Postoperative pain after single-visit root canal treatment or vital pulp therapy: A systematic review and meta-analysis.

BACKGROUND: This systematic review aimed to investigate whether vital pulp therapy and root canal treatment (RCT) promote different postoperative pain. STUDIES REVIEWED: The authors searched PubMed, Cochrane Library, Embase, and Latin American and Caribbean Health Sciences Literature databases for studies published through June 30, 2022. The authors included randomized clinical trials if they reported on the assessment of postoperative pain after direct pulp capping, partial pulpotomy, pulpotomy, or single-visit RCT. The authors assessed the frequency of no, mild, moderate, and severe postoperative pain. They conducted meta-analyses to compare postoperative pain after full pulpotomy (PULP) and RCT. RESULTS: The qualitative synthesis included 57 studies, and the authors conducted meta-analysis of 3. PULP leads to more asymptomatic cases (relative risk [RR], 1.06; 95% CI, 1.01 to 1.11; P < .01; I2 = 67%) and to a lower occurrence of mild (RR, 0.89; 95% CI, 0.79 to 0.99; P < .04; I2 = 37%) and moderate (RR, 0.70; 95% CI, 0.51 to 0.95; P < .02; I2 = 57%) postoperative pain than RCT. The frequency of severe pain was very low for both vital pulp therapy and RCT. Moderate to severe postoperative pain was more common at 48 hours through 72 hours after RCT and up to 36 hours after PULP. Pain intensity after PULP was higher using calcium-enriched material compared with using mineral trioxide aggregate at 12, 18, and 36 hours (P < .001). PRACTICAL IMPLICATIONS: PULP showed a significantly higher incidence of no pain and a lower incidence of mild and moderate pain than single-visit RCT. Clinical decisions for RCT or PULP should not be based on differences in postoperative pain. When analgesia is indicated, it probably should be limited to a short time after PULP.

Cytotoxic, migration, and angiogenic effects of intracanal irrigants on cells involved in revascularization of immature teeth.

OBJECTIVE: To evaluate protocols of root canal irrigation and dentin pretreatment in a cell culture model simulating immature teeth. Cytotoxic, migration, and angiogenic effects of Sodium hypochlorite associated with EDTA (NaOCl/EDTA), NaOCl associated with Smear Clear (NaOCl/SC), and QMix were compared. DESIGN: Three roots of mandibular first premolars had their length and root canal diameter standardized. Root canals were irrigated, and the resulting solutions were diluted in culture medium. Sulforhodamine B (SRB) assay was performed with apical papilla cells and with endothelial cells (HUVECs) to assess cytotoxicity. Polarity index and migration assays of apical papilla cells and sprouting of HUVECs were evaluated. Data were analyzed by ANOVA and Tukey post-hoc tests (p < .05). RESULTS: In apical papilla cells, NaOCl/SC and QMix promoted higher cytotoxicity, decreased fraction of elongated cells, and had lower migration speed and shorter migration distance of cells compared to NaOCl/EDTA. Also, HUVECs treated with NaOCl/SC and QMix showed decreased tubule formation in comparison with NaOCl/EDTA. CONCLUSIONS: NaOCl/SC and QMix showed unfavorable biological responses of cells involved in revascularization in comparison to NaOCl/EDTA. Further studies with other intracanal irrigants should be performed to improve the balance of root canal disinfection with biological responses.

Cytotoxic, Migration, and Angiogenic Effects of Photodynamic Therapy and Photobiomodulation Associated with a Revascularization Protocol.

INTRODUCTION: This study evaluated photodynamic therapy (PDT) and photobiomodulation therapy (PBM) as adjuncts to pulp revascularization using cultures of apical papilla cells (APCs) and endothelial cells (HUVECs). METHODS: The root canal and apical foramen of 2 mandibular first premolars were enlarged to simulate immature teeth. The canal of 1 tooth was filled with 1 mL 0.005% methylene blue (MB). After that, the canals of both teeth were irrigated with 20 mL 1.5% sodium hypochlorite (NaOCl) and 20 mL 17% EDTA. The resulting solutions were diluted in cell culture media at a concentration of 0.5% (0.5% MB + NaOCl + EDTA and 0.5% NaOCl + EDTA). After PDT (0.5% MB + NaOCl + EDTA + PDT) and PBM (0.5% NaOCl + EDTA + PBM) applications, the effects were evaluated to determine cytotoxicity, polarity index, APC migration, and HUVEC sprouting, and results were compared with those of their controls (solutions without laser application). Cell culture media (CT) was also used as a control. Data were analyzed using 1-way analysis of variance and the Tukey post hoc test (P ≤ .05). RESULTS: PDT and PBM promoted greater APC viability than their controls, and PDT had greater cell viability than CT (P < .05). All protocols reduced APC migration when compared with CT (P < .05). HUVEC sprouts grown out of spheroids in PBM had a greater ratio area than their control (P ≤ .01), and the PDT ratio of the spheroid area was similar to that of its control (P > .05). CONCLUSIONS: PBM and PDT seem to be potentially effective adjuncts to revascularization in nonvital immature teeth.