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Clinical Oral Investigations

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01-01-2021 | Root Canal Debridement | Original Article

Effect of calcium hydroxide mixed with lidocaine hydrochloride on postoperative pain in teeth with irreversible pulpitis and symptomatic apical periodontitis: a preliminary randomized controlled prospective clinical trial

Authors: Hakan Arslan, Ezgi Doğanay Yıldız, Hüseyin Sinan Topçuoğlu, Ebru Tepecik, Gizem Taş

Published in: Clinical Oral Investigations | Issue 1/2021

Abstract

Objectives

To investigate the effect of calcium hydroxide mixed with lidocaine HCl on postoperative spontaneous pain.

Materials and methods

Sixty patients having irreversible pulpitis and symptomatic apical periodontitis with a preoperative spontaneous pain and percussion pain which was more than 50 on a visual analogue scale (100 mm VAS) were included in this study. After the preparation of the root canals, the patients were randomly distributed into two groups according to the calcium hydroxide vehicle, control group (mixed with saline) and calcium hydroxide mixed with lidocaine HCl (n = 30). Postoperative spontaneous pain scores were recorded by a VAS every day for a week. Data were analysed using one-way analysis of variance, chi-squared test and Mann-Whitney U tests (p = 0.05).

Results

The calcium hydroxide mixed with lidocaine HCl group resulted in significantly less pain compared with the calcium hydroxide mixed with saline group during days 1 to 4 (p < 0.05). There were no significant differences between the groups in terms of postoperative percussion pain levels (p > 0.05).

Conclusion

Within the limitations of this study, it can be concluded that the calcium hydroxide mixed with lidocaine HCl can be beneficial in reducing postoperative pain in teeth with irreversible pulpitis and symptomatic apical periodontitis.

Clinical relevance

The calcium hydroxide mixed with lidocaine HCl can be beneficial in reducing postoperative pain in teeth with irreversible pulpitis and symptomatic apical periodontitis.

Clinical registration number

TCTR20181121003

Available only for authorised users

Torabinejad M, Kettering JD, McGraw JC, Cummings RR, Dwyer TG, Tobias TS (1988) Factors associated with endodontic interappointment emergencies of teeth with necrotic pulps. J Endod 14(5):261–266PubMed

Ng YL, Glennon J, Setchell D, Gulabivala K (2004) Prevalence of and factors affecting post-obturation pain in patients undergoing root canal treatment. Int Endod J 37(6):381–391PubMed

Udoye CI, Jafarzadeh H, Aguwa EN, Habibi M (2011) Flare-up incidence and related factors in Nigerian adults. J Contemp Dent Pract 12(2):120–123PubMed

Alí A, Olivieri JG, Duran-Sindreu F, Abella F, Roig M, García-Font M (2016) Influence of preoperative pain intensity on postoperative pain after root canal treatment: a prospective clinical study. J Dent 45:39–42PubMed

Torabinejad M, Cymerman JJ, Frankson M, Lemon RR, Maggio JD, Schilder H (1994) Effectiveness of various medications on postoperative pain following complete instrumentation. J Endod 20(7):345–354PubMed

Sathorn C, Parashos P, Messer H (2008) The prevalence of postoperative pain and flare-up in single- and multiple-visit endodontic treatment: a systematic review. Int Endod J 41(2):91–99PubMed

Walton R, Fouad A (1992) Endodontic interappointment flare-ups: a prospective study of incidence and related factors. J Endod 18(4):172–177PubMed

Trope M (1990) Relationship of intracanal medicaments to endodontic flare-ups. Endod Dent Traumatol 6(5):226–229PubMed

Genet JM, Hart AA, Wesselink PR, Thoden van Velzen SK (1987) Preoperative and operative factors associated with pain after the first endodontic visit. Int Endod J 20(2):53–64PubMed

10.

Imura N, Zuolo ML (1995) Factors associated with endodontic flare-ups: a prospective study. Int Endod J 28(5):261–265PubMed

11.

O'Keefe EM (1976) Pain in endodontic therapy: preliminary study. J Endod 2(10):315–319PubMed

12.

Hargreaves K, Abbott PV (2005) Drugs for pain management in dentistry. Aust Dent J 50(4 Suppl 2):14–22

13.

Moore PA, Dunsky JL (1983) Bupivacaine anesthesia—a clinical trial for endodontic therapy. Oral Surg Oral Med Oral Pathol 55(2):176–179PubMed

14.

Parirokh M, Yosefi MH, Nakhaee N, Manochehrifar H, Abbott PV, Forghani FR (2012) Effect of bupivacaine on postoperative pain for inferior alveolar nerve block anesthesia after single-visit root canal treatment in teeth with irreversible pulpitis. J Endod 38(8):1035–1039PubMed

15.

Jaber L, Swaim W, Dionne R (2003) Immunohistochemical localization of μ-opioid receptors in human dental pulp. J Endod 29(2):108–110PubMed

16.

Likar R, Sittl R, Gragger K, Pipam W, Blatnig H, Breschan C, Schalk H, Stein C, Schäfer M (1998) Peripheral morphine analgesia in dental surgery. Pain 76(1–2):145–150PubMed

17.

Mehrvarzfar P, Shababi B, Sayyad R, Fallahdoost A, Kheradpir K (2008) Effect of supraperiosteal injection of dexamethasone on postoperative pain. Aust Endod J 34(1):25–29PubMed

18.

Shantiaee Y, Mahjour F, Dianat O (2012) Efficacy comparison of periapical infiltration injection of dexamethasone, morphine and placebo for postoperative endodontic pain. Int Dent J 62(2):74–78PubMed

19.

Gallatin E, Reader A, Nist R, Beck M (2000) Pain reduction in untreated irreversible pulpitis using an intraosseous injection of Depo-Medrol. J Endod 26(11):633–638PubMed

20.

Arslan H, Gündogdu EC, Sümbüllü M (2016) The effect of preoperative administration of antihistamine, analgesic and placebo on postoperative pain in teeth with symptomatic apical periodontitis: a randomized controlled trial. Eur Endod J 1(1):1PubMedPubMedCentral

21.

Ehrmann E, Messer H, Adams G (2003) The relationship of intracanal medicaments to postoperative pain in endodontics. Int Endod J 36(12):868–875PubMed

22.

Gatchel RJ (1992) Dealing with discomfort managing anxiety and pain during dental treatment. J Am Dent Assoc 123(6):37–41PubMed

23.

Shavit Y, Lewis JW, Terman GW, Gale RP, Liebeskind JC (1984) Opioid peptides mediate the suppressive effect of stress on natural killer cell cytotoxicity. Science 223(4632):188–190PubMed

24.

Arslan H, Güven Y, Karataş E, Doğanay E (2017) Effect of the simultaneous working length control during root canal preparation on postoperative pain. J Endod 43(9):1422–1427PubMed

25.

Arslan H, Khalilov R, Doğanay E, Karatas E (2016) The effect of various kinematics on postoperative pain after instrumentation: a prospective, randomized clinical study. J Appl Oral Sci 24(5):503–508PubMedPubMedCentral

26.

Arslan H, Doğanay E, Alsancak M, Çapar I, Karataş E, Gündüz H (2016) Comparison of apically extruded debris after root canal instrumentation using Reciproc® instruments with various kinematics. Int Endod J 49(3):307–310PubMed

27.

Emara RS, Abou El Nasr HM, El Boghdadi RM (2019) 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 52(3):288–296PubMed

28.

Arslan H, Seckin F, Kurklu D, Karatas E, Yanikoglu N, Capar ID (2017) 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 21(3):857–863PubMed

29.

Gondim E Jr, Setzer FC, Dos Carmo CB, Kim S (2010) Postoperative pain after the application of two different irrigation devices in a prospective randomized clinical trial. J Endod 36(8):1295–1301PubMed

30.

Topçuoğlu HS, Topçuoğlu G, Arslan H (2018) The effect of different irrigation agitation techniques on postoperative pain in mandibular molar teeth with symptomatic irreversible pulpitis: a randomized clinical trial. J Endod 44(10):1451–1456PubMed

31.

Topçuoğlu HS, Topçuoğlu G, Arslan H (2018) The effect of apical positive and negative pressure irrigation methods on postoperative pain in mandibular molar teeth with symptomatic irreversible pulpitis: a randomized clinical trial. J Endod 44(8):1210–1215PubMed

32.

Yıldız ED, Arslan H (2018) Effect of low-level laser therapy on postoperative pain in molars with symptomatic apical periodontitis: a randomized placebo-controlled clinical trial. J Endod 44(11):1610–1615

33.

Arslan H, Doğanay E, Karataş E, Ünlü MA, Ahmed HMA (2017) Effect of low-level laser therapy on postoperative pain after root canal retreatment: a preliminary placebo-controlled, triple-blind, randomized clinical trial. J Endod 43(11):1765–1769PubMed

34.

Arslan H, Ahmed HM, Doganay Yıldız E, Gündogdu EC, Seçkin F, Arslan S Acupuncture reduces the postoperative pain in teeth with symptomatic apical periodontitis: a preliminary randomized placebo-controlled prospective clinical trial. Quintessence Int 50(4):270–277

35.

Gundogdu EC, Arslan H (2018) Effects of various cryotherapy applications on postoperative pain in molar teeth with symptomatic apical periodontitis: a preliminary randomized prospective clinical trial. J Endod 44(3):349–354PubMed

36.

Al-Nahlawi T, Hatab TA, Alrazak MA, Al-Abdullah A (2016) Effect of intracanal cryotherapy and negative irrigation technique on postendodontic pain. J Contemp Dent Pract 17(12):990–996PubMed

37.

Keskin C, Ozdemir O, Uzun I, Guler B (2017) Effect of intracanal cryotherapy on pain after single-visit root canal treatment. Aust Endod J 43(2):83–88PubMed

38.

Vera J, Ochoa J, Romero M, Vazquez-Carcano M, Ramos-Gregorio CO, Aguilar RR, Cruz A, Sleiman P, Arias A (2018) Intracanal cryotherapy reduces postoperative pain in teeth with symptomatic apical periodontitis: a randomized multicenter clinical trial. J Endod 44(1):4–8PubMed

39.

Law A, Messer H (2004) An evidence-based analysis of the antibacterial effectiveness of intracanal medicaments. J Endod 30(10):689–694PubMed

40.

Siqueira J Jr, Lopes H (1999) Mechanisms of antimicrobial activity of calcium hydroxide: a critical review. Int Endod J 32(5):361–369PubMed

41.

Imlay JA, Linn S (1988) DNA damage and oxygen radical toxicity. Science 240(4857):1302–1309PubMed

42.

Kontakiotis E, Nakou M, Georgopoulou M (1995) In vitro study of the indirect action of calcium hydroxide on the anaerobic flora of the root canal. Int Endod J 28(6):285–289PubMed

43.

Tronstad L, Andreasen JO, Hasselgren G, Kristerson L, Riis I (1981) pH changes in dental tissues after root canal filling with calcium hydroxide. J Endod 7(1):17–21PubMed

44.

Foreman PC, Barnes IE (1990) Review of calcium hydroxide. Int Endod J 23(6):283–297PubMed

45.

Khan AA, Sun X, Hargreaves KM (2008) Effect of calcium hydroxide on proinflammatory cytokines and neuropeptides. J Endod 34(11):1360–1363PubMedPubMedCentral

46.

Çalışkan M (2004) Prognosis of large cyst-like periapical lesions following nonsurgical root canal treatment: a clinical review. Int Endod J 37(6):408–416PubMed

47.

Tolska HK, Takala A, Blomgren K, Hamunen K, Kontinen V (2017) Topical ropivacaine in prevention of post-tonsillectomy pain in adults. Anesth Analg 124(5):1459–1466PubMed

48.

Derry S, Wiffen PJ, Moore RA, Quinlan J (2014) Topical lidocaine for neuropathic pain in adults. Cochrane Database Syst Rev (7):Cd010958

49.

Chernow B, Balestrieri F, Ferguson CD, Terezhalmy GT, Fletcher JR, Lake CR (1983) Local dental anesthesia with epinephrine: minimal effects on the sympathetic nervous system or on hemodynamic variables. Arch Intern Med 143(11):2141–2143PubMed

50.

Malamed SF, Gagnon S, Leblanc D (2000) A comparison between articaine HCl and lidocaine HCl in pediatric dental patients. Pediatr Dent 22(4):307–311PubMed

51.

Fukayama H, Suzuki N, Umino M (2002) Comparison of topical anesthesia of 20% benzocaine and 60% lidocaine gel. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 94(2):157–161PubMed

52.

Sezgin Y, Bilgin MÇ, Bulut Ş, Alptekin N, Börçek P (2018) Evaluating the effects of a topical preparation composed of dexpanthenol, silbiol, undecylenic acid and lidocaine on palatal mucosa wound healing in a rat model. Balkan Med J 36(2):88–95PubMed

53.

Ørstavik D, Kerekes K, Eriksen HM (1986) The periapical index: a scoring system for radiographic assessment of apical periodontitis. Dent Traumatol 2(1):20–34

54.

Fava L, Saunders W (1999) Calcium hydroxide pastes: classification and clinical indications. Int Endod J 32(4):257–282PubMed

55.

Athanassiadis B, Abbott P, Walsh LJ (2007) The use of calcium hydroxide, antibiotics and biocides as antimicrobial medicaments in endodontics. Aust Dent J 52(1 Suppl):64–82

56.

Mohammadi Z, Dummer PMH (2011) Properties and applications of calcium hydroxide in endodontics and dental traumatology. Int Endod J 44(8):697–730PubMed

57.

Gomes BPFA, Ferraz CCR, Vianna ME, Rosalen PL, Zaia AA, Teixeira FB, Souza-Filho FJ (2002) In vitro antimicrobial activity of calcium hydroxide pastes and their vehicles against selected microorganisms. Braz Dent J 13(3):155–161PubMed

58.

Solak H, Öztan M (2003) The pH changes of four different calcium hydroxide mixtures used for intracanal medication. J Oral Rehabil 30(4):436–439PubMed

59.

Stamos DG, Haasch GC, Gerstein H (1985) The pH of local anesthetic/calcium hydroxide solutions. J Endod 11(6):264–265PubMed

60.

Estrela C, Sydney GB, Pesce HF, Felippe OJ (1995) Dentinal diffusion of hydroxyl ions of various calcium hydroxide pastes. Braz Dent J 6(1):5–9PubMed

61.

Esberard RM, Carnes DL Jr, Carlos E (1996) Changes in pH at the dentin surface in roots obturated with calcium hydroxide pastes. J Endod 22(8):402–405PubMed

62.

Fuss Z, Rafaeloff R, Tagger M, Szajkis S (1996) Intracanal pH changes of calcium hydroxide pastes exposed to carbon dioxide in vitro. J Endod 22(7):362–364PubMed

63.

Kfir A, Blau-Venezia N, Goldberger T, Abramovitz I, Wigler R (2018) Efficacy of self-adjusting file, XP-endo finisher and passive ultrasonic irrigation on the removal of calcium hydroxide paste from an artificial standardized groove. Aust Endod J 44(1):26–31PubMed

64.

de Oliveira RL, Guerisoli DMZ, Duque JA, Alcalde MP, Onoda HK, Domingues FHF, Vivan RR, Duarte MAH (2019) Computed microtomography evaluation of calcium hydroxide-based root canal dressing removal from oval root canals by different methods of irrigation. Microsc Res Tech 82(3):232–237PubMed

65.

Pabel AK, Hulsmann M (2017) Comparison of different techniques for removal of calcium hydroxide from straight root canals: an in vitro study. Odontology 105(4):453–459PubMed

66.

Alturaiki S, Lamphon H, Edrees H, Ahlquist M (2015) Efficacy of 3 different irrigation systems on removal of calcium hydroxide from the root canal: a scanning electron microscopic study. J Endod 41(1):97–101PubMed

67.

Faria G, Viola KS, Kuga MC, Garcia AJ, Daher VB, De Pasquali Leonardo MF, Tanomaru-Filho M (2014) Effect of rotary instrument associated with different irrigation techniques on removing calcium hydroxide dressing. Microsc Res Tech 77(8):642–646PubMed

68.

Nagendrababu V, Pulikkotil SJ, Suresh A, Veettil SK, Bhatia S, Setzer FC (2019) Efficacy of local anaesthetic solutions on the success of inferior alveolar nerve block in patients with irreversible pulpitis: a systematic review and network meta-analysis of randomized clinical trials. Int Endod J 52(6):779–789PubMed

69.

Ayranci LB, Yeter KY, Arslan H, Kseoglu M (2013) Morphology of apical foramen in permanent molars and premolars in a Turkish population. Acta Odontol Scand 71(5):1043–1049PubMed

70.

Tjan AH, Whang SB (1985) Resistance to root fracture of dowel channels with various thicknesses of buccal dentin walls. J Prosthet Dent 53(4):496–500PubMed

71.

Lloyd PM, Palik JF (1993) The philosophies of dowel diameter preparation: a literature review. J Prosthet Dent 69(1):32–36PubMed

72.

Pilo R, Corcino G, Tamse A (1998) Residual dentin thickness in mandibular premolars prepared with hand and rotatory instruments. J Endod 24(6):401–404PubMed

73.

Raiden G, Costa L, Koss S, Hernandez JL, Acenolaza V (1999) Residual thickness of root in first maxillary premolars with post space preparation. J Endod 25(7):502–505PubMed

74.

Katz A, Wasenstein-Kohn S, Tamse A, Zuckerman O (2006) Residual dentin thickness in bifurcated maxillary premolars after root canal and dowel space preparation. J Endod 32(3):202–205PubMed

75.

Perez AR, Alves FRF, Marceliano-Alves MF, Provenzano JC, Goncalves LS, Neves AA, Siqueira JF Jr (2018) Effects of increased apical enlargement on the amount of unprepared areas and coronal dentine removal: a micro-computed tomography study. Int Endod J 51(6):684–690PubMed

76.

Figini L, Lodi G, Gorni F, Gagliani M (2008) Single versus multiple visits for endodontic treatment of permanent teeth: a Cochrane systematic review. J Endod 34(9):1041–1047PubMed

77.

Sathorn C, Parashos P, Messer HH (2005) Effectiveness of single- versus multiple-visit endodontic treatment of teeth with apical periodontitis: a systematic review and meta-analysis. Int Endod J 38(6):347–355PubMed

78.

Su Y, Wang C, Ye L (2011) Healing rate and post-obturation pain of single- versus multiple-visit endodontic treatment for infected root canals: a systematic review. J Endod 37(2):125–132PubMed

79.

Abbott PV, Yu C (2007) A clinical classification of the status of the pulp and the root canal system. Aust Dent J 52(1 Suppl):17–31

80.

Sjogren U, Hagglund B, Sundqvist G, Wing K (1990) Factors affecting the long-term results of endodontic treatment. J Endod 16(10):498–504PubMed

81.

Vera J, Siqueira JF Jr, Ricucci D, Loghin S, Fernandez N, Flores B, Cruz AG (2012) One- versus two-visit endodontic treatment of teeth with apical periodontitis: a histobacteriologic study. J Endod 38(8):1040–1052PubMed

82.

Sjogren U, Figdor D, Persson S, Sundqvist G (1997) Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical periodontitis. Int Endod J 30(5):297–306PubMed

Title: Effect of calcium hydroxide mixed with lidocaine hydrochloride on postoperative pain in teeth with irreversible pulpitis and symptomatic apical periodontitis: a preliminary randomized controlled prospective clinical trial
Authors: Hakan Arslan
Ezgi Doğanay Yıldız
Hüseyin Sinan Topçuoğlu
Ebru Tepecik
Gizem Taş
Publication date: 01-01-2021
Publisher: Springer Berlin Heidelberg
Keywords: Root Canal Debridement
Root Canal Debridement
Published in: Clinical Oral Investigations / Issue 1/2021
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI: https://doi.org/10.1007/s00784-020-03354-w

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Effect of calcium hydroxide mixed with lidocaine hydrochloride on postoperative pain in teeth with irreversible pulpitis and symptomatic apical periodontitis: a preliminary randomized controlled prospective clinical trial

Abstract

Objectives

Materials and methods

Results

Conclusion

Clinical relevance

Clinical registration number

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Materials and methods

Results

Conclusion

Clinical relevance

Clinical registration number

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