Comparative evaluation of digital radiography, electronic apex locator and simultaneous working length determination on postoperative pain after root canal treatment: a randomized clinical trial

Year 2024, Volume: 58 Issue: 1, 44 - 50, 30.01.2024

Boris Saha , Sharique Alam , Daiasharailang Lyngdoh , Surendra Kumar Mishra

https://doi.org/10.26650/eor.20241264315

Abstract

Purpose: The study aimed to compare postoperative pain after root canal preparation using three different methods of working length determination.
Materials and Method: 60 patients diagnosed with symptomatic irreversible pulpitis were randomly divided into three groups based on the method of working length (WL) determination. Group 1: digital radiograph (DRG), Group 2: electronic apex locator (EAL), Group 3: the simultaneous working length control (SLC) method using an endomotor with an integrated apex locator. The root canal treatments were completed in a single visit, and patients were asked to record their pain response using the Visual Analog Scale (VAS) at 6, 24, 48, and 72 hours postoperatively.
Results: Group 1 (DRG) recorded the highest postoperative pain score, while the lowest was recorded by Group 3 (SLC). There was a statistically significant difference in the VAS pain scores between DRG and SLC (p<0.05) at 6-, 24- and 48-hour intervals.
Conclusion: Within the limitations of this study, it can be concluded that the SLC can be a helpful working length determination technique to reduce postoperative pain.

Keywords

electronic apex locator, postoperative pain, radiograph, root canal therapy, simultaneous working length control, visual analogue scale

References

• American Association of Endodontists. Glossary of Endodontic Terms. 10th Edition. Chicago: American Association of Endodontists; 2020. google scholar
• Tanalp J, Güngör T. Apical extrusion of debris: a literature review of an inherent occurrence during root canal treatment. Int Endod J 2014;47:211-21. google scholar
• Ng Y L, Mann V, Gulabivala K. A prospective study of the factors affecting outcomes of nonsurgical root canal treatment: part 1: periapical health. Int Endod J 2011;44:583-609. google scholar
• Meirinhos J, Martins JNR, Pereira B, Baruwa A, Gouveia J, Quaresma SA, Monroe A, Ginjeira A. Prevalence of apical periodontitis and its association with previous root canal treatment, root canal filling length and type of coronal restoration - a cross-sectional study. Int Endod J 2020;53:573-84. google scholar
• Gordon MP, Chandler NP. Electronic apex locators. Int Endod J 2004;37:425-37. google scholar
• Serna-Peña G, Gomes-Azevedo S, Flores-Treviño J, Madla-Cruz E, Rodríguez-Delgado I, Martínez-González G. In Vivo Evaluation of 3 Electronic Apex Locators: Root ZX Mini, Apex ID, and Propex Pixi. J Endod 2020;46:158-61. google scholar
• Plotino G, Grande NM, Brigante L, Lesti B, Somma F. Ex vivo accuracy of three electronic apex locators: Root ZX, Elements Diagnostic Unit and Apex Locator and ProPex. Int Endod J 2006;39:408-14. google scholar
• Versiani MA, Santana BP, Caram CM, Pascon EA, de Souza CJ, Biffi JC. Ex vivo comparison of the accuracy of Root ZX II in detecting apical constriction using different meter's reading. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;108:41-5. google scholar
• Klemz AA, Cruz ATG, Piasecki L, Carneiro E, Westphalen VPD, da Silva Neto UX. Accuracy of electronic apical functions of a new integrated motor compared to the visual control of the working length—an ex vivo study. Clinical Oral Investigations 2021;25:231-6. google scholar
• 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;41:91-9. google scholar
• Dummer PM, McGinn JH, Rees DG. The position and topography of the apical canal constriction and apical foramen. Int Endod J 1984;17:192-8. google scholar
• Morfis A, Sylaras SN, Georgopoulou M, Kernani M, Prountzos F. Study of the apices of human permanent teeth with the use of a scanning electron microscope. Oral Surg Oral Med Oral Pathol 1994 ;77:172-6. google scholar
• Yaghooti Khorasani MM, Ebrahimnejad H. Comparison of the accuracy of conventional and digital radiography in root canal working length determination: An invitro study. J Dent Res Dent Clin Dent Prospects 2017;11:161-5. google scholar
• Kitagawa H, Scheetz JP, Farman AG. Comparison of complementary metal oxide semiconductor and charge-coupled device intraoral X-ray detectors using subjective image quality. Dentomaxillofac Radiol 2003;32:408-11. google scholar
• Orosco FA, Bernardineli N, Garcia RB, Bramante CM, Duarte MA, Moraes IG. In vivo accuracy of conventional and digital radiographic methods in confirming root canal working length determination by Root ZX. J Appl Oral Sci 2012;20:522-5. google scholar
• Haffner C, Folwaczny M, Galler K, Hickel R. Accuracy of electronic apex locators in comparison to actual length--an in vivo study. J Dent 2005;33:619-25. google scholar
• Tuncer AK, Gerek M. Effect of working length measurement by electronic apex locator or digital radiography on postoperative pain: a randomized clinical trial. J Endod 2014;40:38-41. google scholar
• Arslan H, Güven Y, Karataş E, Doğanay E. Effect of the Simultaneous Working Length Control during Root Canal Preparation on Postoperative Pain. J Endod 2017;43:1422-7. google scholar
• Wang C, Xu P, Ren L, Dong G, Ye L. Comparison of post-obturation pain experience following one-visit and two-visit root canal treatment on teeth with vital pulps: A randomized controlled trial. Int Endod J 2010;43:692-7. google scholar
• Alonso-Ezpeleta LO, Gasco-Garcia C, Castellanos-Cosano L,Martín-González J, López-Frías FJ, Segura-Egea JJ. Postoperative pain after one-visit root-canal treatment on teeth with vital pulps: comparison of three different obturation techniques. Med Oral Patol Oral Cir Bucal 2012;17:e721-7. google scholar
• Pak JG, White SN. Pain prevalence and severity before, during, and after root canal treatment: a systematic review. J Endod 2011;37:429-38. google scholar
• Su Y, Wang C, Ye L. Healing rate and post-obturation pain of single- versus multiple-visit endodontic treatment for infected root canals: a systematic review. J Endod 2011;37:125-32. google scholar
• Kustarci A, Akdemir N, Siso SH, Altunbas D. Apical extrusion of intracanal debris using two engine driven and step-back instrumentation techniques: an in-vitro study. Eur J Dent 2008;2(4):233-9. google scholar
• 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;38:32-6. google scholar
• de Camargo EJ, Zapata RO, Medeiros PL, Bramante CM, Bernardineli N, Garcia RB, et al. Influence of preflaring on the accuracy of length determination with four electronic apex locators. J Endod 2009;35:1300-2. google scholar
• Pecora JD, Capelli A, Guerisoli DM, Spanó JC, Estrela C. Influence of cervical preflaring on apical file size determination. Int Endod J 2005;38:430-5. google scholar
• Attar S, Bowles WR, Baisden MK, Hodges JS, McClanahan SB. Evaluation of pretreatment analgesia and endodontic treatment for postoperative endodontic pain. J Endod 2008;34:652-5. google scholar
• Arslan H, Gündoğdu EC, Sümbüllü M. The Effect of Preoperative Administration of Antihistamine, Analgesic and Placebo on Postoperative Pain in Teeth with Symptomatic Apical Periodontitis: A Randomized Controlled Trial. Eur Endod J 2016 google scholar