Postoperative Pain After Using NiTi Instruments
Condition: Post-Op Complication; Endodontic Inflammation; Endodontically Treated Teeth; Apical Periodontitis
MeSH terms: Periodontitis; Periapical Periodontitis; Tooth, Nonvital; Pulpitis; Inflammation; Pain, Postoperative; Postoperative Complications
Study type: Interventional

Summary: 
      The aim of this randomized clinical trial was to compare the incidence, intensity and
      duration of postoperative pain following the removal of root canal obturation materials
      canals using rotary (ProTaper Universal or Hyflex EDM) or reciprocating file (Reciproc Blue
      or WaveOne Gold) systems. The null hypothesis tested was that there is no difference in
      postoperative pain following the retreatment procedure between the four systems used.
    

Detailed description: 
      Postoperative pain (PP) is not a certain reason for the long term success of root canal
      treatment. However, PP control is important for patient comfort and satisfaction. Apical
      extrusion of debris containing dentin, necrotic pulp tissue, microorganisms, and/or
      irrigation solutions may occur during retreatment procedures which may result in the
      induction of periapical inflammation, postoperative pain, and delayed periapical healing. All
      available techniques and instruments are associated with apical extrusion of debris to some
      degree during the root canal preparation or removal of the obturation materials. The aim of
      this randomized clinical trial was to compare the incidence, intensity and duration of
      postoperative pain following the removal of root canal obturation materials canals using
      rotary or reciprocating file systems.

      Patients referred for non-surgical endodontic retreatment were included. Hundred and eighty
      cases were selected on the basis of the determined inclusion criteria and randomly allocated
      to four groups (n = 45).

      ProTaper Universal group D1, D2 and D3 files were used respectively with a full rotational
      motion with a endodontic motor until working was reached as recommended by the manufacturer.

      Hylex EDM group Hylex EDM files were used with a full rotational motion with a endodontic
      motor until the working was reached.

      Reciproc Blue group R25 files were used with a reciprocating motion using with the "RECIPROC
      ALL" mode with a slow in-and-out pecking motion, and the amplitude of pecking movements did
      not exceed 3 mm until the working lenght was reached.

      Waveone Gold group Primary files were used with a reciprocating motion using with the
      "WAVEONE ALL" mode with a slow in-and-out pecking motion, and the amplitude of pecking
      movements did not exceed 3 mm until the working was reached.

      Assessment of postoperative pain Before participation, all patients had read and signed an
      informed consent form., all patients were given a pain report form on which they would report
      their preoperative level of pain.

      Before beginning of treatment, the clinician filled in an example of pain report with each
      patient to confirm that they understood the instructions.

      The degree of the postoperative pain was measured using an 11-level numeric rating scale
      (NRS) at 24, 48, and 72 h following the retreatment. The NRS is a segmented numeric version
      of the visual analog scale (VAS) and consists of successive numbers from 0 to 10 on a
      horizontal line. The respondent selects a number that best represents the intensity of his
      pain. Number "0" represents "no pain" whereas number "10" represents "the worst pain
      imaginable".

      Patients were asked to fill out forms at relevant times in accordance with the instructions
      given.

      An analgesic tablet (400 mg Ibuprofen) was prescribed to take an in case of severe pain, at
      6-h intervals. Also they were requested to record the number of analgesic pills consumed each
      day. The forms were collected on the 4th day following the retreatment. Also a phone call was
      made every day for 3 days to obtain information on the postoperative pain and the frequency
      of analgesic intake. The patients were asked to call the contact number on the form if they
      encountered severe pain or if they needed to ask any questions regarding the treatment.
    

Intervention name(s): NiTi instruments
Intervention type(s): Procedure
Intervention description(s): Root canal filling removal
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: non-surgical endodontic retreatment; post operative pain; rotary NiTi instrument; reciprocating NiTi instrument; ProTaper Universal; ProTaper Gold; Hyflex EDM; Reciproc Blue; WaveOne Gold