The Incidence of Postoperative Pain After Using Different Types of Sealers

The Incidence of Postoperative Pain After Using Different Types of Sealers (A Randomized Clinical Trial)

The aim of this randomized clinical trial is to evaluate and compare the incidence and intensity of post-operative pain after obturation using resin and silicon-based sealers.

The main objectives of root canal therapy are to achieve long-term comfort, function, and aesthetics for the patients and prevention of reinfection of tooth. These objectives are provided through complete cleaning, shaping, and obturation of canals of affected teeth . Some patients may report moderate-to-severe pain and/or swelling following root canal treatment . This is detrimental for both patient and dentist and may entail an unscheduled emergency visit by patients to relieve their symptoms. Postoperative pain is considered a clinical outcome that exhibits the multifactorial nature of patients' responses to variables among treatment procedures such as maintaining the working length to the apical constriction, finishing the endodontic treatment in single visit or multiple visit, instrumentation technique and the type of endodontic sealer used for obturation . Such pain occurrence is mainly due to mechanical, chemical or microbial injury to the periapical tissues . Trauma of periapical tissue or bacterial extrusion and root canal sealer specifically, extrusion of root canal sealer can disrupt periodontal tissues and cause inflammatory reactions. The intensity of this reaction depends on the composition of the sealer . Root canal sealers can play a crucial role in this regard by coming in contact with the periapical tissues through apical foramen and lateral canals causing a localized inflammation with a direct influence on the degree of inflammation based on the composition of the sealer in turn influencing postoperative pain levels . Silicone is inert and biocompatible and has been widely used in medicine as an implant material Silicone-based root-canal sealers are also available. However, there are no data on the clinical performance of this type of material in endodontic treatment .

Root Canal Treatment (RCT) with 2 parallel groups, two arms, superiority trial with 1:1 allocation ratio

evaluate the incidence and intensity of post-operative pain after obturation using resin based sealers.

evaluate the incidence and intensity of post-operative pain after obturation using sillicon based sealers.

• Access cavity will be performed using a carbide round steel bur and tapered diamond stone until complete deroofing.

bleeding is controlled by using excavator for the removing the pulp tissue . using a piece of cotton soaked with Sodium hypochlorite. using local anesthesia with vasoconstrictor if needed and if suitable for the patient.

Coronal patency of the coronal and the Middle part of the canal using file #10 Apical patency of the apical part of the canal using #10

Coronal flaring using Orifice opener of a certain Rotary system in and out motion first then brushing motion touching all the canal walls

Working length determination (W.L) using #10 K File , working length is recorded using apex locator and confirmatory radiograph.

Glide path of the canal Using #10 ,15 ,20 ,25 K files till becoming Super-Loose Inside the Canal at the recorded w.l to create a path for the rotary file .

Cleaning and shaping using rotary system plus irrigation and apical patency between every rotary file .

Establish the depth of apical constriction - this is the zero reading on your apex locator. your working length will be 0.5mm - 1mm short of this. After cleaning and preparing the canal system to your working length, passively insert 02 taper hand files, starting from #15. If the file goes past the apical constriction (your working length + 0.5-1mm), then choose the next largest file and repeat. When a file passively binds short of the apical constriction, that will be the upper limit of the apical constriction diameter. The smaller file before that would be the lower limit. Apical gauging helps with: Choosing the best master cone that closely matches canal length and taper Achieving true tug back - as opposed to false tug back! Minimising gutta percha extrusions during obturation

Pain is evaluated using visual analogue scale (VAS) which is a pain rating scale. Scores are based on measures that are self-reported of symptoms that are recorded through a single handwritten mark placed at one point along the length of a 10-cm line representing a continuum between the two ends of the scale; on the left end of the scale (0 cm) means "no pain" and the on the right end of the scale (10 cm) "worst pain"

Pain is evaluated using visual analogue scale (VAS) which is a pain rating scale. Scores are based on measures that are self-reported of symptoms that are recorded through a single handwritten mark placed at one point along the length of a 10-cm line representing a continuum between the two ends of the scale; on the left end of the scale (0 cm) means "no pain" and the on the right end of the scale (10 cm) "worst pain" Each Outcome Measure should typically only specify a single time point of assessment

Pain is evaluated using visual analogue scale (VAS) which is a pain rating scale. Scores are based on measures that are self-reported of symptoms that are recorded through a single handwritten mark placed at one point along the length of a 10-cm line representing a continuum between the two ends of the scale; on the left end of the scale (0 cm) means "no pain" and the on the right end of the scale (10 cm) "worst pain"

Pain is evaluated using visual analogue scale (VAS) which is a pain rating scale. Scores are based on measures that are self-reported of symptoms that are recorded through a single handwritten mark placed at one point along the length of a 10-cm line representing a continuum between the two ends of the scale; on the left end of the scale (0 cm) means "no pain" and the on the right end of the scale (10 cm) "worst pain"

Pain is evaluated using visual analogue scale (VAS) which is a pain rating scale. Scores are based on measures that are self-reported of symptoms that are recorded through a single handwritten mark placed at one point along the length of a 10-cm line representing a continuum between the two ends of the scale; on the left end of the scale (0 cm) means "no pain" and the on the right end of the scale (10 cm) "worst pain"

Pain is evaluated using visual analogue scale (VAS) which is a pain rating scale. Scores are based on measures that are self-reported of symptoms that are recorded through a single handwritten mark placed at one point along the length of a 10-cm line representing a continuum between the two ends of the scale; on the left end of the scale (0 cm) means "no pain" and the on the right end of the scale (10 cm) "worst pain"

The 2 blinded and calibrated examiners will evaluate the immediate periapical radiographs after canal obturation. Sealer extrusion will classified to either absent or present. If there will be a sealer extrusion in at least 1 root for multirooted teeth, will be regarded as the "presence" of sealer extrusion Measured by clinical symptoms and signs ( pain , swelling , parasthesia )

The 2 blinded and calibrated examiners will evaluate the immediate periapical radiographs after canal obturation. will classified to either absent or present. If there will be root-filling voids in at least 1 root for multirooted teeth, will be regarded as the "presence" of it

The 2 blinded and calibrated examiners will evaluate the immediate periapical radiographs after canal obturation. just discovered it will be corrected

Inclusion Criteria: • Patient's age ranges from 18-50 years old. Patients with teeth diagnosed with symptomatic irreversible pulpitis. Normal periapical condition confirmed by normal periapical radiograph The teeth are restorable Teeth are periodontally free, with no mobility and negative to percussion and palpation test. Exclusion Criteria: • Teeth with immature roots Non restorable teeth Medically compromised patients with systemic complication that would alter the treatment. Necrotic teeth Teeth with apical periodontitis or periapical lesions Teeth that need multiple visits treatment like necrotic cases.

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