Postoperative Pain Intensity After Using Different Instrumentation Techniques: a Randomized Clinical Study
Condition: Pulpitis
MeSH terms: Pulpitis; Pain, Postoperative; Pain
Study type: Interventional

Summary: 
      Aim The aim of this clinical study was to evaluate the influence of the instrumentation
      techniques on the incidence and intensity of postoperative pain in single-visit root canal
      treatment.

      Methodology Ninety patients with single root/canal and non-vital pulps were included. The
      patients were assigned into 3 groups according to root canal instrumentation technique used;
      the modified step-back (stainless-steel hand files, HF), reciprocal (WaveOne, WO), and
      rotational (ProTaper Next, PTN). Root canal treatment was carried out in a single visit and
      the severity of postoperative pain was assessed by 4-point pain intensity scale. All the
      participants were called through phone at 12, 24 and 48 h to obtain the pain scores. Data
      were analyzed by the Kruskal-Wallis test.
    

Detailed description: 
      Overall, 90 patients who had asymptomatic and non-vital teeth associated with periapical
      lesions, were included to the study. All diagnosis and treatment procedures were performed by
      a single operator to eliminate or minimize individual variability in the treatment between
      clinicians. The patients were randomly stratified into 3 groups of 30 by coin toss.
      Allocation was done by a person other than the operator performing the root canal procedure.
      The patients were assigned into three equal groups according to instrumentation techniques
      used (n=30);

        -  The modified step-back technique (n=30): The canals were instrumented with a modified
           step-back technique using stainless-steel hand files (HF, Dentsply Maillefer,
           Ballaigues, Switzerland). The canals were prepared to a master apical size 02/40 with K
           files by using the balance force technique. Step back technique was performed by using
           K-files #45-55 to a master apical size 02/40 with K files. The step back technique was
           performed using K-files #45-55.

        -  Reciprocal technique (n=30): The canals were instrumented with a driven reciprocation
           motion, using WaveOne (WO, Dentsply Maillefer, Ballaigues, Switzerland) file having a
           size 40 and a taper of 0.06 slow in-and-out pecking motion according to the
           manufacturer's instructions. The flutes of the instrument were cleaned after 3 pecks.

        -  Rotational technique (n=30): The canals were instrumented using ProTaper Next (PTN,
           Dentsply Maillefer, Ballaigues, Switzerland) 06/40 file in the sequence X1, X2, X3, X4
           at a rotational speed of 300 rpm and 200 g/cm torque according to the manufacturer's
           instructions. The instruments were used up to the working length.

      After isolation and access cavity preparation, the initial working length was then determined
      with an electronic root canal measurement device (Root ZX mini; J. Morita, Tokyo, Japan). It
      was confirmed using periapical radiographs. During the instrumentation, a total of 10 ml of
      5% NaOCl were used for irrigation. The irrigation needle (NaviTip 31ga needle; Ultradent,
      South Jordan, UT, USA) was placed as deep as possible into the canal without resistance until
      it was 1 mm short of the predetermined WL.The final irrigation was performed with 5% NaOCl,
      17% EDTA, and 2% chlorhexidine.

      The root canals were obturated with gutta-percha and a resin based sealer (AH26, De Trey
      Dentsply, Konstanz, Germany) using cold lateral compaction technique. A standardized master
      cone size #40.02 gutta-percha was fitted with tug back at the working length. The
      gutta-percha cone was lightly coated with sealer and slowly inserted into the canal. Cold
      lateral compaction with accessory gutta-percha cones size 15 was performed until these could
      not be introduced more than 5 mm into the root canal. All canals were shaped, cleaned, and
      obturated in a single-visit.

      Although no systemic medication was prescribed, the patients were instructed to take mild
      analgesics (400 mg of ibuprofen), if they experienced pain. The assessment of postoperative
      pain was carried out at 12, 24, and 48 hours after initial appointment by one independent
      clinician blinded to the groups. All the participants were called by blinded operator through
      phone at 12, 24 and 48 h to obtain the pain scores using a 4-point pain intensity scale
      (Dalton Orstavik et al. 1998). The presence or absence of pain, or the appropriate degree of
      pain was recorded by using a 4-point pain intensity scale. The pain categories were as
      follows:

        1. no pain;

        2. slight pain (mild discomfort, need no treatment);

        3. moderate pain (pain relieved by analgesics);

        4. severe pain (pain and/or swelling not relieved by simple analgesics and required
           unscheduled visit).
    

Intervention name(s): Reciprocating system; Rotational system
Intervention type(s): Device; Device
Intervention description(s): Different root canal instrumentation systems; Different root canal instrumentation systems
Other intervention name(s): WaveOne; ProTaper Next
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: Single (Participant)
Primary purpose: Treatment