Elsevier

Journal of Endodontics

Volume 43, Issue 9, September 2017, Pages 1422-1427
Journal of Endodontics

CONSORT Randomized Clinical Trial
Effect of the Simultaneous Working Length Control during Root Canal Preparation on Postoperative Pain

https://doi.org/10.1016/j.joen.2017.04.028Get rights and content

Abstract

Aim

The aim of this study was to evaluate the effect of simultaneous length control during root canal preparation on postoperative pain compared with separate working length determination and root canal preparation. The design was a parallel-group, randomized, controlled trial with 2 arms.

Methods

Forty-four molar teeth were randomly divided into 2 groups (n = 22), a control group (separate length determination and root canal preparation) and a simultaneous length control during root canal preparation group. The following variables were recorded: age; gender; tooth number; preoperative pain on the visual analog scale; pain level on days 1, 3, 5, and 7; and analgesic intake after the procedure and initial/final percussion pain. The data were analyzed with the χ2 test, independent samples t test, and Mann-Whitney U test.

Results

The simultaneous length control during root canal preparation group resulted in lower postoperative pain levels on day 1 than did the control group (P < .05). Despite 2 patients' intake of postoperative analgesics in the control group, no patient needed to use postoperative analgesics in the simultaneous length control during root canal preparation group (P > .05).

Conclusions

Simultaneous length control during root canal preparation as a non-pharmacologic strategy for reducing postoperative pain is a beneficial technique for preventing postoperative pain.

Section snippets

Design

The design of this study was a parallel-group, randomized, controlled trial with 2 arms.

A total of 44 patients were selected for this in vivo study. The study subjects were recruited from a pool of patients referred to the department of endodontics for root canal treatment from July 2016 to December 2016. The research ethics committee (2016-73) approved the protocol. Each patient was informed about the study and signed the informed consent form.

First, a pilot study was conducted on 16 patients.

Statistical Analysis

The homogeneity of variances for homogeneity and Kolmogorov-Smirnov for normality were conducted. Data on age, preoperative pain, and pain on preoperative percussion were normally distributed and homogeneous (P > .05); thus, these data were analyzed with an independent samples t test. However, pain on postoperative percussion and postoperative pain level on days 1, 3, 5, and 7 were not normally distributed and homogeneous (P < .05). Thus, these data were analyzed with the Mann-Whitney U test.

Results

Two patients were lost during follow-up (1 patient from the control group and 1 patient from the simultaneous length control during root canal preparation group) (Fig. 2). Demographic data, preoperative and postoperative pain levels, and pain levels on percussion according to the groups are shown in Table 1. No statistically significant differences were found between the groups in terms of demographic data (age, gender, tooth number) (P > .05). According to the statistical analysis, no

Discussion

When using conventional electronic apex locators, the working length is determined after coronal flaring. A stopper is generally used to fix the working length during instrumentation. However, the protection of the working length from deviations can be achieved manually by observing the stopper and coronal reference points. The Gold Reciproc motor allows for simultaneous length control during instrumentation, and the motor automatically controls the working length by stopping the

Weaknesses of the Study

Simultaneous length control during root canal preparation group resulted in lower postoperative pain levels on all days compared with the control group; only the differences on day 1 were statistically significant. However, statistically significant differences would be expected with a large sample-size study. Moreover, in the present study, the applications could not be blinded. However, the statistical analysis was blinded.

Strengths of the Study

The design of the present study was a randomized, controlled clinical trial with 2 arms. The patients were randomly distributed into 2 groups. Thus, the best evidence was provided (Level 1 evidence). Another strength of the present study was the standardization. Only molar teeth were treated by only 1 operator. Moreover, the sample size was determined according to the effect size obtained from the data of a pilot study.

Conclusion

Within the limitations of the present study, the group with simultaneous length control during root canal preparation resulted in lower postoperative pain levels on day 1 than did the control group, and no patient needed postoperative analgesics in the group with simultaneous length control during root canal preparation. Thus, it seems that simultaneous length control during root canal preparation as a non-pharmacologic strategy for reducing postoperative pain is a beneficial technique for

Acknowledgments

The authors deny any conflicts of interest related to this study.

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