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Highlights from the Journal of Endodontics: September — November 2018

By Dr. Austin L. Perera

The Journal of Endodontics is a wealth of research and information about endodontics. In this issue of The Paper Point, I am digging into three articles from the most recent JOE to provide my own synopsis.

September 2018: Yelda Erdem Hepsenoglu, Tan F. Eyuboglu, and Mutlu Özcan.Postoperative Pain Intensity after Single- versus Two-visit Nonsurgical Endodontic Retreatment: A Randomized Clinical Trial

This paper details findings of a controlled clinical trial studying post-operative pain in nonsurgical endodontic retreatments based one or two visits. They studied three test groups – single visit retreatment, two-visit with calcium hydroxide as an intracanal medicament, and two-visit with chlorhexidine as the intracanal medicament. Two-visit treatments were one week apart, and post-operative pain was assessed at 1, 2, 3, and 7 days and 1 month after treatment. On the first day after treatment, the CHX group had significantly more pain. On the second day of assessment and at one month following, both two-visit groups experienced significantly more pain than the single-visit group.  Overall, single visit retreatment produced less occurrences of post-operative pain than two-visit retreatments.

October 2018: Two different studies looking at post-operative pain levels following treatment.

Hüseyin Sinan Topçuoğlu, Gamze Topçuoğlu, and Hakan Arslan. The Effect of Different Irrigation Agitation Techniques on Postoperative Pain in Mandibular Molar Teeth with Symptomatic Irreversible Pulpitis: A Randomized Clinical Trial.

A study comparing the effect of four different irrigation techniques on post-operative patient pain. Subjects were randomly assigned to one of the four techniques during treatment – side-vented needle irrigation with no agitation, sonic agitation, passive ultrasonic irrigation, and manual dynamic agitation (MDA).  Pain levels were then assessed in patients 6, 24, 48, 72 hours, and 1 week post-operatively.  At the 6 and 24-hour intervals, patients subjected to manual dynamic agitation experienced more post-operative pain than the other three groups, between which there was no significant difference.  Manual dynamic agitation involved moving a fitted gutta percha cone to working length multiple times in an effort to help distribute the irrigant.  All treatments used 3% NaOCl as the irrigant.

Saleem Abdulrab, Jean C. Rodrigues, Sadiq Ali Al-maweri, Esam Halboub, Ahmed Yaseen Alqutaibi, and Hatem Alhadainy. Effect of Apical Patency on Postoperative Pain: A Meta-analysis.”

A study that involved a systematic review and meta-analysis, examining how apical patency affected post-op pain. Of five identified studies, four were used for the meta-analysis. Historically authors have debated the merits of apical patency. Some argue in favor of apical patency for maintenance of a glide path and working length, and an apex clear of debris, while others argue that histologic studies show an increased foreign body inflammatory response in the periapical tissue from extruded material. This study examined the effect on post-operative pain, and the analysis of the four studies revealed no significant difference in post-operative pain regardless of whether apical patency was maintained during instrumentation.

November 2018: Dohyun Kim, Sunil Kim, Minju Song, Dae Ryong Kang, Meetu R. Kohli, and Euiseong Kim. Outcome of Endodontic Micro-resurgery: A Retrospective Study Based on Propensity Score–matched Survival Analysis.

A database review was performed to compare the results of endodontic re-surgery versus primary surgery. The study included 571 cases in total – 498 primary surgery cases and 73 re-surgery cases. From there, 146 primary cases were matched against the 73 re-surgery cases. The 5-year success rates were calculated to be 91.6% for the primary surgeries, and 87.6% for the re-surgeries. The results were comparable, and the contributing factor appeared to be the type of tooth, with molars having a lower success rate for re-surgery.