Frequency of Post Obturation Pain after Single versus Multiple Visits Endodontic Therapy by using Hybrid Root Canal Preparation Technique

Background/objective: The hybrid root canal preparation technique is better in a single visit as compared to multiple visit endodontic therapy in reducing the incidence of post endodontic pain. Relationship of post obturation pain and canal preparation has been studied in the past for the better outcomes of the treatment and for the patient’s belief in the treatment. The objective of this study was to compare the frequency of post obturation pain after single versus multiple visits endodontic therapy by using hybrid root canal preparation technique. Materials and methods: This randomized clinical trial (RCT) was carried out in the Department of Operative Dentistry, College of Dentistry, BAMDC, Multan, Pakistan, between 15th December 2017 and 14th June 2018. After approval from the Institutional Ethical Review Committee, a total of 140 patients with acute pulpitis and non-vital asymptomatic maxillary central incisor to first molar teeth were divided into 2 equal groups. In both groups, canal preparation was done by following hybrid canal preparation technique. Group A patients were treated in a single visit and Group B patients were treated in 2 visits. Patient’s pain response was recorded after 24 hours of treatment, using a Visual Analogue Scale. Data were analyzed using SPSS version 20.0. Results: After 24 hours, when post-operative pain was compared in two groups, it was found that in one visit Group A post obturative pain was significantly less as compared to the 2 visit Group B. In one visit Group A, 18 (25.7%) patients reported pain as compared to the two visits Group B where 38 (54.3%) patients complained of pain. When both the groups were compared by Chi-square test p-value was found 0.001, which was highly significant. Conclusion: Single visit endodontic therapy is better than multiple visits endodontic, in relation to post obturation pain when hybrid root canal preparation technique was used.

Eficacia de la técnica paso-atrás en tratamientos de endodoncia en una sesión / Effectiveness of the step-back technique in single-visit endodontic treatment

Introducción: La preparación biomecánica es determinante para el éxito del tratamiento endodóntico, pues el tope apical y el límite de obturación son etapas operatorias fundamentales para garantizar el ensanchamiento del conducto manteniendo al mismo tiempo la configuración preoperatoria inicial. Objetivo: Determinar la eficacia de la técnica de instrumentación paso-atrás en tratamientos de endodoncia en una sesión. Métodos: Se realizó un estudio de intervención terapéutica en 30 pacientes mayores de 12 años de la Clínica Estomatológica Dr. Salvador Allende, municipio Cerro, La Habana, en el periodo comprendido entre diciembre de 2015 y junio de 2017. Se analizaron como variables: dolor posoperatorio, inflamación, exámenes radiográficos, éxito y fracaso de los tratamientos teniendo en cuenta condición pulpar y tipo de diente tratado. La presentación de la información se realizó mediante tablas de contingencia de dos entradas, utilizando como medida de resumen el tanto por ciento. Resultados: El 90 por ciento de los pacientes no padeció dolor posoperatorio; el 96,67 por ciento de los tratamientos fueron eficaces al no existir signos de inflamación; y el 3,3 por ciento de los exámenes radiográficos evolutivos mostró imágenes de procesos inflamatorios crónicos. Conclusiones: La técnica de instrumentación paso-atrás en el tratamiento de endodoncia en una sesión fue eficaz en la mayoría de los casos. El mayor porcentaje de pacientes tratados no refirió dolor posoperatorio ni presentó inflamación(AU)

Introduction: Biomechanical preparation is crucial for the success of endodontic treatment, since the apical top and the obturation limit are fundamental operational stages to ensure appropriate broadening of the duct maintaining the initial preoperative configuration. Objective: Determine the effectiveness of the step-back instrumentation technique in single-visit endodontic treatment. Methods: A therapeutic intervention study was conducted of 30 patients aged over 12 years at Dr. Salvador Allende Dental Clinic in the municipality of Cerro, Havana, from December 2015 to June 2017. The variables analyzed included postoperative pain, swelling, radiographic examination, success and failure of treatment based on pulp condition and type of tooth treated. Data were presented in two-entry contingency tables, with percentage as the measure of summary. Results: 90 percent of the patients did not have any postoperative pain, 96.67 percent of the treatments were effective in that there were no signs of swelling, and 3.3 percent of the evolutionary radiographic tests showed images of chronic inflammatory processes. Conclusions: The step-back instrumentation technique in single-visit endodontic treatment was found to be effective in most cases. The highest percentage of patients treated did not report any postoperative pain or swelling(AU)

Evaluación cualitativa pos instrumentación ex vivo comparando tres técnicas: escalonada con retroceso programado-oregón modificada por la FOB-técnica rotatoria protaper / Ex vivo post-instrumentation qualitative evaluationcomparing three techniques: step back - oregonmodified by F O B – protaper rotary technique

El objetivo de este trabajo fue evaluar cualitativamente las regularidades de los conductos radiculares preparados con diferentes técnicas: técnica escalonada de retroceso programado, técnica Oregón modificada por la F.O.B. y técnica rotatoria Protaper. Fueron utilizados 30 conductos radiculares ex vivo de dientes unirradiculares de un único conducto. Los conductos fueron instrumentados de la siguiente manera: G1 (n=10) con la técnica escalonada de retroceso programado, G2 (n=10) con Oregon modificada por la F.O.B y G3 (n=10) con técnica rotatoria Protaper. Una vez acabada la instrumentación el material de impresión fue inyectado en el conducto radicular; después del fraguado del material de impresión los dientes fueron descalcificados para obtener los moldes de los conductos que fueron fotografiados con aumento 20x con microscopio digital Dino Lite plus para analizar la uniformidad de la instrumentación por tercios por las tres diferentes técnicas, clasificándolas en: CBI (conducto bien instrumentado), CRI (conducto regularmente instrumentado), CPI (conducto pobremente instrumentado). Los resultados mostraron predominancia de CBI para la técnica Protaper en los tercios medio y apical; en el tercio cervical para las tres técnicas y el tercio apical para la técnica Oregon modificada, siendo los peores resultados para la técnica escalonada de retroceso programado y Oregon modificada en el tercio medio, tercio apical en la Escalonada de Retroceso Programado. No hubo diferencias estadísticamente significativas en la efectividad de las técnicas escalonada de retroceso programado, Oregon modificada y Protaper cuando fueron analizados cualitativamente los moldes de los tercios. Concluimos que las técnicas coronoapicales resultaron en una instrumentación más uniforme y de mejor calidad que la técnica escalonada.

The aim of this study was to evaluate qualitatively the regularities of root canalsprepared with different techniques: Step Back – Oregon modified by F.O.B andProtaper. Thirty ex vivo root canals of single-rooted teeth with a single root canal wereused. The canals were instrumented as follows: G1 (n=10) Step Back, G2 (n=10)Oregon modified by FOB and G3 (n=10) Protaper tecniques. Once instrumentation finished, impression material was injected into the root canal. After casting of theimpression material, the teeth were decalcified to obtain molds of the root canals thatwere photographed with 20x magnification using a digital Dino Lite plus microscope toanalyze the uniformity of the instrumentation on the thirds using the three techniquesthat were classified into: WIC (well instrumented canal), RIC (regularly instrumentedcanal) and PIC (poorly instrumented canal). The results shown predominance of WICfor the Protaper technique in the middle and apical thirds, in the apical third for thethree techniques and the apical third for the modified Oregon technique, being theworst results for the Step Back and Oregon techniques in the middle third, and for theStep Back in the apical third. There were no statistically significant differences in theeffectiveness of the Step Back, modified Oregon and Protaper techniques when thethirds molds were analyzed qualitatively. We conclude that the crown-apicaltechniques resulted in more uniform and better quality instrumentation than the StepBack technique.

Effects of different root canal preparation techniques on premolars endodontic interappointment pain / 中国基层医药

Objective To study the clinical effects of different methods on endodontic inter appointment pain (EIAP) happened to the patients after premolar root canal preparations.Methods 152 teeth from 134 patients with acute or chronic pulpitis or apical periodontitis were randomly divided into T group and K group,used TiLos mixed root canal preparation system with step-down technique and stainless steel K file with step-back technique respectively to prepare root canal.Afterwards,the incidence rates of EIAP were observed and recorded.Results The incidence rates of EIAP in T group and K group were 6.17％ and 21.11％,respectively.There was statistically significant difference between the two groups (x2 =7.404,P ＜0.01).Conclusion TiLos mixed root canal preparation system with step-down technique to prepare root cancal can reduce the incidence rate of EIAP.

The study of Mtwo in root canal therapy in elderly patients / 中国医师杂志

Objective To assess the effects of Mtwo for root canal therapy in the aged patients .Methods One hundred and fifty-two root canals in 64 teeth for root canal therapy (RCT) in aged patients(60~70years)were randomly divided into M groups and K groups.Mtwo machine with nickel titanium file was used in M group (32 teeth, 78 root canals), and stainless steel file in K group (32 teeth, 74 root canals).Root canal preparation time, root spread reaction, and canal filling effects were compared between two groups.Results The root canal preparation and filling in group M were better than in K group ( P <0.05).The time consumption of RCT in M group was shorter than in group K .Conclusions Mtwo shows good shaping ability and is safe for aged patients in root canal treatment with high efficiency .

Efectividad de la técnica step back en tratamientos endodónticos mediante mediciones microbiológicas y radiográficas, presentación de casos clínicos. Facultad de Odontología, universidad de el salvador. 2013-2014 / Effectiveness of the step back technique in endodontic treatments through microbiological and radiographic measurements, presentation of clinical cases. Faculty of Dentistry, University of El Salvador. 2013-2014

Objetivo: Determinar la efectividad de la técnica step back en tratamientos endodóntico mediante mediciones microbiológicas y radiográficas por medio de la presentación de 19 casos clínicos en pacientes atendidos en la Facultad de Odontología de la Universidad de El Salvador durante el período 2013 2014. Metodología: El estudio es de tipo descriptivo, longitudinal, denominado serie de casos, se observó la realización del trabajo biomecánica (TBM), tomando en cuenta el uso de medidas de bioseguridad, presencia y estado del instrumental estéril, y la aplicación de la técnica: Utilización de la misma regla, conductometría, secuencia de las limas y la irrigación entre cada una de ellas así como el sentido de los movimientos al instrumentar. Se evaluó los niveles de reducción microbiana mediante cultivos bacterianos antes y después del procedimiento, tomándolos con una lima estéril que se sumergió en un tubo de ensayo con agua buferada para su posterior procesamiento. Se tomaron 3 controles radiográficos por paciente, uno antes del procedimiento, otro al finalizarlo, y un último control 6 meses posteriores. Cada radiografía fue interpretada basándose en el índice periapical (PAI) y así se evaluó la evolución de cada caso. Resultados: La respuesta al seguimiento de los 19 casos presentados, muestra progresión favorable en la cicatrización de lesiones periapicales en 18 de los casos, mientras que uno no presentó cambios y se mantuvo el mismo estado radiográfico en el periápice 6 meses posteriores. Se mantuvo una tendencia de reducción de microorganismos y hubo reducción de microorganismos aerobios en 12 de 19 casos, en 3 casos no se encontró microorganismos aerobios ni antes ni después del TBM y hubo aumento en 4 casos. Se encontró 10 casos reportados con lactobacillus de 19 pacientes, que presentaron reducción en la última medición, los 9 casos restantes no presentaron dicho microorganismo antes ni después. En 16 casos se presentó reducción de microorganismos anaerobios en el cultivo final, mientras que 3 casos reportaron aumento de microorganismos en el conteo final. Conclusiones: La ejecución de la técnica de TBM step back fue efectiva, ya que mostró una progresión favorable en la mayoría de casos, y al control radiográfico posterior es evidente la cicatrización de las lesiones previas al procedimiento, una muestra que con la aplicación correcta de los protocolos para realizar tratamientos endodónticos se obtienen tratamientos efectivos que satisfacen las expectativas de los pacientes atendidos.

Objective: To determine the effectiveness of the step back technique in endodontic treatment by microbiological and radiographic measurements through the presentation of clinical cases in 19 patients treated at the Faculty of Dentistry at the University of El Salvador during the period 2013 - 2014. Methodology: This is a case series study, descriptive and longitudinal, the realization of the biomechanical work (TBM for its spanish initials) was observed, taking into account the use of biosecurity measures, presence and condition of sterile instruments and application of the technique. Using the same rule, radiograph, sequence files and irrigation between each of them and the direction of movement to implement and the application of technique. Microbial reduction levels was assessed using bacterial cultures before and after the procedure, taking them with a sterile file which was immersed in a test tube with water buffered for further processing. 3 radiographic controls per patient, one before the procedure, one to complete it, and a final check after 6 months. Each radiograph was interpreted based on the periapical index (PAI) and thus the evolution of each case was evaluated. Results: The response to the monitoring of the 19 cases presented a favorable progression in healing periapical lesions in 18 cases, while one case showed no radiographic change, and the periapical state remained in the 6 months. A trend of reduction of microorganisms was maintained and there was reduction of aerobic microorganisms in 12 of 19 cases, 3 cases not aerobic microorganisms before or after the TBM was found and was increased in 4 cases. 10 cases, out of 19 who showed reduction in the last measurement were reported with lactobacillus, the remaining 9 cases showed no microorganism nor before nor after. In 16 cases reducing anaerobic microorganisms in the final culture is introduced, whereas 3 patients reported increase in the final microorganisms count. Conclusions: The implementation of the technique of step back TBM was effective, as it showed a favorable progression in most cases, and the posterior radiographic control shows healing of the pre-procedure injuries, an evident sample that with the proper application of protocols effective treatments that meet the expectations of the patients treated are obtained .

A clinical evaluation of new type of rotary nickel-titanium instrument Mtwo for seniles in root canal therapy / 实用口腔医学杂志

To evaluate the clinical effects of rotary nickel-titanium instruments Mtwo in root canal therapy in the aged patients. Using step-back technique,80 teeth with pulpal and periapical involvement were instrumented by Mtwo in the M group, and by K file in the K group. Mtwo could keep the original curvature and flow of the root canals. No transportation, apical blockage, ledge or perforation was found in the M group. There was more complications in the K group than in the M group.The operative time was shorter and posttreatment pain seldom occurred in the M group. With rotary NiTi instruments Mtwo for seniles' root canals treatment, root canals can be prepared effectively and quickly,and is worth of clinical application.

Frecuencia de dolor post-operatorio en dientes multirradiculares tratados con endodoncia utilizando dos técnicas de instrumentación, step-back y protaper / Post-operative pain frequency in multiradicular teeth treated with endodontics using two instrumentation techniques, step-back and protaper

Comparar la frecuencia de dolor post-operatorio en dientes multirradiculares tratados con endodoncia, utilizando dos técnicas de instrumentación; Step Back y Sistema ProTaper en pacientes atendidos en la Facultad de Odontología de la Universidad de El Salvador en el periodo de Julio 2008- Marzo 2009, es el objetivo principal de la realización del presente estudio. En donde se busca establecer las diferencias entre ambas técnicas con respecto a la frecuencia de dolor post-operatorio en los pacientes atendidos. Dicho estudio se llevó a cabo en las instalaciones de la Facultad de Odontología contando con una población total de 30 pacientes, que presentaron signos y síntomas característicos de una Pulpitis Irreversible en órganos dentarios multirradiculares sin evidencia radiográfica de lesión periapical. De la población total, los primeros 15 pacientes conformaron el Grupo A y fueron tratados con Técnica manual Step Back. El Grupo B fue conformado por 15 pacientes a quienes se les realizó el tratamiento de conductos con Sistema Rotatorio ProTaper. En ambos grupos se realizaron controles durante las siguientes 24, 36 y 72 horas posteriores a la finalización del tratamiento, en donde se verificaba a través del interrogatorio al paciente y pruebas clínicas de palpación y percusión la presencia de sintomatología dolorosa. Del total de pacientes evaluados en la Técnica Manual Step Back el 100% experimentó Dolor Post-Operatorio durante las primeras 24 horas presentando variaciones en la intensidad del dolor. La presencia de dolor se verificó, aunque con menos intensidad, hasta el tercer control realizado en las siguientes 36 y 72 horas. Mientras que del total de pacientes atendidos con la técnica rotatoria Sistema ProTaper el 100% de los pacientes manifestó Dolor Post-Operatorio de intensidad Leve únicamente durante las primeras 24 horas. Sin registrarse alteraciones dolorosas en los siguientes controles realizados. En base a los resultados obtenidos se concluye que la utilización del Sistema Rotatorio ProTaper desencadenó menor cantidad de pacientes con dolor post-operatorio con respecto a la Técnica manual Step Back durante las siguientes 36 y 72 horas posteriores a la realización del tratamiento. La aplicación del sistema rotatorio ProTaper para la investigación favoreció no solo en la reducción del tiempo de trabajo sino también por brindar un mejor diseño en la conformación del conducto, limpieza rápida y reducción de fatiga en los instrumentos utilizados.

To compare the frequency of postoperative pain in endodontically treated multiradicular teeth, using two instrumentation techniques; Step Back and ProTaper System in patients treated at the School of Dentistry of the University of El Salvador in the period of July 2008- March 2009, is the main objective of the realization of this study. Where it is sought to establish the differences between both techniques with respect to the frequency of post-operative pain in the patients attended. This study was carried out in the facilities of the Faculty of Dentistry with a total population of 30 patients, who showed signs and symptoms characteristic of Irreversible Pulpitis in multiradicular dental organs without radiographic evidence of periapical lesion. Of the total population, the first 15 patients made up Group A and were treated with the Manual Step Back Technique. Group B consisted of 15 patients who underwent root canal treatment with the ProTaper Rotary System. In both groups, controls were carried out during the following 24, 36 and 72 hours after the end of the treatment, where the presence of painful symptoms was verified through the questioning of the patient and clinical tests of palpation and percussion. Of the total number of patients evaluated in the Manual Step Back Technique, 100% experienced Post-Operative Pain during the first 24 hours, presenting variations in pain intensity. The presence of pain was verified, although with less intensity, until the third control carried out in the following 36 and 72 hours. While the total number of patients treated with the ProTaper System rotary technique, 100% of the patients manifested Post-Operative Pain of Mild intensity only during the first 24 hours. Without registering painful alterations in the following controls performed. Based on the results obtained, it is concluded that the use of the ProTaper Rotary System triggered fewer patients with post-operative pain compared to the manual Backward Step Technique during the following 36 and 72 hours after the treatment was performed. The application of the ProTaper rotary system for research favored not only in the reduction of work time but also by providing a better design in the conformation of the canal, rapid cleaning and reduction of fatigue in the instruments used.