Comparison of Pain after Single-Visit Root Canal Treatment Following Different Irrigants; Double Blind Randomized Clinical Trial

Abstract

Background and Aim Proper and sufficient irrigation of root canals with irrigation solutions removes many microorganisms, debris, and infectious agents from the root canals and reduces pain following root canal treatment. The present study compared patients’ postoperative pain intensity using different irrigation solutions after root canal treatment in symptomatic irreversible pulpitis, asymptomatic irreversible pulpitis, and asymptomatic necrotic molar teeth.

Materials and Methods A total of 153 patients with asymptomatic necrotic, symptomatic irreversible pulpitis, and asymptomatic irreversible pulpitis molar teeth were included in this randomized prospective controlled clinical trial and assigned to three groups. In each group the root canals were prepared and irrigated with 2.5% NaOCl, 2% chlorhexidine (CHX) or sterile serum throughout instrumentation. The root canals were dried with paper points during this visit and obturated with gutta-percha and AH26 sealer using the cold lateral compaction technique. Patients registered their pain intensity for seven days using a 10-score visual analog scale. Then, they were rated in four categories based on the number of painkillers taken (pain-free and mild, moderate, and severe pain). Pain levels were compared between the groups at different time intervals for any tooth type by the Kruskal-Wallis test. Regression analysis was used to determine the impact of different variables on pain intensity (α=0.05). Results In asymptomatic irreversible pulpitis teeth, no significant difference was seen among the irrigation groups regarding pain levels. In symptomatic irreversible pulpitis teeth, there were significant differences among the irrigation solutions at 6-h (P=0.04) and 24-h intervals (P=0.02), and similar levels of pain were also observed after applying the NaOCl and CHX solutions, with less pain in the sterile serum group. In asymptomatic necrotic teeth, significant differences were observed between the irrigation solutions at 12-h (P=0.03), 24-h (P=0.02), and 96-h intervals (P<0.001), with the highest and lowest pain levels in the CHX and sterile serum groups, respectively. The tooth status (P<0.001) and preoperative levels (P<0.001) significantly affected VAS pain scores of patients up to 96 h after the treatment. The type of irrigation agent significantly affected the prediction of pain levels (P=0.015).

Conclusion Pain intensity after root canal treatment was different depending on the tooth pulpal diagnosis type. Although the patients’ pain intensity was relatively similar with different irrigation solutions in asymptomatic irreversible pulpitis teeth, in symptomatic irreversible pulpitis and asymptomatic necrotic teeth, the lowest pain levels were recorded with sterile serum, and the highest pain levels were recorded with NaOCl and CHX solutions.