2024 Top Story in Clinical Dentistry: Postoperative Pain After Single-Visit Root Canal Treatment vs Vital Pulp Therapy

Postoperative pain is a complex phenomenon influenced by various factors following vital pulp therapy (VPT) or root canal therapy (RCT). One of the primary sources of this pain is the presence of inflammatory mediators. When aiming to relieve pain caused by an inflamed pulp, treatment choices often favor methods that result in a lower risk of postoperative pain and discomfort.

Clinicians tend to believe that complete removal of the pulp tissue and its remnants minimizes pain severity and discomfort. However, advancements in materials science and technology have introduced several new materials for VPT and innovative irrigation techniques for RCT, which aim to eliminate inflammatory mediators associated with postoperative pain.

A recent systematic review and meta-analysis by Signor et al in 2024 compared postoperative pain incidence and severity associated with conventional RCT with those associated with VPT.¹ This study evaluated pain levels following direct pulp capping, partial pulpotomy, complete pulpotomy, and single-visit RCT. It also examined the role of medicaments in VPT, including traditional materials like calcium hydroxide and mineral trioxide aggregate and newer generations of bioceramic materials, also known as calcium-enriched materials.

The overall findings of this study indicate that the incidence of pain associated with VPT is lower than that associated with RCT. Notably, VPT resulted in a significantly higher occurrence of no pain and a lower incidence of mild to moderate pain than single-visit RCT.

Research on inflammatory mechanisms in the dental pulp supports the notion that the etiology of pulpal inflammation is predominantly linked to bacterial invasion, leading to a cascade of inflammatory degenerative changes in the pulp tissue. Initially, this process is often confined to the coronal portion, resulting in an acute stage of pulpitis. It can later progress to a chronic stage of pulpal necrosis, affecting the remaining radicular pulp tissue and causing destruction of the periapical tissue. The primary goal of VPT or RCT is to eliminate the bacterial load, which eventually reduces the concentration of inflammatory mediators and addresses the activation of nociceptive sensory nerve endings.

In conclusion, clinicians must understand the multifactorial nature of postoperative mechanisms when making treatment decisions related to managing vital pulp. An effective pain management plan is crucial for alleviating pain and discomfort following VPT or RCT.