Association between rheumatoid arthritis and pulpal-periapical pathology: a systematic review.

OBJECTIVES: Rheumatoid arthritis (RA) is a debilitating disease where numerous pro-inflammatory cytokines have a proven role in its pathology. These cytokines are also involved in the pathogenesis of apical periodontitis (AP) where they have a pro-inflammatory role and induce bone resorption. Patients with RA may therefore be more prone to develop pulpal-periapical pathology (PPP). This study systematically reviewed the existing literature evaluating the association between RA and PPP. MATERIALS AND METHODS: Studies including human participants with both RA and PPP were included. The search was performed in PubMed, Web of Science, and The Cochrane Library databases using keywords and Medical Subject Headings (MeSH) search terms. The risk of bias was assessed using Newcastle-Ottawa Quality Assessment Scale. The following parameters were extracted and analyzed by the reviewers; author, journal, year, design of the study, diagnostic criteria for periapical pathology, the association between rheumatoid arthritis and periapical pathology, and the evidence level. RESULTS: The search identified 142 records. Inclusion criteria were as follows; studies in the English language, including human participants only, including patients with RA and PPP, cohort studies, cross-sectional studies, clinical trials, and case-control studies. According to the inclusion criteria, 5 studies were included in this systematic review. Three of the five studies reported significant association between RA and PPP. CONCLUSIONS: Existing evidence suggests there may be an association between RA and PPP. CLINICAL RELEVANCE: Clinicians should be aware that RA patients can be more prone to develop PPP which may result in a reduced quality of life.

Association Between Single-nucleotide Polymorphisms in Candidate Genes and Success of Pulpal Anesthesia after Inferior Alveolar Nerve Block.

INTRODUCTION: The present study aimed to investigate the possible association between the single-nucleotide polymorphisms (SNPs) in the SCN9A, SCN10A, SCN11A, OPRM1, and COMT genes and the success rate of pulpal anesthesia after inferior alveolar nerve block (IANB). METHODS: A total of 70 patients (45 females and 25 males) presenting mandibular molar teeth with symptomatic irreversible pulpitis were included. Saliva samples were collected from the participants before the application of IANB. A standard IANB was performed with 1.8 mL 4% articaine with 1:100,000 epinephrine. Endodontic treatment was initiated 15 minutes after injection, and the patients were asked to report their pain level during the procedure on a 170-mm Heft-Parker visual analog scale. If the patient recorded a pain level of lower than 54 on the visual analog scale (no pain or mild pain), the anesthesia was considered successful. The DNA isolation and genotyping were performed, and the association between rs4286289, rs6746030, rs6795970, rs6801957, rs11709492, rs1799971, rs1799973, rs4680, rs6269, rs4633, and rs740603 SNPs and the success rate of anesthesia was investigated. RESULTS: The anesthesia success rate was significantly lower for the GG genotypes (45%) than the GA and AA genotypes (90%) for rs6795970 in the SCN10A gene. Additionally, the A allele for rs6795970 and the T allele for rs6801957 in the SCN10A gene were significantly associated with higher anesthesia success rates. CONCLUSIONS: SNPs in the SCN10A gene affect the success rate of pulpal anesthesia after IANB.

Effect of final irrigation with sodium hypochlorite at different temperatures on postoperative pain level and antibacterial activity: a randomized controlled clinical study.

OBJECTIVE: To evaluate the effect of final irrigation of root canals with NaOCl solution at different temperatures on postoperative pain level and antimicrobial activity. METHODOLOGY: 45 patients were randomly divided into three groups using a web program according to the irrigation selected: NaOCl 2ºC, NaOCl 25ºC and NaOCl 45ºC. First root canal samples were collected before treatment (S1). After chemo-mechanical preparation, final irrigation was performed with the selected irrigant (NaOCl 2ºC, NaOCl 25ºC and NaOCl 45ºC) and second samples were collected (S2). Samples were subjected to quantitative real-time polymerase chain reaction to evaluate the levels of total bacteria. The root canal treatments were completed and the participants were given instructions to record postoperative pain levels at 24, 48 and 72 hours, 5 days and 1 week after treatment using a visual analog scale (VAS). RESULTS: The reduction in the number of total bacterial cell equivalents from S1 to S2 was statistically significant in all groups (p<0.001). The NaOCl 2˚C group reported significantly less postoperative pain than the NaOCl 45˚C group (p<0.05). Postoperative analgesic intake was significantly higher in the NaOCl 45˚C group than in the NaOCl 2˚C group (p<0.05). CONCLUSION: We conclude that final irrigation with NaOCl at different temperatures results in similar antibacterial effectiveness. Final irrigation with cold NaOCl (2˚C) is better than NaOCl 45˚C when comparing postoperative pain levels.

Postoperative Pain After the use of Sodium Hypochlorite gel and Solution Forms: A Randomized Clinical Study.

OBJECTIVE: The present study aimed to compare the effect of sodium hypochlorite (NaOCl) gel and solution forms on postoperative pain level. METHODS: Fifty-two patients were divided into two groups according to the root canal irrigation solution. In the NaOCl solution group, the root canals were irrigated with 2 mL of 5.25% NaOCl between each pecking motion. In the NaOCl gel group, 5.25% NaOCl gel was used according to the manufacturer's instructions. The root canal treatments were completed and the participants were given instructions to record postoperative pain levels on 24, 48, and 72 hours and 1 week after treatment using VAS. RESULTS: Intergroup analyses revealed that the NaOCl gel group resulted in significantly less postoperative pain than the NaOCl solution group on day 1. CONCLUSION: It can be concluded that using NaOCl gel during root canal preparation results in less postoperative on day 1 when compared with the NaOCl solution.

Effect of calcium hydroxide alone or in combination with ibuprofen and ciprofloxacin on postoperative pain and periapical prostaglandin E2 level: A randomized clinical study.

AIM: The aim of the present study was to compare pure Ca(OH)2, Ca(OH)2 + ibuprofen and Ca(OH)2 + ciprofloxacin in terms of postoperative pain and prostaglandin E2 (PGE2) level in previously treated teeth with periapical lesions. MATERIALS AND METHODS: Sixty-six patients were randomly assigned into 3 groups according to the intracanal medication (Ca(OH)2, Ca(OH)2 + ibuprofen and Ca(OH)2 + ciprofloxacin). After removing gutta-percha from the root canals, the PGE2 sample collection was obtained by introducing three sterile paper points into the root canals through the root apex (2 mm). Selected intracanal medicament was placed into the root canal and the participants were told to record postoperative pain levels at 24, 48, and 72 h and on 1 week after treatment using visual analog scale (VAS). At the second appointment, the medicaments were removed and second sampling was performed using the same method. The PGE2 levels measured by enzyme-linked immunosorbent assay kits, and the data were statistically analyzed. RESULTS: All the tested Ca(OH)2 pastes were found to be significantly effective in lowering the preoperative PGE2 levels. However, intergroup analyses revealed that the Ca(OH)2 + ciprofloxacin group had the highest effectiveness in lowering PGE2 with a significant difference when compared with the pure Ca(OH)2 group. There was no statistically significant difference among the groups in terms of pre- and post-operative pain levels. CONCLUSION: The Ca(OH)2 + ciprofloxacin medication is more effective than the pure Ca(OH)2 medication in lowering periapical PGE2 level. However, addition of ibuprofen or ciprofloxacin to the Ca(OH)2 paste does not provide extra benefit in terms of post-operative pain relief.

Effect of final irrigation with sodium hypochlorite at different temperatures on postoperative pain level and antibacterial activity: a randomized controlled clinical study

Abstract Objective To evaluate the effect of final irrigation of root canals with NaOCl solution at different temperatures on postoperative pain level and antimicrobial activity. Methodology 45 patients were randomly divided into three groups using a web program according to the irrigation selected: NaOCl 2ºC, NaOCl 25ºC and NaOCl 45ºC. First root canal samples were collected before treatment (S1). After chemo-mechanical preparation, final irrigation was performed with the selected irrigant (NaOCl 2ºC, NaOCl 25ºC and NaOCl 45ºC) and second samples were collected (S2). Samples were subjected to quantitative real-time polymerase chain reaction to evaluate the levels of total bacteria. The root canal treatments were completed and the participants were given instructions to record postoperative pain levels at 24, 48 and 72 hours, 5 days and 1 week after treatment using a visual analog scale (VAS). Results The reduction in the number of total bacterial cell equivalents from S1 to S2 was statistically significant in all groups (p<0.001). The NaOCl 2˚C group reported significantly less postoperative pain than the NaOCl 45˚C group (p<0.05). Postoperative analgesic intake was significantly higher in the NaOCl 45˚C group than in the NaOCl 2˚C group (p<0.05). Conclusion We conclude that final irrigation with NaOCl at different temperatures results in similar antibacterial effectiveness. Final irrigation with cold NaOCl (2˚C) is better than NaOCl 45˚C when comparing postoperative pain levels.

Association between Rheumatoid Arthritis and Apical Periodontitis: A Cross-sectional Study.

Objective: The present cross-sectional study aimed to investigate possible association between Rheumatoid Arthritis (RA) and Apical Periodontitis (AP). Methods: In table one it is mentioned 48 patients diagnosed with RA were included in the experimental group. Another 48 healthy age- and gender-matched participants who reported no history of any systemic disease were selected to form the control group. All the patients were examined radiographically and clinically to diagnose the presence of AP. The following data was recorded for all patients; the number of teeth present, the number of teeth with AP, the number of patients with AP, the number of patients with root canal treated teeth (RCT) and the number of patients with RCT+AP. The chi-square test and logistic regression analysis were used to determine the possible association between RA and AP. Results: A total of 1026 teeth were examined in the RA group and 45 of them was diagnosed as AP. In the control group, 1025 teeth were examined and 21 teeth were diagnosed as AP. It was found that the prevalence of teeth with AP (4.3%) was significantly higher in the RA group than the control (2%) (odds ratio [OR]=2.193, P=0.003). Logistic regression analysis showed that RA is significantly associated with AP. Conclusion: It can be concluded that patients with RA can be more prone to develop AP.

Association of ankylosing spondylitis with radiographically and clinically diagnosed apical periodontitis: A cross-sectional study.

BACKGROUND: There are no studies evaluating the possible association between ankylosing spondylitis (AS) and apical periodontitis (AP). OBJECTIVES: The aim of the present cross-sectional study was to investigate the possible association between AS and AP. MATERIAL AND METHODS: Fifty patients diagnosed with AS, receiving treatment at the Rheumatology Clinic in Erzurum, Turkey, were included in the experimental group. Another 50 ageand gender-matched individuals without any history of systemic disease were included in the study as the control group. All patients were examined radiographically and clinically to diagnose the presence of AP. The following data was recorded for all patients: the smoking habit, the number of teeth present, the number of teeth with AP, the number of root canal-treated (RCT) teeth, and the number of RCT teeth with AP. RESULTS: There were 1,283 teeth in the AS group and 1,305 in the control group. There was a significant association between teeth with AP and AS, as the prevalence of teeth with AP was significantly lower in the control group (1.3%) than in the AS group (2.9%) (OR (odds ratio) = 2.250; p = 0.005). There was no statistically significant difference between the groups in terms of the number of RCT teeth and RCT teeth with AP (p > 0.05). CONCLUSIONS: Ankylosing spondylitis is significantly associated with an increased prevalence of AP. It can be concluded that patients with AS can be more prone to develop AP. However, AS does not reduce the success rate of endodontic treatment, because there was no significant difference between the AS and control groups in terms of RCT teeth with AP.

Effects of continuous irrigation at room temperature or +4ºC on the cyclic fatigue resistance of K3XF instruments.

Background. The present study aimed to evaluate the impact of continuous irrigation with saline solution at room temperature or +4°C on the cyclic fatigue resistance of K3XF files. Methods. Forty-eight new K3XF files (#30, .04 taper) were randomly assigned to three groups: control group (no irrigation), continuous irrigation with saline solution at room temperature, and continuous irrigation with saline solution at +4°C. The instruments were tested in an artificial, stainless steel root canal with a double curvature at body temperature (37±1°C). Time to fracture was converted to the number of cycles to fracture (NCF). The lengths of the fractured fragments were recorded. Kruskal-Wallis H test and one-way ANOVA were used to analyze data. Results. K3XF files' cyclic fatigue resistance was significantly higher in the continuous irrigation groups than in the control group. Continuous irrigation with saline solution at +4°C resulted in higher cyclic fatigue resistance than continuous irrigation with saline solution at room temperature. There were no significant differences between the groups in terms of the fractured fragments' length. Conclusion. Within this study's limitations, continuous irrigation with saline solution increased the NCF of NiTi instruments; decreasing the saline solution's temperature increased this effect.

Micro-computed Tomographic Assessment of the Residual Filling Volume, Apical Transportation, and Crack Formation after Retreatment with Reciproc and Reciproc Blue Systems in Curved Root Canals.

INTRODUCTION: The purpose of the present study was to evaluate the remaining root canal filling material, apical transportation, and crack formation after retreatment with M-Wire Reciproc (VDW GmbH, Munich, Germany) and Reciproc Blue (VDW GmbH) systems in curved root canals. METHODS: Twenty-six mandibular first and second molars with mesial roots that had 2 separate canals with angles between 20° and 40° were selected for this study. The root canals were prepared with M-Wire Reciproc size 25 instruments (VDW GmbH), and they were filled with gutta-percha and AH Plus sealer (Dentsply Sirona, Tulsa, OK). The samples were randomly divided into 2 groups (n = 13 each) according to the retreatment system used: an M-Wire Reciproc group and a Reciproc Blue group. The canals were retreated up to instrument size 25 and then to size 40 in both groups. After the retreatment procedures, the residual filling material volume, apical transportation, and crack formation were assessed using micro-computed tomographic imaging. RESULTS: There were no significant differences between the groups in the amount of residual filling material (P > .05). The apical canal transportation values were significantly higher in the M-Wire Reciproc group than in the Reciproc Blue group at 1 mm. No significant differences were observed between the groups at any of the other levels with regard to apical transportation (P > .05) The new uncompleted and completed cracks were observed in both groups. There were no statistically significant differences between the groups in terms of crack and fracture formation (P > .05). CONCLUSIONS: The Reciproc Blue system is as effective as the M-Wire Reciproc system in terms of the retreatment of the curved mesial roots of mandibular molars. However, the formation of new uncompleted and completed cracks was found during the retreatment procedures.

Effect of Calcium Hydroxide Alone or in Combination with Ibuprofen and Ciprofloxacin on Nuclear Factor Kappa B Ligand and Osteoprotegerin Level in Periapical Lesions: A Randomized Controlled Clinical Study.

INTRODUCTION: The aim of the present study was to evaluate the effects of calcium hydroxide (Ca[OH]2), Ca(OH)2 + ibuprofen, and Ca(OH)2 + ciprofloxacin in terms of receptor activator of nuclear factor kappa B ligand (RANKL) and osteoprotegerin (OPG) levels in asymptomatic periapical lesions. METHODS: Sixty-six patients were randomly divided into 3 groups using a Web program according to the medication selected: Ca(OH)2, Ca(OH)2 + ibuprofen, and Ca(OH)2 + ciprofloxacin. After removing gutta-percha from the root canals, the RANKL and OPG samples were taken from the interstitial fluid of the apical tissues using 3 paper points. At the second appointment, medicaments were removed, and second sampling was performed using the same method. The RANKL and OPG levels were measured by the enzyme-linked immunosorbent assay, and the RANKL/OPG ratio was calculated. RESULTS: According to the intragroup analysis, there were no statistically significant differences between the preoperative and postoperative levels of the RANKL/OPG ratio in any of the groups. Intergroup analyses showed that there were no statistically significant differences among the Ca(OH)2, Ca(OH)2 + ibuprofen, Ca(OH)2 + ciprofloxacin groups in terms of the percentage change in RANKL/OPG levels before and after treatment. CONCLUSIONS: Within the limitations of the present study, it can be concluded that addition of ibuprofen or ciprofloxacin to Ca(OH)2 paste does not provide any extra benefit in terms of lowering RANKL and OPG levels.

Comparison of the cyclic fatigue resistance of ProGlider, PathGlider and One G path-finding instruments.

Background . The aim of the present study was to compare the cyclic fatigue resistance of novel nickel titanium rotary pathfinding instruments. Methods . Twenty instruments were selected for each file system. A simulated stainless steel root canal, with a 90° angle of curvature and a curvature radius of 3 mm, was used for cyclic fatigue test of the ProGlider (#16, progressive taper: 0.02‒ 0.085), PathGlider (#15, taper: .03), and One G (#14, taper: .03) instruments. Statistical analyses were performed with oneway ANOVA (P=0.05). Post hoc Tukey tests were used to determine any statistically significant differences between the groups. Results . The ProGlider instruments exhibited significantly more cyclic fatigue resistance than both PathGlider and One G instruments (P<0.001). One G instruments had significantly more resistance to fracture than PathGlider instruments (P<0.05). Conclusion . ProGlider instruments had better cyclic fatigue resistance than PathGlider and One G instruments.

Effect of intracanal medicaments on matrix metalloproteinase-9 and vasoactive intestinal peptide secretion in periapical lesions of re-treated canals: a randomized controlled clinical study.

OBJECTIVE: The aim of this study was to evaluate the effect of calcium hydroxide (Ca[OH]2) and chlorhexidine (CHX) gel on matrix metalloproteinase-9 (MMP-9) and vasoactive intestinal peptide (VIP) secretion in periapical lesions. MATERIALS AND METHODS: A total of 60 patients were randomly divided into two groups that were to receive different medications. Pre-and post-treatment samples were collected from the interstitial fluid of periapical lesions using sterile paper points. VIP and MMP-9 levels were measured by enzyme-linked immunosorbent assay kits, and the data were statistically analyzed. RESULTS: Gender and smoking habits had no effect on the pre- and post-treatment VIP and MMPs levels. Intragroup analyses revealed that in the Ca(OH)2 group, the post-treatment VIP level was found to be significantly higher than the pre-treatment VIP level. In the CHX group, the post-treatment MMP-9 level was significantly higher than the pre-treatment MMP-9 level. CONCLUSION: According to the results of the present study, the type of the medication affected the amount of periapical VIP and MMP-9 secretion. CLINICAL RELEVANCE: VIP is a neuropeptide that promotes new bone formation. Thus, intracanal Ca(OH)2 medication may accelerate the repair process of bone tissue.

Comparative study of ProTaper gold, reciproc, and ProTaper universal for root canal preparation in severely curved root canals.

AIM: The aim of this study is to evaluate the root canal transportation, centering ability, and instrumentation times with the ProTaper Gold (Dentsply Tulsa Dental, Tulsa, OK, USA), Reciproc (VDW, Munich, Germany), and ProTaper Universal (Dentsply Maillefer, Ballaigues, Switzerland) using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: Thirty mesial root canals of mandibular first molars with curvature angles of 35°-70° and radii of 2-6 mm were included in the study. Root canal instrumentation was performed up to F2 or R25. The instrumentation times were recorded. CBCT scanning was performed both pre- and post-instrumentation. Root canal transportation and the centering ratio were calculated for groups, and the data were analyzed using a one-way ANOVA and least significant difference post hoc tests for the instrumentation time, root canal transportation, and centering ratio at the 95% confidence level (P = 0.05). RESULTS: At 3, 5, and 7 mm levels, there was no significant difference in the root canal transportation and centering ratio among the groups (P > 0.05). There were significant differences between the Reciproc and ProTaper Universal groups in the instrumentation times (P < 0.05). CONCLUSION: Root canal transportation and the centering ratio with the ProTaper Gold were similar to those obtained with the ProTaper Universal and Reciproc.

Effect of instrument speed when used in reciprocating motion on root canal transportation and centering ability.

AIM: This study aims to evaluate the root canal transportation, centering ability, and instrumentation times after root canal preparation using reciprocating motion at 300 rotations per minute (rpm) and 600 rpm. MATERIALS AND METHODS: Twenty mesial root canals of mandibular first molars with curvature angles of 35°-70° and radii of 2-6 mm were included in the study. Root canal instrumentation was performed using R25 according to the manufacturer's instructions at 300 rpm or 600 rpm (n = 10). Cone-beam computed tomography scanning was performed both pre- and post-instrumentation. Root canal transportation and the centering ratio were calculated for both the groups, and the data were analyzed using independent sample t-test for the instrumentation time, root canal transportation, and centering ratio at the 95% confidence level (P = 0.05). RESULTS: At the three levels (3 mm, 5 mm, and 7 mm), there were no significant differences in centering ratio between the groups (P > 0.05). At 3 mm, 600 rpm resulted in more transportation than 300 rpm. However, there were no significant differences in the root canal transportation between the groups at 5 mm and 7 mm levels (P > 0.05). CONCLUSION: At the 3 mm level, 600 rpm resulted in more transportation than 300 rpm. However, centering ratio was similar at both 600 rpm and 300 rpm.

Effect of Low-level Laser Therapy on Postoperative Pain after Root Canal Retreatment: A Preliminary Placebo-controlled, Triple-blind, Randomized Clinical Trial.

INTRODUCTION: Low-level laser therapy (LLLT) is a practical, nonpharmacologic technique for reducing pain. This study evaluated the effect of LLLT on postoperative pain after root canal retreatment (RCR). METHODS: This study enrolled patients (N = 36) who required root canal retreatment (RCR) on mandibular molar teeth, presented with periapical lesions with periapical index scores of 2 or 3, and had a pain visual analog scale (VAS) <50 and a percussion pain VAS <50. The participants were divided into 2 groups: (1) patients scheduled for RCR followed by LLLT (n = 18) and (2) patients scheduled for RCR followed by a mock LLLT (placebo) (n = 18). Postoperative pain was assessed using the VAS. Data were collected and statistically analyzed with the chi-square test, the independent sample t test, and the Mann-Whitney U test (P = .05). RESULTS: On the first 4 days, postoperative pain significantly reduced in the LLLT group compared with the placebo group (P < .05). However, no statistically significant differences in postoperative pain were found between the 2 groups after 5 and 7 days (P > .05). The number of patients who needed analgesics was lower in the LLLT group than in the placebo group (P < .05). No patient reported pain during LLLT application. CONCLUSIONS: LLLT may reduce postoperative pain after RCR of mandibular molars.

Effect of the Simultaneous Working Length Control during Root Canal Preparation on Postoperative Pain.

AIM: The aim of this study was to evaluate the effect of simultaneous length control during root canal preparation on postoperative pain compared with separate working length determination and root canal preparation. The design was a parallel-group, randomized, controlled trial with 2 arms. METHODS: Forty-four molar teeth were randomly divided into 2 groups (n = 22), a control group (separate length determination and root canal preparation) and a simultaneous length control during root canal preparation group. The following variables were recorded: age; gender; tooth number; preoperative pain on the visual analog scale; pain level on days 1, 3, 5, and 7; and analgesic intake after the procedure and initial/final percussion pain. The data were analyzed with the χ2 test, independent samples t test, and Mann-Whitney U test. RESULTS: The simultaneous length control during root canal preparation group resulted in lower postoperative pain levels on day 1 than did the control group (P < .05). Despite 2 patients' intake of postoperative analgesics in the control group, no patient needed to use postoperative analgesics in the simultaneous length control during root canal preparation group (P > .05). CONCLUSIONS: Simultaneous length control during root canal preparation as a non-pharmacologic strategy for reducing postoperative pain is a beneficial technique for preventing postoperative pain.

Apical transportation of ProGlider and ProTaper Next activated with different motions.

PURPOSE: The aim of this study was to investigate the apical transportation of the ProGlider and ProTaper Next using 3 different motions (150° clockwise [CW]; 0° counter clockwise [CCW], 270° CW-30° CCW; and [360° CW] continuous rotation). MATERIALS AND METHODS: 36 simulated, curved, plastic training blocks were randomly distributed into 3 groups for treatment according to the movement kinematics used for ProGlider (Dentsply Maillefer) followed by ProTaper Next (Dentsply Maillefer) instruments (n = 12): 150° CW-30° CCW, 270° CW-30° CCW, and 360° CW (continuous rotation). Pre- and post-instrumentation photographs were taken from the root canals in a standardized manner. Root canal transportation was calculated at 1, 2, 3, 4, and 5 mm from the apical terminus of the canal. Data were analyzed using a Kruskal-Walis H test (p = .05). RESULTS: At the 1- and 2-mm levels, both reciprocating motions (150° CW-30° CCW and 270° CW-30° CCW) resulted in less transportation than those of continuous rotation (p<.05). However, there were no significant differences between the groups at the 3-, 4-, and 5-mm levels (p>.05). CONCLUSIONS: Both reciprocating motions were found to have less canal transportation than the continuous rotation group at the 1- and 2-mm levels. This is the first study about the use of the ProGlider and ProTaper Next activated by different motions. Reciprocating motion can be beneficial for ProGlider and ProTaper Next to reduce transportation of root canals.

The effect of various occlusal reduction levels on postoperative pain in teeth with symptomatic apical periodontitis using computerized analysis: a prospective, randomized, double-blind study.

OBJECTIVE: The objective of this study was to evaluate the effect of various occlusal reduction levels on the postoperative pain in teeth diagnosed as symptomatic apical periodontitis by using a computerized analysis system. MATERIALS AND METHODS: Thirty-nine molar teeth with symptomatic apical periodontitis were included. After the root canal preparation and filling was performed, the subjects were divided into three groups according to the level of occlusal reduction determined by using T-Scan (T-Scan III for Windows, Tekscan Inc., South Boston, MA) as follows: (1) no reduction (control), (2) semi-reduction, and (3) full-reduction groups. Preoperative and postoperative pain levels using visual analogue scale, percussion pain, and analgesic intake were recorded for each subject. The data were evaluated statistically using two-way analysis of variance and Holm-Sidak post hoc tests at a 95 % confidence level (P = 0.05). RESULTS: There was no significant difference between the groups in terms of occlusal reduction (P > 0.005). CONCLUSION: Within the limitation of the present study, there were no significant differences among the no reduction, semi-reduction, and full-reduction groups at 1, 3, 5, and 7 days in terms of postoperative pain levels. CLINICAL RELEVANCE: Occlusal reduction, determined using a computerized analysis system, did not influence the postoperative pain in teeth diagnosed as symptomatic apical periodontitis.

The effect of various kinematics on postoperative pain after instrumentation: a prospective, randomized clinical study.

OBJECTIVE:: To evaluate various kinematic movements on postoperative pain using a Reciproc system. MATERIAL AND METHODS:: Fifty-six molar teeth were divided into four groups according to kinematics as follows: continuous rotation, 360° CCW - 30° CW, 270° CCW - 30° CW, and 150° CCW - 30° CW. Preoperative and postoperative pain levels using visual analogue scale (VAS), percussion pain, and analgesic intake were recorded for each subject. Postoperative pain levels at 1, 3, 5, and 7 d were evaluated. Data were analyzed statistically using the Kruskal-Walis, Mann-Whitney-U, one-way analysis of variance, and chi-square tests (p=0.05). RESULTS:: Continuous rotation resulted in more pain at Day 1 when compared with the reciprocating groups (360° CCW - 30° CW and 270° CCW - 30° C) (p<0.05). CONCLUSIONS:: Continuous rotation resulted in more postoperative pain at Day 1 than in reciprocating groups, and thereafter no significant pain was found among the groups.