EFFECT OF OCCLUSAL REDUCTION ON POST OPERATIVE PAIN IN PATIENT WITH SYMPTOMATIC PERIAPICAL PERIODONTITIS FOLLOWING ENDODONTIC INSTRUMENTATION- A RANDOMIZED CONTROL TRIAL
DOI:
https://doi.org/10.55519/JAMC-01-14418Keywords:
Pain; Occlusal adjustment; Root canal therapyAbstract
Background: Post endodontic treatment pain is the most common complications within the first 72 hours. Various therapeutic modalities are used to reduce post endodontic pain, including use of NaOCl irrigant, long-acting anaesthetic, and preoperative drug delivery. One such techniques is to take the treated tooth completely out of occlusion. This study aimed to assess the effect of occlusal reduction versus no occlusal reduction on post endodontic pain. Methods: A randomized clinical trial was done from April 2024 to August 2024 in the operative dentistry department of Rawal Institute of Health Sciences, Islamabad. Sixty adult volunteers presented with symptomatic apical periodontitis for endodontic treatment and fulfilling the inclusion criteria were selected by convenience non-probability sampling. The patients were randomly divided into two groups, the occlusal reduction (OR) group and the no occlusal reduction (NOR) group, with 30 patients in each group. The patients of both groups were instructed to complete the VAS at 24 hours after the procedure to rate their pain as mild, moderate or severe and were asked to bring the Performa along at the next scheduled appointment. All the data collected was entered and analysed using (SPSS version 22.0). Chi-square test was used for qualitative variable (frequency of post-operative pain, gender) and independent sample T-test for quantitative variable (age). Results: There were 12 (40.0%) males in the non-occlusal group while 14 (46.6%) males in the occlusal reduction group. The majority of participants fell into the 18‒30 age range 12 (40.0%) in non-occlusal group and 11 (36.6%) in the occlusal reduction group. Average pain was significantly high in no occlusal reduction group (4.10±1.18 versus 2.11±1.00) and this difference was significant (p<0.001). This difference was also proven as per gender and age stratified analysis. Conclusion: Compared to non-occlusal reduction, the patients in occlusal reduction group had noticeably low pain scores.
References
1. Varma K, Satish RK, Sajjan G, Varma K, Panitini B, Ponnada N. Advances in the management of post endodontic pain: a review. Int J Dent Mater 2023;5(1):13–6.
2. Zakir S, Jan MZ. A prospective study of postoperative pain after root canal treatment. J Rehman Coll Dent. 2022;3(1):23–6.
3. Heta S, Alliu N, Robo L, Ostreni V. Antibiotics for the treatment of apical periodontitis: indications or contraindications. Bull Natl Res Cent 2023;47:61.
4. Pathak I, Smant P, Chauhan R. Evaluation of postoperative pain in single-visit endodontic treatment after pre-medication with oral anti-inflammatory and antibiotics. Turk Endod J 2021;6(1):7–13.
5. Viana E, Herkrath F, Martins I, Lopes L. Effect of occlusal adjustment on postoperative pain after root canal treatment: a randomized clinical trial. Braz Dent J 2020;31(4):353–9.
6. Khadka J, Nepal M, Adhikari B, Lamichhane P, Kunwar D. Effect of occlusal reduction on postoperative pain during root canal treatment in teeth with symptomatic apical periodontitis. MedS Alliance J Med Med Sci 2023;3(5):7–10.
7. Yousaf A, Ali F, Mohibullah, Hussain SM, Maryam M, Yousaf N. Incidence of postoperative pain in teeth with symptomatic irreversible pulpitis with and without occlusal reduction. J Khyber Coll Dent 2020;10(1):68–72.
8. Manigandan K, Karthick S, Rajendran MR, Gopal K. Influence of occlusal surface reduction on post endodontic pain following instrumentation and obturation: a randomized double-blinded clinical study. J Conserv Dent Endod 2024;27(9):902–7.
9. Raza I, Ahmed A, Khalid N, Batool F. Effect of occlusal reduction on frequency of postoperative pain relief following endodontic instrumentation. Pak Oral Dent J 2016;36(4):650–3.
10. Kumar K, Sarim S, Hammad H, Ahmed M, Irfan F, Nafees H. Effect of occlusal reduction on postoperative pain in multi-visit root canal treatment. Biol Clin Sci Res J 2022;157:1–4.
11. Shamszadeh S, Shirvani A, Asgary S. Does occlusal reduction reduce post-endodontic pain? A systematic review and meta-analysis. J Oral Rehabil 2020;47(4):528–35.
12. Dorn SO, Moodnik RM, Feldman MJ, Borden BG. Treatment of the endodontic emergency: a report based on a questionnaire—part I. J Endod 1977;3(3):94–100.
13. Moghal A, Khokhar SA, Mirza A, Dildar I, Zaheer A. Effect of occlusal reduction on alleviating pain in symptomatic apical periodontitis. J Pak Dent Assoc 2023;32(3):91–4.
14. Balevi B. Managing post endodontic treatment pain by eliminating occlusal contacts. Evid Based Dent 2019;20(4):109–10.
15. Emara R, Abou El Nasr H, El Boghdadi R. Evaluation of postoperative pain intensity following occlusal reduction in teeth associated with symptomatic irreversible pulpitis and symptomatic apical periodontitis: a randomized clinical study. Int Endod J 2019;52(3):288–96.
16. Parirokh M, Rekabi AR, Ashouri R, Nakhaee N, Abbott PV, Gorjestani H. Effect of occlusal reduction on postoperative pain in teeth with irreversible pulpitis and mild tenderness to percussion. J Endod 2013;39(1):1–5.
17. Walton R, Kaltenbach R. Effect of occlusal relief on endodontic pain. J Am Dent Assoc 1984;109(1):64–7.
18. Arslan H, Seckin F, Kurklu D, Karatas E, Yanikoglu N, Capar ID. 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. Clin Oral Investig 2017;21(3):857–63.
19. Arias A, de la Macorra JC, Hidalgo J, Azabal M. Predictive models of pain following root canal treatment: a prospective clinical study. Int Endod J 2013;46(8):784–93.
20. ElMubarak AHH, Abu-bakr NH, Ibrahim YE. Postoperative pain in multiple-visit and single-visit root canal treatment. J Endod 2010;36(1):36–9.
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