0099-2399/85/1103-0135/$02.00/0 JOURNAL OF ENDODONTICS Copyright �9 1985 by The American Association of Endodontists

Printed in U.S.A. VOL. 11, NO. 3, MARCH 1985

CLINICAL ARTICLE

Incidence of Postoperative Pain Following the Use of Different Sealers in Immediate Root Canal Filling

Incidencia del Dolor Postoperatorio Luego de la Obturacion del Conducto Radicular en Una Sola Sesion Realizada Con Distintos Materiales

Tayfun Ala~am, DDS, PhD

Whether to instrument and obturate an endodontically involved tooth in single or in multiple visits is a subject of disagreement among both practitioners and investi- gators. Filling the canal in one sitting is a time-reducing procedure for both clinician and patient. However, pos- sible complications such as postoperative pain and swelling raise some objections to this procedure.

Ferranti (1) compared postoperative symptoms fol- lowing single-and multiple-visit endodontic therapy. He found that 48.6% of the patients had slight tenderness while 7.3% experienced intense pain in the 109 cases completed in a single visit.

Fox et al. (2) evaluated 247 teeth following complete endodontic treatment in one visit. Within 24 h after the treatment, 90% of the patients had little or no sponta- neous pain.

O'Keefe (3), in his study on pain in endodontic ther- apy, found no significant difference in the total post- operative pain response after one- or two-visit endo- dontic therapy.

Soltanoff (4) reported that 19% of the cases he completed in one visit had moderate to severe pain while only 14% of the cases experienced the same degree of pain after multiple visit root canal therapy. This result was statistically significant.

Ashkenaz (5) reported a 4% incidence of postoper- ative pain in 195 vital teeth that were treated in a single visit.

In Pekruhn's study (6), 15.6% of the patients that were treated in either single or multiple visits reported a relatively painful response on the first postobturation :lay. The single-visit patients seemed to experience a greater degree of postobturation pain than the multiple-

135

visit patients. However, the difference was not statisti- cally significant.

Oliet (7) conducted a clinical study to compare single- visit endodontic procedures. The single-visit patients had moderate to severe pain in 10.6% of the cases. However, the amount of postoperative pain experi- enced by the single- and two-visit patients was not significant.

Finally, Roane et al. (8) investigated the incidence of postoperative pain after single- and multiple-visit en- dodontic procedures. They found that the frequency of pain was lower in the single-visit group (15.2% of treatments) when compared with the multiple-visit group (31.2% of treatments) and pointed out the need for further studies to explain various aspects of one- visit endodontic treatment.

Realizing the need for more specific investigations, the present study was conducted to correlate the post- operative pain present after single-visit endodontic ther- apy of vital teeth with the type of root canal sealer utilized in the obturation.

MATERIALS AND METHODS

The study involved 212 vital single or multirooted teeth which required endodontic therapy as a result of a diagnosis of irreversible pulpitis. All of the teeth were treated by the same operator. Each canal was instru- mented to the radiographic apex utilizing 3% hydrogen peroxide as the irrigant, dried, and filled with laterally condensed gutta-percha cones. However, four different root canal sealers were used. Iodoform paste was used in 53 cases, Oxpara root canal cement (R. R. Co.) was

136 Alar/arn

TABLE 1. Presence of pain in teeth sealed with different root canal sealers

Sealing No. of Material patients

Postobturation

3rd Day 7th Day

No. of No. of % % patients patients

Iodoform 53 7 13.2 2 3.77 Oxpara 52 9 15.25 2 3.84 Endomethasone 57 7 12.2 AH26 50 7 14 1 2

TABLE 2. Type of pain experienced by patients after obturation

Postobturation

Pain 3rd Day 7th Day

Category No. of No. of %

patients patients %

Spontaneous pain Iodoform 7 13.2 2 3.77 Oxpara 9 15.25 2 3.84 Endomethasone 7 12.2 AH26 7 14 1 2

Percussion sensitivity Iodoform 7 13.2 3 5.66 Oxpara 9 15.25 4 7.69 Endomethasone 7 12.2 3 5.28 AH26 7 14 5 10

Palpation pain Iodoform 1 1.88 Oxpara 2 3.85 Endomethasone 2 3.5 AH26 1 2

used in 52 cases, Endomethasone (Septodont) paste was used in 57 cases while AH26 (De Trey) was used in 50 of the cases. No antibiotics or analgesics were prescribed for the patients.

Patients were called 3, 7, and 30 days after treatment and questioned concerning the degree of discomfort they had experienced after the obturation. Sponta- neous pain, percussion sensitivity, and pain to palpation were the types of discomfort evaluated. The presence and type of pain relative to the type of sealer used were then evaluated statistically utilizing chi-square analysis.

RESULTS

The results are presented in Tables 1 and 2. No pain was experienced by any of the patients 30 days after the treatment.

Chi-square analysis revealed that there was no sta- tistical significance between th~ presence and type of postoperative pain and the type of sealer used (p > 0.05).

DISCUSSION

All of the cases included in this study were treated in a single visit without experiencing much postoperative

Joumal of Endodontics

discomfort. With precise radiographic control and care- ful canal preparation techniques, damage to the periph. eral tissues can be minimized, resulting in minimal inflammation and subsequent postoperative discom- fort.

Some investigators (1-8) support single-visit treat- ments while others (4, 9) indicate that the use of such a procedure produces more discomfort. According to Calhoun and Landers (9), the majority of endodontists believe that there would be more postoperative pain if treatment was completed in one visit.

The results of this study indicated that 14% of the vital cases with irreversible pulpitis experienced dis- comfort 3 days after a single-visit treatment. However, this percentage decreased to 2.5% 7 days after the treatment was completed.

During multiple-visit therapy, pain may be experi- enced after either the instrumentation or obturation steps. Thus, in some multiple-visit endodontic proce- dures, the total number of pain days may exceed those experienced when single-visit therapy was performed (6, 8).

The operator's technique in canal cleaning and shap- ing may be correlated with postoperative pain after endodontic therapy. In order to eliminate this variable, the same operator treated all of the cases in this study.

The type of obturation materials used in the treat- ment may also influence the degree of postoperative discomfort. Fox et al. (2) found that the type of filling material used (gutta-percha or silver points) had no significant influence upon postoperative pain.

The root canal cement or sealer is an integral part of the canal obturation and it should be nonirritating to the periapical tissue. Numerous types of sealers are avail- able commercially and each of them possesses different physical and biological properties. Realizing this, we evaluated the relationship that four sealers had on the type and degree of postoperative pain that occurred after their use in single-visit therapy. No statistical relationship between the type of sealer used (Iodoform, Oxpara, Endomethasone, and AH26) and the presence and type of postoperative pain experienced was found.

There is also some concern regarding the long-term success of teeth treated, in one appointment. Soltanoff (4) and Oliet (8), however, reported no significant differ- ence between the healing of teeth treated in single or multiple visits.

In conclusion, our findings indicate that there is min- imal postoperative pain when teeth with vital pulps are treated in one visit and there is no correlation between the incidence and type of pain experienced and the type of root canal sealer used in the study.

SUMMARY

A clinical investigation was conducted to compare the incidence and type of postoperative pain in single- visit endodontic therapy when different root canal seal-

Vol. 11, No. 3, March 1985

ers were utilized (Iodoform, Oxpara, Endomethasone, and AH26). There was no statistical significance be- tween the presence and type of postoperative discom- fort and the type of sealer utilized.

Se realiz6 una investigacibn clinica para comparar la incidencia y tipo de dolor postoperatorio en tratamientos de conductos en una sola sesibn en los que se usaron distintos selladores (Iodoformo, Oxpora, Endometasone, y AH26). No se observb diferencia estadisticamente significativa entra la presen- cia y el tipo de dolor postoperatorio y tipo de sellador utilizado.

Dr. Ala~am is affiliated with the Faculty of Dentistry, Department of Endo- dontics, Ankara University, Be~evler-Ankara, Turkey.

Incidence of Postoperative Pain 137

References

1. Ferranti P. Treatment of the root canal of an infected tooth in one appointment: a report of 340 cases. Dent Digest 1959;65:490-4.

2. Fox J, Atkinson JS, Dinin AP, et al. Incidence of pain following one-visit endodontic treatment. Oral Surg 1970;30:123-30.

3. O'Keefe EM. Pain in endodontic therapy: a preliminary clinical study. J Endodon 1976;2:315-9.

4. Soltanoff W. A comparative study of the single visit and multiple-visit endodontic procedure. J Endodon 1978;4:278-281.

5. Ashkenaz PJ. One visit endodontics--a preliminary report. Dent Surg 1979;55:62-7.

6. Pekruhn RB. Single visit endodontic therapy: a preliminary clinical study. J Am Dent Assoc 1981 ;103:875-7.

7. Oliet S. Single-visit endodontics: a clinical study. J Endodon 1983;9:147- 52.

8. Roane JB, Dryden JA, Grimes EW. Incidence of postoperative pain after single and multiple-visit endodontic procedures. Oral Surg 1983;55:68-72.

9. Calhoun RL, Landers RR. One appointment endodontic therapy: a nationwide survey of endodontists. J Endodon 1982;8:35-40.