Effect of a Controlled Final Irrigation Protocol on Acute Pain after Single-versus Two-visit Root Canal Treatment in Necrotic Teeth with Apical Periodontitis
Jorge Paredes Vieyra *
Endodontics, Autonomous University of Baja California, School of Dentistry, Tijuana Campus, Mexico.
Francisco Javier Jimenez Enriquez
Department of Oral Surgery, Autonomous University of Baja California, School of Dentistry, Tijuana Campus, Mexico.
Alan Hidalgo Vargas
Autonomous University of Baja California, Campus Tijuana, Mexico.
*Author to whom correspondence should be addressed.
Abstract
Background: Postoperative acute pain and flare-ups remain important complications following root canal treatment (RCT), particularly in teeth with necrotic pulp and apical periodontitis. Controlled final irrigation protocols have been proposed to improve canal disinfection and reduce postoperative complications.
Objective: This study aimed to determine whether a controlled final irrigation protocol after cleaning and shaping procedures would reduce acute pain after single- versus two-visit RCT of teeth with necrotic pulp and apical periodontitis.
Methodology: A prospective multicentre randomised controlled trial was conducted involving 90 patients. Working length was established with an electronic device and confirmed radiographically. For mechanical enlargement, Twisted File Adaptive and ProTaper Next instruments were used in a brushing rotary movement and reciprocating mode, respectively. For the control group, the Balanced Force technique was employed. A controlled final irrigation protocol was used in all groups. The same clinical protocol was used in three different cities in Mexico.
Results: Clinical samples were distributed as 45 teeth in the one-visit group and 45 teeth in the two-visit group. Two cases (2.5%) experienced acute pain in teeth that received RCT. In previously asymptomatic/symptomatic teeth, treatment eradicated pain in 83.33% of cases. Statistical analysis of healing results showed no significant difference between groups (p = 0.05). The controlled final irrigation protocol was associated with a low incidence of postoperative acute pain and flare-ups across all treatment groups.
Conclusions: This study provided clinical evidence that properly instrumented single-visit RCT can be as effective as two-visit treatment in managing teeth with necrotic pulp and apical periodontitis. The use of a controlled final irrigation protocol incorporating sodium hypochlorite, EDTA, irrigant activation, and cold distilled water was associated with a low incidence of postoperative acute pain and flare-ups. The use of antibacterial irrigants and effective irrigation strategies appears to be a valuable adjunct for controlling endodontic infection and improving patient comfort.
Keywords: Acute pain, one- visit versus two-visit, apical periodontitis, success and failure rate, flare-up