Analgesic benefit of metamizole and ibuprofen vs. either medication alone: a randomized clinical trial.

BACKGROUND: Postoperative pain relief remains a key problem after surgery. Multimodal pain therapy has proven beneficial in alleviating pain to a certain extent. However, when combining non-opioids, the focus has been on NSAIDs and paracetamol, but effects of combined use are only moderate. Metamizole could be a potent adjunct, due to its preclusion in several countries, data on its combined use are sparse, despite its common use in many countries. The aim of this study was to examine whether the combination of metamizole and ibuprofen is superior in relieving postoperative pain to either drug alone. METHODS: For this randomized, placebo-controlled, cross-over study, 35 patients undergoing bilateral lower third molar extraction were randomized. Each patient received three applications of 1000 mg metamizole + 400 mg ibuprofen for surgery on one side and either 1000 mg metamizole + placebo or 400 mg ibuprofen + placebo on the other side. Pain ratings, rescue-medication (tramadol), and sleep were assessed for 18 hours. RESULTS: The combined treatment of metamizole and ibuprofen showed lower mean pain scores over 12 hours than ibuprofen (2.4±1.3 vs 3.8±1.6; P=0.005). Further, combined treatment showed lower mean pain scores over 6 hours than ibuprofen (2.0±1.2 vs. 3.1±1.6; P=0.022) or metamizole alone (2.0±1.2 vs. 3.3±1.7; P=0.015). Consumption of rescue medication was lowest in the combination-group (25% vs. 46%-metamizole; 50%-ibuprofen). The trial was stopped prematurely as the COVID-pandemic halted elective surgeries. CONCLUSIONS: Combined use enables superior pain control compared to ibuprofen after molar extraction and tends to be superior to metamizole alone. The premature study-termination may overestimate this effect.

[Micro Apical Placement System (MAPS) . A new instrument for retrograde root filling]. / Micro Apical Placement System (MAPS). Ein neues Instrumentarium zur retrograden Wurzelfüllung.

A retrograde radicular preparation in the axis of the root canal as well as an excess-free obturation of the canal is surgically very demanding due to the complex anatomical structures and to the limited intraoral operative field. As from the early 1990s, advisable methods for the retrograde root canal obturation under minimal place requirements have been implemented thanks to ultrasonic- and sonic-driven microinstruments. This publication presents a new microsurgical instrument, the "Surgical-Retro" Micro Apical Placement System (MAPS), which facilitates in a large extent the retrograde obturation with a plas tic root canal filling material. The device provides an unrestricted access to the retrograde cavity, allowing thus an accurate obturating technique whilst avoiding the dispersion of the root canal filling material in the surrounding bone. Thanks to the "Surgical-Retro" Micro Apical Placement System, a further gap in the improvement of the quality and, thus, of the success of the treatment by apical resection has been filled.