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Postoperative Pain Intensity After the Use of 8.25% vs 2.50% Sodium Hypochlorite for Necrotic Mandibular Molars With Apical Periodontitis
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersBACKGROUND
This study aimed to evaluate whether the use of 8.25% sodium hypochlorite (NaOCl), compared with the use of 2.5% NaOCl, leads to higher postoperative pain after endodontic treatment.
METHODS
A total of 154 patients were randomly assigned into 2 groups: 8.25% and 2.5% NaOCl. A single-visit endodontic treatment was performed using a standard protocol, varying only the NaOCl concentration. Postoperative pain was assessed using the numeric rating scale at multiple times over 30 days. Overall pain scores over time were explored via multilevel mixed-effects negative binomial regression. The need for pain medication was recorded and compared between groups via the Mann-Whitney U test.
RESULTS
The use of 8.25% NaOCl increased postoperative pain scores over time by 3.48 times compared with the use of 2.5% NaOCl (incident rate ratio [IRR], 3.48; 95% CI, 1.57 to 7.67). Furthermore, the 8.25% NaOCl group exhibited higher pain incidence than the 2.5% NaOCl group during the 12-hour through 3-day period, with scores at these times ranging from 2.21 (IRR, 2.21; 95% CI, 1.35 to 3.62) through 10.74 (IRR, 10.74; 95% CI, 3.74 to 30.87) higher. No difference was detected in the number of analgesic capsules administered between groups.
CONCLUSIONS
The use of 8.25% NaOCl resulted in higher postoperative pain than the use of 2.5% NaOCl, with pain scores increasing by 3.48 times when this solution was used. Furthermore, the 8.25% NaOCl group exhibited higher pain incidence than the 2.5% NaOCl group during the 12-hour through 3-day period.
PRACTICAL IMPLICATIONS
The use of 8.25% NaOCl during endodontic treatment can increase postoperative pain significantly. This clinical trial was registered at the Brazilian Registry of Clinical Trials database (RBR-6vq3hc4).
Additional Info
Disclosure statements are available on the authors' profiles:
Postoperative pain after endodontic treatment using 8.25% vs 2.5% sodium hypochlorite in necrotic mandibular molars with apical periodontitis: A randomized double-blind clinical trial
J Am Dent Assoc 2024 May 30;[EPub Ahead of Print], FC Vitali, PS Santos, LDFR Garcia, CDS TeixeiraFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Chemo-mechanical debridement of tissue debris from the root canal space, along with the disinfection procedure, is essential for a successful outcome of root canal therapy (RCT). Sodium hypochlorite (NaOCl), a strong alkaline liquid, has a solvent action on the organic tissue. Antimicrobial action is attributed to the generation of hypochlorous acid and the release of hydroxyl ions in an aqueous environment, resulting in tissue dissolution via saponification, amino acid neutralization, and chloramination reactions. Several root canal irrigation solutions and protocols have been proposed with literature support. A recent randomized double-blind clinical trial by Vitali et al (2024) with two parallel groups compared two concentrations of 8.25% vs 2.50% of NaOCl to evaluate the incidence of pain associated with the use in a sample size of 154 participants who required RCT for the first or second molar teeth with pulp necrosis and apical periodontitis.
The results of this study suggested that the use of a higher concentration (8.25%) of NaOCl led to a higher incidence of postoperative pain by 3.48 times than the use of a lower concentration of NaOCl. Additionally, the study also noted a higher incidence of pain (2.21–10.74 times) during the 12-hour to 3-day period with the use of higher concentrations of NaOCl. Additional clinical research to support the quantity/concentration of NaOCl is necessary. In conclusion, clinicians should be aware of the incidence of postoperative pain associated with the use of higher concentrations of NaOCl. Therefore, while irrigating root canals with NaOCl, the use of an appropriate irrigation needle gauge (with a side vent) and protocols in relation to the root apex should be well-controlled to prevent the apical extrusion of NaOCl.