Endodontide Post-operatif Ağrı Yönetimine Güncel bir Yaklaşım: Kriyoterapi

Abstract

Özet: Endodontik tedavinin önemli zorluklarından biri, tedaviden sonra hastalar tarafından sıklıkla bildirilen postoperatif ağrı ve rahatsızlığın yönetimidir. Post-operatif ağrı görülme oranı yüksektir ve tüm vakaların %3 ile %58'inde ortaya çıkar. İşlem öncesi hasta sakinleştirici yaklaşımlar ve açıklamalar, oklüzal redüksiyonlar, glide-path uygulamaları, kök kanal tedavisi sırasında farklı mekanik tekniklerin ve hareketlerin uygulanması gibi mekanik teknikler ve uzun etkili anestezi enjeksiyonları, antihistaminikler, non-steroid antienflamatuar ilaçlar (NSAID'ler), salisilik asit, asetaminofen, ibuprofen ve asetaminofen kombinasyonları ve narkotik analjezikler gibi farmakolojik ilaçlar dahil olmak üzere ağrı insidansını azaltmak için çeşitli protokoller kullanılmıştır. Soğuk terapi olarak da bilinen kriyoterapinin kas-iskelet ağrısı, kas spazmları, bağ dokusu gerginliği, kanama, iltihaplanma ve sinir iletkenliğini azalttığı fizyolojik ve klinik olarak kanıtlanmıştır. Kriyoterapi dokularda kan akışını ve sıcaklığını düşürmede, kimyasal mediyatörler tarafından uyarılan nosiseptörleri inhibe etmede ve metabolik aktiviteyi azaltmada etkilidir. İlaç dışı yöntemlerden biri olan soğuk terapi yani kriyoterapi tıp alanında cerrahi işlemler sonrası ağrı kontrolünde uzun yıllardır kullanılmaktadır. Diş hekimliğinde kriyoterapi, özellikle cerrahi işlemlerden sonra postoperatif ağrı kontrolü için uzun süredir uygulanmaktadır. Endodontik tedavide de kriyoterapi uygulamasının kullanılması oldukça güncel bir konudur. Bu derlemenin amacı endodontik tedavi sonrası post-operatif ağrı kontrolünde kriyoterapinin rolü hakkında genel bilgi vermektir.

Keywords

• Ağrı
• apikal periodontitis
• diş hekimliği
• endodonti
• kriyoterapi
• Apical periodontitis
• cryotherapy
• dentistry
• endodontics
• pain.

A Current Approach to Post-operative Pain Management in Endodontics: Cryotherapy

Abstract

Abstract: One of the major challenges of endodontic treatment is the management of postoperative pain and discomfort frequently reported by patients after treatment. The incidence of post-operative pain is high and occurs in 3% to 58% of all cases. Mechanical techniques such as patient calming approaches and explanations prior to the procedure, occlusal reductions, glide-path applications, application of different mechanical techniques and movements during root canal treatment, and pharmacological drugs such as long-acting anesthetic injections, antihistamines, non-steroidal anti-inflammatory drugs, and narcotic analgesics various protocols have been used to reduce the incidence of pain. Cryotherapy, also known as cold therapy, has been physiologically and clinically proven to reduce musculoskeletal pain, muscle spasms, connective tissue tension, bleeding, inflammation, and nerve conductivity. Cryotherapy is effective in reducing blood flow and temperature in tissues, inhibiting nociceptors stimulated by chemical mediators, and reducing metabolic activity. Cold therapy, that is, cryotherapy, which is one of the non-drug methods, has been used in the field of medicine for pain control after surgical procedures for many years. Cryotherapy in dentistry has long been applied for postoperative pain control, especially after surgical procedures. The use of cryotherapy in endodontic treatment is a very current issue. The aim of this review is to give general information about the role of cryotherapy in post-operative pain control after endodontic treatment.

Keywords

• Apical periodontitis
• cryotherapy
• dentistry
• endodontics
• pain.

References

1. Ahdoot M, Lebastchi AH, Turkbey B, Wood B, Pinto PA. Contemporary treatments in prostate cancer focal therapy. Curr Opin Oncol. 2019;31(3):200-206.
2. Albashaireh ZS, Alnegrish AS. Postobturation pain after single- and multiple-visit endodontic therapy. A prospective study. J Dent. 1998;26(3):227-232.
3. Alharthi AA, Aljoudi MH, Almaliki MN, Almalki MA, Sunbul MA. Effect of intra-canal cryotherapy on post-endodontic pain in single-visit RCT: A randomized controlled trial. Saudi Dent J. 2019;31(3):330-335.
4. Al-Nahlawi T, Hatab TA, Alrazak MA, Al-Abdullah A. Effect of intracanal cryotherapy and negative irrigation technique on postendodontic pain. J Contemp Dent Pract. 2016;17(12):990-996.
5. Arslan H, Ahmed HMA, Yıldız ED, Gündoğdu EC, Seçkin F, Arslan S. Acupuncture reduces the postoperative pain in teeth with symptomatic apical periodontitis: a preliminary randomized placebo-controlled prospective clinical trial. Quintessence Int. 2019;50(4):270-277.
6. Arslan H, Doğanay E, Karataş E, Ünlü MA, Ahmed HMA. Effect of Low-level Laser Therapy on Postoperative Pain after Root Canal Retreatment: A Preliminary Placebo-controlled, Triple-blind, Randomized Clinical Trial. J Endod. 2017;43(11):1765-1769.
7. Arslan H, Khalilov R, Doğanay E, Karatas E. The effect of various kinematics on postoperative pain after instrumentation: a prospective, randomized clinical study. J Appl Oral Sci. 2016;24(5):503-508.
8. Arslan S, Celebioğlu A. Postoperative pain management and alternative approachs. J Hum Sci. 2006;(1):1‑7.

9. Attar S, Bowles WR, Baisden MK, Hodges JS, McClanahan SB. Evaluation of pretreatment analgesia and endodontic treatment for postoperative endodontic pain. J Endod. 2008;34(6):652-655.
10. Bahcall J, Johnson B, Xie Q, et al. Introduction to vital pulp cryotherapy. Endod Pract US. 2019;(1):14.
11. Bashetty K, Hegde J. Comparison of 2% chlorhexidine and 5.25% sodium hypochlorite irrigating solutions on postoperative pain: A randomized clinical trial. Indian J Dent Res. 2010;21(4):523-527.
12. Bazaid DS, Kenawi LMM (2018) The effect of intracanal cryotherapy in reducing postoperative pain in patients with irreversible pulpitis: a randomized control Trial. Int J Health Sci Res. 8:83–88.
13. Belitsky RB, Odam SJ, Hubley–Kozey C. Evaluation of the effectiveness of wet ice, dry ice, and cryogen packs in reducing skin temperature. Phys Ther. 1987;67(7):1080-1084.
14. Bleakley CM, Hopkins JT. Is it possible to achieve optimal levels of tissue cooling in cryotherapy? Phys Ther Rev. 2010;15:344–50.
15. Crout RJ, Koraido G, Moore PA. A clinical trial of long-acting local anesthetics for periodontal surgery. Anesth Prog 1990;37: 194-8.
16. Doğanay Yıldız E, Arslan H. Effect of Low-level Laser Therapy on Postoperative Pain in Molars with Symptomatic Apical Periodontitis: A Randomized Placebo-controlled Clinical Trial. J Endod. 2018;44(11):1610-1615.
17. Emad, Ahmed, Nelly Abdelsalam, and Dalia Fayyad. Influence of intracanal cryotherapy on postendodontic pain and interleukin-6 expression using different irrigation protocols: A randomized clinical trial. Saudi Endodontic Journal 2021; 11.2 246-246.
18. Ergun S, Guneri P. Analgesic selection in dental pain. J Ondokuz Mayıs Univ Fac Med. 2009;10:30‑40.
19. Ernst E, Fialka V. Ice freezes pain? A review of the clinical effectiveness of analgesic cold therapy. J Pain Symptom Manage. 1994;9(1):56-59.
20. Farah CS, Savage NW. Cryotherapy for treatment of oral lesions. Aust Dent J 2006;51:2–5
21. Fayyad DM, Abdelsalam N, Hashem N. Cryotherapy: A New Paradigm of Treatment in Endodontics. J Endod. 2020 ;46(7):936-942.
22. Gundogdu EC, Arslan H. Effects of various cryotherapy applications on postoperative pain in molar teeth with symptomatic apical periodontitis: a preliminary randomized prospective clinical trial. J Endod. 2018;44(3):349-354.
23. Hargreaves KM, Hutter JW. Endodontic pharmacology. In: Cohen S, Burns R, editors. Pathways of the Pulp. 8th ed. St Louis, MO: Mosby; 2002. p. 665–82.
24. Herrera E, Sandoval MC, Camargo DM, Salvini TF. Motor and sensory nerve conduction are affected differently by ice pack. Phys Ther 2010;90:581–91.
25. Houghton PE, Nussbaum E, Hoens A. Electrophysical agents contraindications and precautions. An evidence-based approach to clinical decision-making in physical therapy. Physiother Can. 2010;62(5):1-80.
26. Jain A, Davis D, Bahuguna R et al (2018) Role of cryotherapy in reducing postoperative pain in patients with irreversible pulpitis; an in-vivo study. Int J Dent Med Sci Res. 2:43–49.
27. Keskin C, Ozdemir O, Uzun İ, Guler B. Effect of intracanal cryotherapy on pain after single‑visit root canal treatment. Aust Endod J. 2017;43(2):83-88.
28. Kwekkeboom KL. Pain management strategies used by patients with breast and gynecologic cancer with postoperative pain. Cancer Nurs. 2001;24(5):378-386.
29. Lande S, Templeton M. Cryotherapy for TMJ pain. J Calif Dent Assoc. 1988;16(12):30-2.
30. Liesinger A, Marshall FJ, Marshall JG. Effect of variable doses of dexamethasone on posttreatment endodontic pain. J Endod. 1993;19(1):35-39.
31. MacAuley D. Textbooks agree on their advice on ice? Clin J Sport Med 2001;11: 67–72.
32. Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgrad Med. 2015;127(1):57-65.
33. McDowell JH, McFarland EG, Nalli BJ. Use of cryotherapy for orthopaedic patients. Ortho Nursing 1994;13 : 21–30.
34. McLean D. The use of cold and superficial heat in thetreatment of soft tissue injuries. Br J Sports Med. 1989;23(1):53-54.
35. Modabber A, Rana M, Ghassemi. Three-dimensional evaluation of postoperative swelling in treatment of zygomatic bone fractures using two different cooling therapy methods: a randomized, observer-blind, prospective study. Trials. 2013;14:238.
36. Nath R, Daneshmand A, Sizemore D, Guo J, Enciso R. Efficacy of corticosteroids for postoperative endodontic pain: A systematic review and meta-analysis. J Dent Anesth Pain Med. 2018;18(4):205-221.
37. Nayeema S, Subha DR. Cryotherapy–a novel treatment modality in oral lesions. Int J Pharm Sci. 2013;(5):4–5.
38. Nielsen BA, Baumgartner JC. Comparison of the EndoVac system to needle irrigation of root canals. J Endod. 2007;33(5):611-615.
39. Odrich RB, Kelman CD. Cryotherapy, a new and experimental approach to the treatment of periodontal disease. Periodontics. 1967;5(6):313-7.
40. Parirokh M, Rekabi AR, Ashouri R, Nakhaee N, Abbott PV, Gorjestani H. Effect of occlusal reduction on postoperative pain in teeth with irreversible pulpitis and mild tenderness to percussion. J Endod. 2013;39(1):1-5.
41. Pasqualini D, Mollo L, Scotti N, Cantatore G, Castellucci A, Migliaretti G, Berutti E. Postoperative pain after manual and mechanical glide path: a randomized clinical trial. J Endod. 2012 ;38(1):32-6.
42. Rana M, Gellrich N‑C, Ghassemi A, Gerressen M, Riediger D, Modabber A. Three‑dimensional evaluation of postoperative swelling after third molar surgery using 2 different cooling therapy methods: A randomized observer‑blind prospective study. J Oral Maxillofac Surg. 2011;69(8):2092-2098.
43. Ryan JL, Jureidini B, Hodges JS, Baisden M, Swift JQ, Bowles WR. Gender differences in analgesia for endodontic pain. J Endod 2008; 34: 552-6.
44. Sahuquillo J, Vilalta A. Cooling the injured brain: how does moderate hypothermia influence the pathophysiology of traumatic brain injury. Curr Pharm Des. 2007;13(22):2310-2322.
45. Sambroski W, Stratz T, Sobieska M. Individual comparison of effectiveness of whole body cold therapy and hot packs therapy in patients with generalized tendomyopathy (fibromyalgia). Z Rheumatol. 1992;51(1):25-30.
46. Sathorn C, Parashos P, Messer H. The prevalence of postoperative pain and flare-up in single- and multiple-visit endodontic treatment: A systematic review. Int Endod J. 2008;41(2):91-99.
47. Schoeffel JG. The EndoVac method of endodontic irrigation, part 2—efficacy. Dent Today. 2008;27(1):82-87. Seymour R, Walton J. Pain control after third molar surgery. Int J Oral Surg. 1984;13(6):457-485.
48. Shamszadeh S, Asgary S, Shirvani A, Eghbal MJ. Effects of antibiotic administration on post-operative endodontic symptoms in patients with pulpal necrosis: A systematic review and meta-analysis. J Oral Rehabil. 2021;48(3):332-342. PMID: 32681652.
49. Siqueira JF Jr, Rôças IN, Favieri A, Machado AG, Gahyva SM, Oliveira JC, et al. Incidence of postoperative pain after intracanal procedures based on an antimicrobial strategy. J Endod. 2002;28(6):457-460.
50. Siu C, Baumgartner JC. Comparison of the debridement efficacy of the EndoVac irrigation system and conventional needle root canal irrigation in vivo. J Endod. 2010;36(11):1782-1785.
51. Topçuoglu HS, Arslan H, Topçuoglu G, Demirbuga S. The effect of cryotherapy application on the success rate of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis. J Endod. 2019;45(8):965-969.
52. Torabinejad M, Dorn SO, Eleazer PD, Frankson M, Jouhari B, Mullin RK, et al. Effectiveness of various medications on postoperative pain following root canal obturation. J Endod 1994; 20: 427-31.
53. Vera J, Ochoa J, Romero M, Vazquez-Carcaño M, Ramos-Gregorio CO, Aguilar RR, et al. Intracanal cryotherapy reduces postoperative pain in teeth with symptomatic apical periodontitis: A randomized multicenter clinical trial. J Endod. 2018;44(1):4-8.
54. Vera J, Ochoa-Rivera J, Vazquez-Carca~no M, et al. Effect of intracanal cryotherapy on reducing root surface temperature. J Endod. 2015;41(11):1884-1887.
55. Vieyra JP, Enriquez FJ, Acosta FO, Guardado JA. Reduction of post endodontic pain after onevisit root canal treatment using three irrigating regimens with different temperature. Niger J Clin Pract. 2019;22(1):34-40.
56. Watkins AA, Johnson TV, Shrewsberry AB. Ice packs reduce postoperative midline incision pain and narcotic use: a randomized controlled trial. J Am Coll Surg. 2014;219(3):511-517.
57. Xu T, Tay FR, Gutmann JL, et al. Micro computed tomography assessment of apical accessory canal morphologies. J Endod. 2016;42(5):798-802.