POST-OPERATIVE PAIN INCREASE AFTER ADDITIONAL ENLARGEMENT OF ROOT CANAL PREPARATION - RANDOMIZED CLINICAL TRIAL

Abstract

The fact that single-file preparation is incapable in resulting completely disinfect root canals, makes room for the idea that further enlargement of the endodontic preparation would be necessary to optimize root canal disinfection, especially in cases of pulp necrosis. The aim of this study was to evaluate the influence of additional root canal enlargement of single-file preparation on the incidence and intensity of postoperative pain after endodontic treatment of 46 mandibular molars with pulp necrosis and radiographically visible periapical lesion (PAI Index). A prospective, randomized, double-blind, single-center clinical trial was developed. Groups were randomly divided into: Group 1: instrumentation completed using a single reciprocating file (Reciproc System, VDW); Group 2: instrumentation was performed with additional enlargement after single file preparation, using an instrument immediately larger than the previous one. Postoperative pain and analgesic intake were assessed after 24h, 48h and 7 days using a numerical scale (NRS). Intergroup comparison was performed using Mann-Whitney U tests. The incidence of postoperative pain and frequency of analgesic intake were analyzed with the chi-square test with statistical significance of P<0.05. After 24h, the incidence of postoperative pain was significantly higher in group 2 (P = 0.033), but similar in the periods of 48h (P = 0.135) and 7 days (P = 1.000). Mean postoperative pain levels were significantly higher after 24h in group 2 (P = 0.015), however, with no difference after 48h (P = 0.068) and 7 days (P = 0.317). It is concluded that further enlargement of the root canal preparation in mandibular molars with pulp necrosis and periapical lesion resulted in higher incidence and intensity of postoperative pain after 24hs of the endodontic treatment, without impact after 48h and 7 days.