CONSORT Randomized Clinical Trial
Postoperative Pain after Endodontic Treatment under Irrigation with 8.25% Sodium Hypochlorite and Other Solutions: A Randomized Clinical Trial

https://doi.org/10.1016/j.joen.2021.02.004Get rights and content

Abstract

Introduction

The aim of this study was to evaluate the postoperative pain in patients after endodontic treatment using 8.25% sodium hypochlorite (NaOCl) compared with other concentrations and 2% chlorhexidine (CHX).

Methods

In this double-blind randomized trial, 180 patients were evaluated who underwent a single session of endodontic treatment under irrigation with 2.5%, 5.25%, or 8.25% NaOCl or 2% CHX solutions. The presence of postoperative pain was assessed 24, 48, and 72 hours after treatment and recorded using the visual analog scale (VAS). A descriptive analysis, logistic regression, and Wald test were performed.

Results

Altogether 169 patients participated, of whom 107 were women, and the mean age was 38.1 ± 14.4 years. No significant differences occurred between the irrigants and the pain outcomes, not even for the use of postoperative pain medication and responses to VAS (P > .05). In the multivariate model including irrigants, after 24 hours or at any time, a significant difference (P < .05) remained in preparation time ≥10 minutes and the presence of overfilling. Also, in relation to the VAS, the overfilling presented significantly different results (P < .05).

Conclusions

There was no significant difference in the presence of postoperative pain between the 8.25% NaOCl and the other irrigation solutions. However, the extended preparation time and the overfilling material were responsible for the increase of postoperative pain.

Section snippets

Materials and Methods

This double-blind randomized controlled trial was approved by the Institutional Research Ethics Committee under registration no. 2,406,004 and registered in the Brazilian Registry of Clinical Trials (Registro Brasileiro de Ensaios Clínico, http://www.ensaiosclinicos.gov.br/, database no. RBR-33yhw9).

The sample calculation for the research was based on a pilot study in which patients who used 2% CHX constituted a control group, which had a lower percentage of patients who had pain; the 5.25%

Results

The flowchart of the study is presented in Figure 1. The patients’ return rate was 93.9% (n = 169) with groups and those who respectively remained (2% CHX and 2.5% NaOCl, n = 43; 5.25%, n = 42; and 8.25%, n = 41). Dropouts simply did not return to the follow-up, without there being any specific reason for that.

The results of the descriptive analysis of demographic and clinical characteristics for each group are shown in Table 1. Of the 169 participants, 107 (63.3%) were women, and 62 (36.7%)

Discussion

This study attempted to evaluate endodontic postoperative pain at different time points in patients undergoing treatment with different irrigation solutions. No significant difference between the irrigants occurred, but 5.25% NaOCl showed the highest percentage of postoperative pain (28.6%) followed by 8.25% NaOCl (24.4%), whereas 2.5% NaOCl and 2% CHX were represented by 14% of the cases. Other variables, such as extended preparation time and overfilling, were associated with pain outcomes.

The

Conclusion

The 8.25% NaOCl solution was not significantly more associated with either the presence or intensity of pain compared with other solutions. An extended preparation time and overfilled material have a negative impact on the incidence of postoperative pain, which is more frequently reported in the first 24 hours. Thus, 8.25% NaOCl can be used as an irrigant solution as long as the preparation time is reduced.

Acknowledgments

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

References (30)

  • M.E. Mostafa et al.

    Postoperative pain following endodontic irrigation using 1.3% versus 5.25% sodium hypochlorite in mandibular molars with necrotic pulps: a randomized double-blind clinical trial

    Int Endod J

    (2020)
  • J.F. Siqueira Junior et al.

    Unprepared root canal surface areas: causes, clinical implications, and therapeutic strategies

    Braz Oral Res

    (2018)
  • D. Zhang et al.

    In vitro evaluation by quantitative real-time PCR and culturing of the effectiveness of disinfection of multispecies biofilms in root canals by two irrigation systems

    Clin Oral Investig

    (2019)
  • A. Jena et al.

    Root canal irrigants: a review of their interactions, benefits, and limitations

    Compend Contin Educ Dent

    (2015)
  • M. Haapasalo et al.

    Irrigation in endodontics

    Br Dent J

    (2014)
  • Cited by (13)

    • Cytotoxicity of root canal irrigating solutions and photodynamic therapy using curcumin photosensitizer

      2022, Photodiagnosis and Photodynamic Therapy
      Citation Excerpt :

      The higher cytotoxicity of hypochlorite concentration irrigating solution can be explained by its chemical properties of dissolving organic tissues and its toxicity, by recruiting an expressive number of inflammatory mediators [5]. The organic tissue dissolving properties and cytotoxicity effect of sodium hypochlorite are proportional to the irrigating solution concentration [28,29], justifying the results obtained in the present study. In the same way, it is crucial to assess the potentially toxic effects of photodynamic therapy to the host´s cells, which are also affected by the singlet oxygen action [30].

    • Efficacy of 6% Sodium Hypochlorite on Infectious Content of Teeth with Symptomatic Irreversible Pulpitis

      2022, Journal of Endodontics
      Citation Excerpt :

      In this regard, the microbiota of teeth with irreversible pulpitis may have similarities with persistent/secondary endodontic infections due to the levels of LPS and LTA11,19. The use of NaOCl at higher concentrations was proposed because it improves pulp tissue dissolution38 without interfering with postoperative pain compared with other concentrations of NaOCl and chlorhexidine39. This was a pioneer investigation conducted to monitor the levels of bacteria, LPS, and LTA in teeth with symptomatic irreversible pulpitis in different phases of endodontic treatment performed with 6% NaOCl.

    View all citing articles on Scopus
    View full text