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| During RCT, patients may experience acute exacerbations or flare-ups, which can cause significant distress and require an unexpected clinic visit. Therefore, managing interappointment pain is crucial. The etiology of this pain is complex, involving microbial factors (a disturbed host-bacteria relationship), chemical injury, or mechanical injury to pulpal or periradicular tissues. |
| Effective techniques to manage pain include: |
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| Incision and Drainage |
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Procedure: Incision and Drainage (I&D) is used to evacuate pus, microorganisms, and toxins from periradicular tissue, helping alleviate pain and decompress tissue in endodontic emergencies. |
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Surprising Outcome: The mock I&D group (simulated procedure) reported greater pain reduction without opioid use compared to the actual I&D group. |
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| Re-instrumentation |
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Procedure: Involves reentering the tooth to perform access opening, cleaning, shaping, drainage, and copious irrigation to remove microbial debris and prevent postoperative symptoms. |
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Treatment outcome: In Case 1, a 22-year-old male with severe swelling and pain from nonvital teeth had rapid relief through drainage via incision and apical trephination, while in Case 2, a 53-year-old female with intense jaw pain from a periapical radiolucency under a fixed dental prosthesis experienced immediate pain relief after removing the prosthesis and draining through the affected tooth. |
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| Trephination |
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Procedure: Involves creating an opening in the alveolar cortical plate or apical foramen to drain inflammatory exudate. |
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Effectiveness: Provides prompt pain relief with minimal need for analgesics after the procedure. |
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| Occlusal Reduction |
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Systematic Review: A meta-analysis of six randomized controlled trials (344 participants) found occlusal reduction did not significantly reduce postoperative pain in the first two days but showed positive effects on pain control on the third day. |
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Trial Findings: In a study with 308 patients, occlusal reduction in mandibular posterior teeth with irreversible pulpitis reduced post-treatment pain significantly at 12 and 24 hours, decreasing the risk of moderate-to-severe pain by 40% at 12 hours |
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| Platelet-Rich Fibrin (PRF) |
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Composition: A living biomaterial containing fibrin matrix, platelet cytokines, growth factors, and cells. |
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Application: Commonly used in oral and maxillofacial surgeries and has shown effectiveness in endodontic surgeries for pain management. |
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Study Findings: In a study comparing PRF, hydroxyapatite, and CERAMENT™ for managing endodontic apical surgery, PRF was found to be superior in reducing pain, suggesting it as a recommended option for pain management in endodontics. |
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| Cryotherapy |
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Method: Involves applying low temperatures, specifically using a saline solution chilled to 2.5 °C, applied for five minutes via the EndoVac negative pressure device in root canal procedures. |
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Purpose: Aimed to reduce root surface temperature and utilize the benefits of cold therapy for post-surgical recovery. |
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Study Findings: The application of cold saline as the final irrigant significantly reduced postoperative pain compared to a standard control group, making cryotherapy an effective, economical, and safe method for alleviating discomfort in single-visit root canal treatments. |
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| GGI-CO-A1-AQS-300023454-APPEMC-L24-0152 |
| For the use of a Registered Medical Practitioner, Hospital or Laboratory only. |
| Reference: |
| Falatah AM, Almalki RS, Al-Qahtani AS, Aljumaah BO, Almihdar WK, Almutairi AS. Comprehensive Strategies in Endodontic Pain Management: An Integrative Narrative Review. Cureus. 2023;15(12):e50371. Published 2023 Dec 12. doi:10.7759/cureus.50371 Click here to view the original article |
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