Effect of Cryotherapy and LLLT on Postoperative Pain After Root Canal Treatment
Condition: Root Canal Infection; Pain, Postoperative; Cryotherapy Effect; Laser; Pulpitis
MeSH terms: Pulpitis; Pain, Postoperative
Study type: Interventional

Summary: 
      The aim of this study is to evaluate the effect of low-level laser therapy (LLLT) and
      intracanal cryotherapy applications on postoperative pain in endodontic interventions of
      primary molar teeth with apical periodontitis. 75 patients were randomly assigned to the
      control, low-level laser and cryotherapy groups.Root canal treatments were performed in a
      single session. The pain intensity felt by the patients on the preoperative and postoperative
      1st, 3rd, 5th and 7th days were recorded using the Wong Baker visual pain scale. Preoperative
      and postoperative 7th day percussion sensitivity was recorded using the VAS (visual analog
      scale) scale. The pain scores of the groups at different times after the procedure were
      compared. Statistical analysis of the data was performed at the 0.05 significance level.
    

Detailed description: 
      Patient Selection Criteria This study will be on primary molar teeth with acute pain at
      Atatürk University Faculty of Dentistry, Department of Pedodontics. While calculating the
      sample value, the effect value of Gundogdu et al.(2018) in terms of 1 day use in the
      evaluation was taken as 0.85, the standard deviation was 20, the α value was 0.05 and the β
      value was 95%, and the sample value was selected as 9 patients for each group. However, those
      who would be in good standing were in the unit 0.37 in the good group and in the 80% strong
      component, 0.05 significance elements were 75 samples for 3.

      Treatment Protocol For treatment, 75 samples were first randomized with a web program
      (www.randemizer.org). According to this randomization, the incoming controls were separated
      from the leveled therapy (LLLT group) and intracanal cryotherapy (cryotherapy group)
      divisions (n=25).

      The information about the data received for the study and the data related to the analysis
      are studied. Patients were treated by a single clinician.

      The current pain intensity felt by the patients was determined using the Wong Baker visual
      pain assessment scale. In the evaluation of preoperative percussion sensitivity, a 10 cm VAS
      scale marked by the patient after the percussion test was used.

      The teeth to be treated in each group were anesthetized using 1.8 ml of articain HCl
      (Ultracain DS; Pharma Vision San. ve Tic. A.Ş., Istanbul, Turkey) containing 1:100,000
      epinephrine.After ensuring that anesthesia was provided, treatment was started.

      After the carious tissue was removed and the endodontic cavity was opened, isolation was
      provided with a rubber-dam. #15 K files (Dentsply Maillefer, Ballaigues, Switzerland) were
      used to identify the root canals. After the pulp tissue in the canal was extracted with a
      tirnerf, the canals were washed with 2 ml of 1% NaOCl and dried using paper cones. The
      working length of the canals was determined using a #15 K file and electronic apex locator
      (Propex Pixi; Dentsply Maillefer, Ballaigues, Switzerland). After the working length has been
      determined, the canals are filled with Ni-Ti endodontic rotary instrument files (EndoArt Pedo
      Gold and EndoArt Expert Gold; İnci Dental Medical Malz. San. ve Tic. Ltd. Ş, Istanbul,
      Turkey) at the torque value recommended by the manufacturer, X Smart Plus ( Dentsply
      Maillefer, Ballaigues, Switzerland) was prepared using an endodontic motor.

      In canals that could not be advanced passively up to the working length using a #20 K file,
      the canal length was measured with the #15 K file and 30.04 EndoArt Pedo Gold Ni-Ti
      endodontic rotary instrument file (İnci Dental Medical Malz. San. Ve Tic. Ltd. Şti, Istanbul,
      Turkey). ) has been prepared until. In the canals that cannot be progressed passively until
      the working length when the 25 numbered K file is used, the canal lengths were measured with
      the 20 numbered K file and 40.04 EndoArt Expert Gold Ni-Ti endodontic rotary instrument file
      (İnci Dental Medical Malz. San. Ve Tic. Ltd. Şti., Istanbul. ,Turkey) was prepared using. 30
      gauge needles (Zhejlang Kangkang Medical-Devices Co.Ltd., Zhejlang, China) were preferred for
      use in canal irrigations. Irrigation needles were kept 4-5 mm shorter than the working
      length, and irrigation of the channels was performed. Irrigation was performed using 5 ml of
      1% NaOCl in total for each canal, with 2 ml between each pecking movement of the files. Final
      irrigation of the canals was carried out using 5 ml of saline (0.9% Isotonic Sodium Chloride,
      Osel İlaç Sanayi ve Tic. A.Ş., Beykoz, Istanbul).

      After the last irrigation, in the intracanal cryotherapy group, unlike the first two groups,
      each canal was washed with 5 ml of 2°C cold saline for 5 minutes. After the canals were dried
      with the help of a paper cone, the canals were filled by injecting iodoform and calcium
      hydroxide-containing canal paste (Viopex; Spident Co. Ltd, Incheon, Korea). After the paste
      residues on the cavity walls were cleaned with alcohol-impregnated cotton, resin modified
      glass ionomer cement (Ionoseal; Voco, GmbH, Cuxhaven, Germany) was placed on the pulp chamber
      floor and a LED light device (WoodPecker LED.B, Guilin Woodpecker Medical Instrument Co. Ltd,
      China) was used polymerized for 20 seconds. Dentin bonding agent (Futurabond U; Voco, GmbH,
      Cuxhaven, Germany) was applied to the cavity walls for 10 seconds, spread with light air for
      5 seconds and then polymerized with light for 10 seconds. In the restoration of teeth, each
      layer of compomer (Figure 3.6., Twinky Star; Voco, GmbH, Cuxhaven, Germany) placed using the
      layering technique was light cured for 20 seconds. Following the occlusion control, polishing
      was done using green polishing rubber (OptraGloss, Ivoclar Vivadent Schaan, Liechtenstein)
      and the restoration process was completed.

      After the restoration of the teeth is completed, unlike the other groups, in the LLLT group,
      the diode laser device (Diode Laser 3 Watt Expert03D810, China) biostimulation option was
      used in accordance with the user manual, at a wavelength of 980 nm, in continuous mode, 300
      mW at the root apex level and 4 mm from the gingiva. It was activated for 30 seconds in the
      buccal region and 30 seconds in the lingual/palatal region. Before the DSLT application,
      protective glasses were used for patient and physician safety.

      Painkillers (10 mg/kg paracetamol) were prescribed to all patients in case of very severe
      pain. Parents were asked to mark the patients' pain scores on the 1st, 3rd, 5th and 7th days
      according to the Wong Baker visual pain scale on the form given to the patients. The patients
      were called to a control appointment with the patient follow-up form they marked one week
      later. At the control appointment, the patients were asked whether they used painkillers
      after the procedure, and the presence of postoperative swelling, palpation and fistula tract
      was evaluated in their clinical examination and recorded in the form. In addition, the
      percussion sensitivity of the patients at the 7th day control appointment was determined
      using the VAS scale by performing the percussion test.

      Statistical analysis After the data obtained in this study were recorded in Microsoft Excel
      program, statistical analyzes were performed in SPSS v26 program at p<0.05 significance
      level. Categorical variables were presented as numbers and percentages, and numerical
      variables as mean and standard deviation. Using the Kolmogrov Smirnov Test and the graphing
      method, it was evaluated whether the numerical variables were suitable for normal
      distribution or not. Chi-square test was used to compare categorical variables (gender, jaw,
      post-operative drug use and vitality) that did not show normal distribution. The numerical
      age variable with normal distribution was compared using one-way ANOVA. Kruskal Wallis test
      was used to evaluate more than two independent variables (pain difference between groups)
      that did not show normal distribution. More than two dependent variables (temporal variation
      of pain presence between groups) that did not show normal distribution were compared using
      Friedman analysis. The Willcoxon Sign test was used to evaluate two dependent variables (pain
      on the 1st, 3rd, 5th and 7th days within the groups) that did not show normal distribution.

      In order to model the pain in the pain scores felt on the 1st and 7th days and the percussion
      sensitivity on the 7th day, the Binary Logistics regression analysis was performed with the
      Backward Conditional method using the relevant independent variables. The "no pain" group was
      taken as a reference in the analysis. The Hosmer-Lemeshow test result was evaluated in order
      to measure the effectiveness of the best model used to explain the dependent variable. The
      ratio of the independent variables in the model to explain the change in the dependent
      variable is shown by Cox and Snell and Nagelkerke statistics.
    

Intervention name(s): Control; Laser; Cryotherapy
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): Root canal treatment; Root canal treatment+Laser application; Root canal treatment + Cryotherapy application
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: After the canal length was determined with the Apex locater, the canals were prepared using Ni-Ti endodontic rotary instrument files. Irrigation needles were kept 4-5 mm shorter than the working length, and irrigation of the channels was performed. A total of 5 ml of 1% NaOCl was washed for each canal, with 2 ml between each pecking movement of the files. The final washing of the channels was carried out using 5 ml of saline at room temperature.
After the last wash, in the cryotherapy group, unlike the first two groups, each canal was washed with 5 ml of 2°C cold physiological saline for 5 minutes. After the canals were dried with the help of a paper cone, the canals were filled by injecting iodoform and calcium hydroxide-containing canals. Then the restoration was completed with compomer. Following the restoration in the LLLT group, the diode laser was activated in biostimulation mode for a total of 1 minute, 30 seconds in the buccal and lingual/palatal regions at the root apex.
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: cryotherapy; LLLT; postoperative pain; pulpectomy; primary teeth