Apical periodontitis healing and postoperative pain following endodontic treatment with a reciprocating single-file, single-cone approach: A randomized controlled pragmatic clinical trial

• Published in: PloS one 2020-02, Vol.15 (2), p.e0227347
• Main Authors: de-Figueiredo, Fabricio Eneas Diniz, Lima, Laila Fernandes, Lima, Giana Silveira, Oliveira, Ludmila Smith, Ribeiro, Maria Amália, Brito-Junior, Manoel, Correa, Marcos Brito, Sousa-Neto, Manoel D, Faria E Silva, André Luis
• Format: Article
• Language: English
• Subjects: Adult; Biology and Life Sciences; Clinical trials; Compaction; Demographics; Dentistry; EDTA; Endodontics; Engineering and Technology; Equivalence; Female; Gum disease; Healing; Health sciences; Humans; Instrumentation; Intervention; Male; Matching; Medicine and Health Sciences; Pain; Pain management; Pain Measurement - methods; Pain, Postoperative - pathology; Periapical Periodontitis - pathology; Periapical Periodontitis - surgery; Periodontitis; Postoperative pain; Postoperative period; Regenerative Endodontics - methods; Regression analysis; Root Canal Filling Materials - therapeutic use; Root Canal Preparation - methods; Root Canal Therapy - methods; Stainless steel; Standard deviation; Studies; Tapering; Teeth; Time; Tooth - physiopathology; Tooth - surgery; Wound Healing
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0227347

This trial assessed post-operative pain and healing of apical periodontitis following endodontic therapy with a reciprocating system compared to a crown-down technique with hand files and lateral compaction filling. One-hundred and twenty nonvital anterior teeth with apical periodontitis were randomly treated using either a reciprocating single file followed by matching-taper single-cone filling or a hand file and lateral compaction filling. Postoperative pain was assessed during the 7 days after the treatment, using a visual analogue scale and a verbal rating scale. Apical healing was assessed using the periapical index score after a 12-month follow-up. The hypothesis tested was that both protocols were equivalent and present similar effectiveness in healing periapical lesions. Data were analyzed through two one-sided tests, t-tests, as well as Mann-Whitney and Chi-squared tests (α = 0.05). Logistic regression was used to investigate the association of clinical and demographic factors with the success of treatment. Regardless of the assessment time, no difference in incidence (38%-43% at first 24h), intensity of postoperative pain, and incidence of flare-up (≈ 3%) was observed between the two endodontic protocols. Both protocols resulted in a similar healing rate of apical periodontitis. After 12 months, the success rate ranged from 73% to 78% and the difference between the treatments fell within the pre-established equivalence margin (-0.1; -0.41 to 0.2). Endodontic treatment combining a reciprocating single file with matching-taper single cone showed similar clinical effectiveness to the treatment using hand-file instrumentation and the lateral compaction filling.