You are on page 1of 5

ORIGINAL ARTICLE

ASSESSMENT OF POST-OBTURATION PAIN:
SINGLE VS TWO VISITS ROOT CANAL TREATMENT
Muhammad Atif Saleem1 BDS, FCPS
Abu Bakar Sheikh2 BDS, FCPS
3
Muhammad Athar Khan MBBS, MCPS, DCPS-HCSM, DCPS-HPE, MBA, PGD-Statistics
4
Sadaf Atif BDS

OBJECTIVE: The objectives of this study was to evaluate the severity of post-obturation pain following single
visit and two visit root canal treatment using VAS (Visual Analogue Scale)and to determine the correlation between
pre-obturation and post-obturation pain.
METHODOLOGY: This was a Quasi Experimental study that was conducted in the Operative Dentistry Department
of Altamash Institute of Dental Medicine was done in duration of six months. Sixty patients were selected. After
access preparation, working length was determined by Periapical radiograph. Canal preparation was done by Step-
Back technique using K-files and obturation was done by lateral condensation of gutta percha. In two visit group,
canal preparation was completed in first visit and obturation was carried out at a later date. Data analysis was
performed through SPSS version-13.0. Repeated measure analysis of variance (ANOVA), Chi-square and Pearson's
correlation (r) were used with p-value <0.05 considered as significant.
RESULTS: After postoperative 4 hours, the mean VAS in single root canal visit group was 4.7±2.96 and 2.8±1.73
in two root canal visit group. The mean VAS score of two visits for postobturation pain after 12 and 24 hours was
less in as compared to one visit treatment. Data showed direct correlation in pre-operative pain and post-obturation
pain in both groups.
CONCLUSION: No advantage was observed when one-visit and two-visit root canal treatment were compared
regarding post-obturation pain in the initial 4 hours, but two-visit root canal treatment showed better results in terms
of post-obturation pain after 12 and 24 hours. Though the present study reported favourable results in two- visit root
canal treatment regarding post-obturation pain.
KEY WORDS: One visit endodontic treatment, , Pre-operative pain, Post-obturation pain, Two visit endodontic
treatment, Visual Analogue Scale.
HOW TO CITE: Saleem MA, Sheikh AB, Khan MA, Atif S. Assessment Of Post-obturation Pain: Single
Vs Two Visits Root Canal Treatment. J Pak Dent Assoc 2014;23(1):25-29

INTRODUCTION swelling, the result can be very distressing to both the
patient and the operator1,2.

O
dontogenic pain is a primary reason for a patient The general population generally regards root canal
to seek conventional endodontic treatment. Root treatment as a painful and unpleasant experience. Usually,
canal treatment or endodontic treatment is a the root canal treatment relieves the pain symptoms;
common procedure in dentistry. Pain and discomfort are however pain may persist for a few days following the
often associated with root canal treatment. When the treatment. Postobturation pain after nonsurgical root
treatment itself appears to initiate the onset of pain and/or canal treatment has been reported to range from
approximately 3% to more than 50%3,4.
1. Assistant Professor Operative Dentistry, Karachi Medical & Dental College.
2. Assistant Professor Operative Dentistry, Fatima Jinnah Dental College Some authors concluded in their study that there
3. Department of Medical Education King Saud bin Abdulaziz University of Health was no difference in the post-operative pain between
Sciences Riyadh, Kingdom of Saudi Arabia
4. Dental Officer , Karachi Medical & Dental College
patients treated in one-visit and patients treated in two-
Corresponding author: “Dr. Muhammad Atif Saleem” appointments. The majority of patients in both groups
Email: dratifagwan@yahoo.com
Cell# 0092-3002271820
reported no pain or only minimal pain within 24 to 48

25 JPDA Vol. 23 No. 01 Jan-Mar 2014

4 years and in two vist group was 30. USA) using the the vitality status of tooth18 and number of appointments.5 +8. the teeth were obturated as in group 1. Germany). associated with pain after endodontic treatment. Saleem MA / Sheikh AB / Khan MA / Atif S Assessment Of Post-obturation Pain hours of treatment 5-9.3%) were males and 28 (46. Verbal informed consent was taken from the patients.05. The working length was determined incidence of postobturation pain following two visit root radiographically from a coronal reference to a distance canal treatment 11. conventional endodontic treatment15.9+ 12. Chemomechanical preparation was no effect on post-obturation pain19. tooth type. Patients were for post-obturation pain and flare-ups following the contacted by telephone at 4.1: single visit treatment were included in Group 1(N=30) 1). lateral condensation technique. Other studies presented higher preparation. caries excavation. pulp vitality status. A sterile cotton pellet was placed in the pulp debris. technique used during root canal treatment. The standard procedure for both groups at the first obturation pain (48. the presence or absence of pre. experiencing severe preoperative pain have an increased Ballaigues. Patients hand files.7 2(N=30). or chemicals paste chamber. paper points. a recorded data including (p= 0.591). Patients requiring endodontic treatment were RESULTS included in the study. 22 JPDA Vol. isolation. and the access cavity was sealed with Provis the root apex into the periapical tissues20. 2 1 Data analysis was performed through SPSS The objective of this study were to determine rate (Statistical package for social sciences) version-17. in two visits. 12 and 24 hours respectively were recorded by using a While some researchers presented a higher incidence visual analogue scale (VAS). Oginni & Udoye reported higher incidences for return of the form after 24 hours. this study also showed that teeth 24 hrs to remind those to complete the VAS form. Out of 30 patients of single root canal visit. Switzerland). The prevalence then filled with gutta-percha points sealed with Sealapex of postobturation pain is also significantly affected by root canal sealer (Sybron Endo. multi-visit gender.8%). and standard access obturation pain (50. pain score analogue scale)22 and to evaluate the relationship between (VAS) were presented by Mean ± Standard deviation pre-obturation and post-obturation pain when performing and frequencies and percentages were computed for root canal treatment in single visit compare to treatment presentation of qualitative response variables like gender. 1 mm short of the radiographic apex.7%) females (M: F=1.3%)10. hospital ethical committee of Altamsah Institute of Dental Medicine. Pearson’s correlation METHODOLOGY (r) and Chi-square test was applied to compare these variables between two groups. and type of filling material showed not obturated. The teeth were then randomly incidence of moderate to severe post-endodontic pain assigned to two groups as follows: group 1. pain was significantly associated with the obturation One week later. 23 No. and Gates-Glidden drills (Dentsply/Maillefer. clinical examination and Out of 60 patients who underwent root canal. tooth position. with vital pulps reported the lowest frequency of post. But the operator may completed in the first visit using the same technique for induce postobturation pain by exuding instruments.17. status while in 30 patients of two visits root canal . all cases. Group 2. 19 (63%) had vital and 11 (37%) had necrotic tooth operative pain and degree of postobturation pain at 6. The mean age of patients in single visit group was and patients received two visit treatments in group 31. Repeated measure analysis of variance (ANOVA). Statistical significance Study was conducted with prior approval of the was taken at p < 0. addressed envelope treatment. Karlsruhe. The root canals Certain preoperative and operative factors are were cleaned and shaped using the step-back technique.14. while those with non-vital pulps appointment included local anesthesia. single-visit when compared to those having no pain prior to therapy each root canal was dried with paper points. Patients requiring (53.0.Postoperative Temporary Restoration( Favodent. rubber dam were found to have the highest frequency of post. but were status. along with a stamped. CA. 01 Jan-Mar 2014 26 . and severity of postobturation pain using VAS (visual Quantitative response variables like age. tooth status and presenting complaint. History. 12 hours and again after single visit procedures.The patient were given the of postobturation pain following single visit root canal VAS form. size of periapical lesion bacteriologic therapy the teeth were prepared as in group 1.16. For each tooth treated. 32 radiographic investigation were done. filling materials.

correlation was weak The limitations of this study was that VAS had been positive r=0.239) used to measure the levels of pain since there is no while in two visits root canal group. but two visit root 6.97 +1. This has been supported by Albashaireh and two root canal visits (p=0. especially in concerning the effectiveness of an appointment versus communities where patients default after the first 27 JPDA Vol.001).20 0. Pain was the commonest presenting compliant post obturation pain.7% and 70%. correlation was objective method for measuring pain.e.40±1.97 1.03 0. While in the group of two may experience slightly higher frequency of post visit root canal was 1.405).13 Post Operative Pain 6 Hourly 0.1 And also in this study since the age.222 and statistically insignificant (p=0. 2 1.60±0. two root canal visit group(p=0.085).3%) had vital and 8 (26. Therefore the ability to generalize the Table :1 Comparison of Pre and Post Operative Pain between Visit 1 and 2 results is weak. Saleem MA / Sheikh AB / Khan MA / Atif S Assessment Of Post-obturation Pain (73.03 1.7% and 10%. experience is very subjective and is dependent on so many factors.7% and 10%(p=0.77 Hence the hypothesis of this study was not supported DISCUSSION by the results of this study but single visit endodontic therapy has been shown to be a safe and effective Debate is still ongoing among researcher and clinician alternative to multiple visit treatment. canal treatment shoed better result in term of post The mean preoperative pain score (VAS) in the obturation pain after 12 and 24 hours.98 and 0. In single root canal visit group.12 and 1. Unlike Jalil Modaresi et al found visit group was 1. in the groups of single and two root canal visits Although it was found that there was no advantage respectively 56.408). sensitivity 10% and 10% and prosthetic post obturation pain in initial 6 hours .829). 2 0.71 1 1.66 in group than in the single-visit group within 24 h of two root canal visit group.77 in found that for both single and multiple visit procedures.97 1.7%) had necrotic tooth status multiple appointment endodontic treatment in term of (p=0. the mean VAS in single root canal take pain killers 23. as the pain strong positive i. positive correlation between pre-operative and post- After postoperative 24 hours. According to patients who underwent in the group of single root canal Figini L et al found patients undergoing a single visit visit group was 2.27 0.60 0. The attenuation in pain score after 6 endodontic treatment as compare to two visit endodontic hours was statistically significant in the groups of single treatment 24. After obturation pain and are significantly more likely to postoperative 6 hours.07 and 1. the mean VAS in single of postobturation pain was found in the multiple-visit root canal visit group was 1.09( p=. pulp 1 1.003 vitality and presenting complain had been equally 2 1.03±0.67 0.085 can be identified in future studies.The present study pain after 12 and 24 hours was observed in both groups also supports this correlation.71 in two root low incidence of post obturation pain in single visit canal visit group. 01 Jan-Mar 2014 . there were statistically significant correlations between Statistically insignificant attenuation in postoperative pre-operative and post-obturation pain. However.40 1. r=0. a careful case selection and Number of Mean SD p-value adherence to the basic principles of endodontic treatment Visit will reduce the incidence of post-obturation pain and Pre Operative Pain 1 2.00 0.97±1.27.0±0.117). Oginni and Udoye10 in their study root canal visit group was 1. followed by food packing for one visit or two visit root canal treatment regarding 26.117 factors on postobturation pain had not been identified 1 1. pain. in both the single and however the mean VAS of the group of two root canal multiple visit groups there were statistically significant visits remained less than that of single root canal visits correlation between pre-operative and post-obturation group after 12 and 24 hours.98 so the influence of these factors on post obturation pain Post Operative Pain 24 Hourly 0. The attenuation in pain score obturation 25.20±0. the mean VAS in single obturation pain 26. 23 No.03 +1.07 distributed in both the groups hence the effect of these Post Operative Pain 12 Hourly 2 1. after 12 hours was statistically insignificant in the groups Previous studies have shown that there is a strong of single and two root canal visits (p=0.803 and also significant (p=0.003). gender.829 thus enhance a successful outcome. ZS et al also found a significantly higher incidence After postoperative 12 hours.

Gasco-Garcia C. Pain associated with root canal endodontic therapy: a nationwide survey of endodontists. 2002. Controversies in Oral Radiol Endod. 2003. 1983. Myths of single visit endodontics.and Endod J. Kirby-Turner N. Gulabivala K. Dos Carmo CB. Gulabivala K. Glennon JP.27:23-27. 2012 1. 2010. Flare rate in pulpaly necrotic 21. Ibrahim shown to be a safe and effective alternative to two visit YE. Martín-González J. 36: 453-463 J 2004. Landers RR.versus multiple-visit endodontic treatment and two-visit root canal treatment were compared for infected root canals: A systematic review. Int Endod J. Endodontic flare-ups: to aid management of child and adult patients in clinical JPDA Vol. examples of brief assessment methods 10. 2010. Int Endod J. 2004.36:36-39. Ye L. treatment. regarding post-obturation pain in the initial 6 hours. default after the first appointment at which pain is 14. Habahbeh R. Wahl MJ. BeGole EA.Yousuf M. Kim S. 2. Gen 20. 2009.Postoperative pain in multiple-visit and single-visit treatment. El Mubarak AH. Toosy A. Eleazer PD. 8: 35-40. Prevalence of and factors affecting postoperation pain 3. 2004. Ren L.37:125-132. two. Single visit endodontics: a clinical study J irrigation devices in a prospective randomized clinical Endod. Su Y.Epub 2009 J Endod. Fusobacterium of post-obturation pain experience following one-visit nucleatum in endodontic flare-up. Bergenholtz G. 1982. Healing rate and post-obturation Although no advantage was observed when one-visit pain of single.visit root canal treatment regarding post-obturation 2012. especially in communities where patients root canal treatment. Int Endod J. Wang C. Comparison 16.93:179-183 pulps: a randomized controlled trial. central incisor teeth in patients attending a military 22. 01 Jan-Mar 2014 28 . in patients undergoing root canal treatment.Incidence of post-operative terms of post-obturation pain after 12 and 24 hours. 2001. Singh S. Dong G. Oliet S. treatment on teeth with vital pulps: comparison of three 9. Abu-bakr NH. 2. 2010. Calhoun RL. Ng YL. Castellanos- molar in one visit versus two visit root canal treatment Cosano L. Wang C.91:617-618 Endodontics. one-visit treatment idea. May 8.37 29-37. 8.37:381-91. necrotic molar in one-visit versus 2 visit endodontic treatment. comparison of incidence between single and multiple visit procedures in patients attending a Nigerian teaching CONCLUSION hospital.15:323-327. Odontostomatol Trop. J Endod 1998. Dent. Xu P. Velasco-Ortega E. Oral Surg Oral Med Oral Pathol 4.24:614-616. Setzer FC. two-visit root canal treatment showed better results in 12. 15:99-114 19. Spangberg LS. Crit Rev Oral Biol Med. Oral Surg Oral Med Oral 18. Postoperative pain after one-visit root-canal and Surgeons Pakistan. Eleazer KR. College of Physicians Egea JJ. Al-Negrish AR. Microbial causes of endodontic flare. Chavez de Paz Villanueva LE. REFERENCES 15. Alonso-Ezpeleta LO.visit root canal therapy. Gresla T. Flare-up rate related different obturation techniques. 23 No. J Endod. Oral Surg Oral Med and two-visit root canal treatment on teeth with vital Oral Pathol Oral Radiol Endod 2002. Llamas-Carreras 5. J Dent 2006. 6. Visual/verbal hospital.36:1295-1301.42:614-620. Rogers M.17:e721-727. Ng YL. analogue scales.Udoye CI. One-appointment JM. 2002. Saleem MA / Sheikh AB / Khan MA / Atif S Assessment Of Post-obturation Pain appointment at which pain is relieved. J Endod. López-Frías FJ. Int Tucker D. 17. However. pain. DiRenzo A. 11. Gondim E Jr. single visit endodontic therapy has been 13. Prevalence of and factors affecting post-obturation pain 1. 44: 126-131 Postoperative pain after the application of two different 7. Cisneros-Cabello R.43:692-697. Int Endod ups. Jhonson BR. 1996. Segura-Egea JJ. Spa°ngberg L. Ye L. Setchell DJ. 34: 635-640. Setchell DJ.. J Endod. Med Oral Patol Oral Cir to root canal treatment of asymptomatic pulpally necrotic Bucal. pain after single visit and multiple visit root canal Though the present study reported favourable results in treatment: A randomized controlled trial J Conserv Dent. Chapman HR. 9: 147-152 trial. Oginni A. Aniket Garg A. Siqueira JF Jr. Glennon JP. but 2011. in patient undergoing two visit root canal treatment. Segura- [dissertation] Operative dentistry. Flareup rate in pulpally relieved. 93: 605-610. Evidence-based endodontics: the Pathol Oral Radiol Endod. Postoperative pain after 1.2004.

Comparison pain after endodontic retreatment: single versus two visit of flare up incidence between single and two treatment. 134-136. 98: 483-487. Isci AS. Oral Med Oral Pathol Oral Radiol Endod visit endodontic treatment. Albashaireh ZS. 23 No. J Dent.26:227-232. Topuz A.and multiple-visit endodontic therapy. Br Dent J 2002. Modaresi J. Oztunc H. Lodi G. Cochrane Database Syst Rev 2007: A prospective study. Single 25. Figini L. CD005296 26.193:447-450. 1998. Davari A. Postoperative 24.16: 2004. 29 JPDA Vol. Saleem MA / Sheikh AB / Khan MA / Atif S Assessment Of Post-obturation Pain practice. Daneskazemi A. Postobturation pain versus multiple visits for endodontic treatment of after single. J Pak Dent Assoc 2007. Yoldas O. Gorni F. 01 Jan-Mar 2014 . permanent teeth. Gagliani M. Alnegrish AS. 23.