25%
      NAOCl, distilled water, 17% ethylene diamine tetraacetic acid , distilled water, 2%
      chlorhexidine solutions were used respectively. The root canal were dried with paper points .
      Then, all teeth were randomly assigned one of the three study groups by using online software
      (http://www.random.org). (n:21).

      Cold Lateral Compaction (CLC-Control Group): After the root canal preparation was completed,
      the working length was checked with the master cone and periapical radiography. The master
      cone was then covered with root canal sealer and placed in the root canal. Then, a gap was
      created for the .02 angled lateral cones using #30, 25 and 20 finger spreader. The obturation
      process continued until the spreader went 2 mm beyond the level of the canal orifice. Next, a
      hot excavator removed the coronal gutta-percha 1 mm below the canal orifice.

      Continuous Wave Compaction (CWC): After the root canal preparation was completed, the working
      length was checked with the master cone and periapical radiography. Root canal sealer was
      applied to the root canal walls using a master cone. The plugger connected to the down-pack
      unit was adjusted to be 4 mm shorter than the working length. The master cone was cut 1 mm
      shorter than the working length with a heated plugger and applied to the root canal. Then,
      the heated plugger was advanced in the apical direction and the apical region was obturated.
      Obturation was completed in 2 stages with gutta-percha in the cartridge connected to the
      remaining root canal cavity back-fill unit and heated to 200 °C. Heated gutta-percha was
      vertically condensed with plugger to 1 in the first stage and 2 in the second. The root canal
      obturation was completed by removing the gutta-percha 1 mm below the canal orifice.

      Thermoplasticized Gutta-Cor (TGC): After the root canal preparation was completed, the
      working length was controlled with the master cone and periapical radiography. Root canal
      sealer was applied to the root canal walls using a master cone. Root canal obturation was
      completed with gutta-percha heated according to the manufacturer's instructions using. The
      heated gutta-percha was slowly inserted into the canal up to the working length. After
      cutting the handle of the obturators at the level of the canal orifice with a hot excavator,
      it was condensed into the canal using a gutta-percha plugger. The coronal gutta-percha were
      removed 1 mm below the canal orifice using a hot excavator.

      In the same visit, all teeth were permanently restored using direct composite resin .
    

Intervention name(s): Single Visit Non Surgical Root Canal Treatment Protocol
Intervention type(s): Other
Intervention description(s): The current study aimed to compare the effects of different obturation techniques on postoperative pain level and radiographic healing in non-surgical endodontic treatment applied in a single visit in teeth with single root canal and apical periodontitis.
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: warm vertical compaction; single visit; postoperative pain; non-surgical endodontic retreatment; cold lateral compaction; numeric rating scale