Single Visit Root Canal Treatment: Intensity of Postoperative Pain Using AH Plus Sealer Versus Endosequence BC Sealer in Patients with Asymptomatic Apical Periodontitis (A Randomized Clinical Trial)
Muna Abubaker Beshir1*, Hany Samy Sadek2 and Heba El-Asfouri2
1Master Degree in Endodontics, Oral and Dental Medicine, Cairo University, Giza, Egypt
2Associate Professor of Endodontics, Faculty of Dentistry, Cairo University, Giza, Egypt
*Corresponding Author: Muna Abubaker Beshir, Master Degree in Endodontics, Oral and Dental Medicine, Cairo University, Giza, Egypt.
Received: October 27, 2021; Published: November 30, 2021
Introduction: Pain is unwanted but common sensation after root canal treatment. Studies have shown that endodontic postoperative pain between 3 to 58%. Pain may occur in periodontal tissues after mechanical, chemical and microbial injuries. There are various parameters in treatment that can cause postoperative pain. one of these parameters is including working length. Also, the number of visits, selection of instruments and the selection of root canal sealers.
Aim of the Study: To compare the potential effects of resin-based and bioceramic sealers on the occurrence and intensity of postoperative pain in patients with asymptomatic apical periodontitis.
Methods: Sixty eight patients with asymptomatic apical periodontitis multirooted teeth were included. After confirming the diagnosis clinically and radiographically, patients were randomly assigned into two equal groups of 34 patients each. Standard endodontic treatment was performed in single visit. During the obturation the patients in the intervention group were treated using Endosequence BC sealer; while AH Plus sealer was used during obturation in patients assigned to the comparator group.
Assessment was done 6, 12, 24, 48, 72 hours and 5 days postoperatively. Visual Analogue Scale (VAS) was used in the outcome measurement. Contact with the patients was done over the phone at each follow up time as a reminder for the patients and an appointment was scheduled to receive the chart. Then data was statistically analyzed.
Results: Results showed that there was no statistically significant difference between the two sealers groups: AH Plus sealers and Endosequence BC sealer regarding intensity of postoperative pain at 6 hours, 12 hours, 24 hours, 48 hours, 72 hours and 5 days.
Conclusion: Post endodontic pain in the teeth diagnosed with asymptomatic apical periodontitis (AAP) and obturated with resin based or bioceramic root canal sealers without extrusion beyond the apex was low. No differences were observed at 6, 12, 24, 48, 72 hours and 5 days post obturation. This means that resin-based and bioceramic root canal sealers act the same in incidence and postoperative pain severity.
Keywords: Postoperative Pain; Sealers; Bioceramic Sealers; Endosequence BC Sealer; Ah-Plus Sealer; Resin-Based Sealer
- Sathorn C., et al. "The prevalence of postoperative pain and flare‐up in single‐and multiple‐visit endodontic treatment: a systematic review”. International Endodontic Journal2 (2008): 91-99.
- Jamali S., et al. "Evaluation of the Effect of the Intensity and Occurrence of Postoperative Pain of Resin-Based and Bioceramic Root Canal Sealers: A Systematic Review and Meta-Analysis of Randomized Controlled Trial Studies”. Pesquisa Brasileira em Odontopediatria e Clínica Integrada 21 (2021): e0219.
- Nabi S., et al. "Comparison of various sealers on postoperative pain in single-visit endodontics: a randomized clinical study”. Indian Journal of Dental Sciences2 (2019): 99.
- Eghbal M., et al. "Postendodontic pain after pulpotomy or root canal treatment in mature teeth with carious pulp exposure: a multicenter randomized controlled trial”. Pain Research and Management 2020 (2020).
- Imura N., et al. "Factors associated with endodontic flare‐ups: a prospective study”. International Endodontic Journal5 (1995): 261-265.
- Levin L., et al. "Post-operative pain and use of analgesic agents following various dental procedures”. American Journal of Dentistry4 (2006): 245-247.
- Omoigui S., et al. "The biochemical origin of pain: the origin of all pain is inflammation and the inflammatory response. Part 2 of 3–inflammatory profile of pain syndromes”. Medical Hypotheses6 (2007): 1169-1178.
- West A., et al. "Mitochondria in innate immune responses”. Nature Reviews Immunology6 (2011): 389-402.
- Hackel D., et al. "The connection of monocytes and reactive oxygen species in pain”. PloS One5 (2013): e63564.
- Vengerfeldt V., et al. "Oxidative stress in patients with endodontic pathologies”. Journal of Pain Research 10 (2017): 2031.
- Silva G O., et al. "Cytotoxicity and genotoxicity of natural resin-based experimental endodontic sealers”. Clinical Oral Investigations4 (2016): 815-819.
- Fonseca B., et al. "Assessment of extrusion and postoperative pain of a bioceramic and resin-based root canal sealer”. European Journal of Dentistry03 (2019): 343-348.
- Rosen E., et al. "The prognosis of altered sensation after extrusion of root canal filling materials: a systematic review of the literature”. Journal of Endodontics6 (2016): 873-879.
- Zhang W., et al. "Ex vivo cytotoxicity of a new calcium silicate–based canal filling material”. International Endodontic Journal9 (2010): 769-774.
- Lodienė G., et al. "Detection of leachables and cytotoxicity after exposure to methacrylate‐and epoxy‐based root canal sealers in vitro”. European Journal of Oral Sciences5 (2013): 488-496.
- Okiji T., et al. "Non‐surgical Root Canal Treatment Case V: Mandibular Premolar”. Clinical Cases in Endodontics (2018): 79-90.
- Victoria-Escandell A., et al. "Cellular responses in human dental pulp stem cells treated with three endodontic materials”. Stem Cells International 2017 (2017): 8920356.
- Ates AA., et al. "Post-obturation pain following the use of carrier-based system with AH Plus or iRoot SP sealers: a randomized controlled clinical trial”. Clinical Oral Investigations7 (2019): 3053-3061.
- Graunaite I., et al. "Effect of resin-based and bioceramic root canal sealers on postoperative pain: a split-mouth randomized controlled trial”. Journal of Endodontics5 (2018): 689-693.
- Saini H R., et al. "Pain following foraminal enlargement in mandibular molars with necrosis and apical periodontitis: a randomized controlled trial”. International Endodontic Journal12 (2016): 1116-1123.
- Figini L., et al. "Single versus multiple visits for endodontic treatment of permanent teeth: a Cochrane systematic review”. Journal of Endodontics9 (2008): 1041-1047.
- Izadpanah A., et al. "The Comparison of Short-Term Postoperative Pain in Single-versus Multiple-Visit Root Canal Treatment: A Systematic Review and Meta-Analysis Study”. Pain Research and Management 2021 (2021): 1-12.
- Gotler M., et al. "Postoperative pain after root canal treatment: a prospective cohort study”. International Journal of Dentistry 2012 (2012): 1-5.
- Farrugia Patricia, et al. "Research questions, hypotheses and objectives”. Canadian Journal of Surgery4 (2010): 278.
- Kao Lillian S., et al. "Clinical research methodology I: introduction to randomized trials”. Journal of the American College of Surgeons2 (2008): 361-369.
- Derashri A., et al. "Randomization and Randomized Control Trial”. International Journal of Pharmaceutical Sciences Review and Research1 (2013): 40-46.
- Arslan H., et al. "Effect of the simultaneous working length control during root canal preparation on postoperative pain”. Journal of Endodontics9 (2017): 1422-1427.
- Arias A., et al. "Predictive models of pain following root canal treatment: a prospective clinical study”. International Endodontic Journal8 (2013): 784-793.
- Alí A., et al. "Influence of preoperative pain intensity on postoperative pain after root canal treatment: A prospective clinical study”. Journal of Dentistry 45 (2016): 39-42.
- Menke E R., et al. "The effectiveness of prophylactic etodolac on postendodontic pain”. Journal of Endodontics12 (2000): 712-715.
- Mokhtari F., et al. "Effect of premedication with indomethacin and ibuprofen on postoperative endodontic pain: a clinical trial”. Iranian Endodontic Journal1 (2016): 57.
- Gilbert GH., et al. "Discordance between presumed standard of care and actual clinical practice: the example of rubber dam use during root canal treatment in the National Dental Practice-Based Research Network”. BMJ Open12 (2015): e009779.
- Herrera M., et al. "Critical diameter of apical foramen and of file size using the Root ZX apex locator: an in vitro study”. Journal of Endodontics9 (2011): 1306-1309.
- Silva EJNL., et al. "Postoperative pain after foraminal enlargement in anterior teeth with necrosis and apical periodontitis: a prospective and randomized clinical trial”. Journal of Endodontics2 (2013): 173-176.
- Iqbal M., et al. "Incidence and factors related to flare‐ups in a graduate endodontic programme”. International Endodontic Journal2 (2009): 99-104.
- Rodríguez‐Lozano F J., et al. "Chemical composition and bioactivity potential of the new Endosequence BC Sealer formulation HiFlow”. International Endodontic Journal9 (2020): 1216-1228.
- Loushine B. A., et al. "Setting properties and cytotoxicity evaluation of a premixed bioceramic root canal sealer”. Journal of Endodontics5 (2011): 673-677.
- Candeiro G T M., et al. "Cytotoxicity, genotoxicity and antibacterial effectiveness of a bioceramic endodontic sealer”. International Endodontic Journal9 (2016): 858-864.
- Borges R P., et al. "Changes in the surface of four calcium silicate‐containing endodontic materials and an epoxy resin‐based sealer after a solubility test”. International Endodontic Journal5 (2012): 419-428.
- Zhang H., et al. "Antibacterial activity of endodontic sealers by modified direct contact test against Enterococcus faecalis”. Journal of Endodontics7 (2009): 1051-1055.
- Zoufan K., et al. "Cytotoxicity evaluation of Gutta flow and endo sequence BC sealers”. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 5 (2011): 657-661.
- Huang F M., et al. "Induction of c‐fos and c‐jun protooncogenes expression by formaldehyde‐releasing and epoxy resin‐based root‐canal sealers in human osteoblastic cells”. Journal of Biomedical Materials Research: An Official Journal of The Society for Biomaterials, The Japanese Society for Biomaterials, and The Australian Society for Biomaterials and the Korean Society for Biomaterials3 (2002): 460-465.
- Ribeiro D A., et al. "Genotoxicity and cytotoxicity of mineral trioxide aggregate and regular and white Portland cements on Chinese hamster ovary (CHO) cells in vitro”. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology2 (2006): 258-261.
- Camargo S E A., et al. "Cytotoxicity and genotoxicity of pulp capping materials in two cell lines”. International Endodontic Journal3 (2009): 227-237.
- Bin C V., et al. "Cytotoxicity and genotoxicity of root canal sealers based on mineral trioxide aggregate”. Journal of Endodontics4 (2012): 495-500.
- Camargo CHR., et al. "Setting time affects in vitro biological properties of root canal sealers”. Journal of Endodontics4 (2014): 530-533.
- Ding S J., et al. "Evaluation of human osteosarcoma cell line genotoxicity effects of mineral trixoide aggregate and calcium silicate cements”. Journal of Endodontics7 (2010): 1158-1162.
- Karapınar‐Kazandağ M., et al. "Cytotoxicity of 5 endodontic sealers on L929 cell line and human dental pulp cells”. International Endodontic Journal7 (2011): 626-634.
- Troiano G., et al. "In vitro evaluation of the cytotoxic activity of three epoxy resin-based endodontic sealers”. Dental Materials Journal3 (2018): 374-378.
- Tan H S G., et al. "Postobturation pain associated with tricalcium silicate and resin-based sealer techniques: a randomized clinical trial”. Journal of Endodontics2 (2021): 169-177.
- Gudlavalleti B., et al. "Comparative Evaluation of Postoperative Pain after Root Canal Treatment using Three Different Sealers, Viz., Tubli-Seal EWT, Apexit Plus, AH Plus: An In-Vivo Study”. Journal of Clinical and Diagnostic Research1 (2020): 4-9.
- Khandelwal A., et al. "Comparative Evaluation of Postoperative Pain and Periapical Healing After Root Canal Treatment Using Three Different Base Endodontic Sealers–A Randomized Control Clinical Trial”. (2021): 1-22.