Apical Periodontitis
Conditions
Keywords
Apical Patency, Postoperative Pain, Root Canal Treatment, Periapical Lesion, Cone-Beam Computed Tomography
Brief summary
This prospective clinical study evaluated whether maintaining apical patency during single-visit root canal treatment influences postoperative pain in adults with single-rooted maxillary anterior teeth and chronic apical periodontitis. Participants were systematically allocated in consecutive order to treatment with apical patency or treatment without apical patency. The study also evaluated the relationship between baseline periapical lesion volume measured on clinically indicated cone-beam computed tomography images and postoperative pain.
Detailed description
Eligible participants received standardized single-visit root canal treatment under local anesthesia and rubber dam isolation. In the apical patency group, a #10 stainless-steel K-file was passively advanced approximately 0.5-1 mm beyond the working length after each rotary instrument without intentional apical enlargement or dentin removal. In the no-apical-patency group, canal preparation was confined to the working length and no instrument was intentionally extended beyond the apical foramen. Conventional randomization was not used. To maintain numerical balance during enrolment, a systematic consecutive allocation approach was used, whereby apical patency was performed in one case and not performed in the subsequent case. Participants were aware of the treatment approach. Postoperative pain was assessed with a 100-mm visual analog scale at 8 hours, 24 hours, 3 days, 5 days, and 7 days. Analgesic use was also recorded. Periapical lesion volume was measured in cubic millimeters using manual three-dimensional segmentation with ITK-SNAP on eligible CBCT images obtained for clinical purposes.
Interventions
PROCEDUREApical Patency During Root Canal Treatment
A #10 stainless-steel K-file was passively advanced approximately 0.5-1 mm beyond the working length after each rotary instrument during standardized single-visit root canal treatment.
Standardized single-visit root canal treatment was performed with instrumentation confined to the working length and without intentional passage of an instrument beyond the apical foramen.
Sponsors
Recep Tayyip Erdogan University
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients. * Systemically healthy and not using regular systemic medications. * A single-rooted maxillary anterior tooth requiring primary root canal treatment. * Diagnosis of chronic apical periodontitis in the study tooth. * The tooth was restorable. * Absence of root fracture or crack. * Absence of internal or external resorption. * Root canal negotiable to the apical region with a small hand file. * Ability to establish a reliable working length. * Availability of a CBCT scan of the relevant maxillary anterior region, previously obtained for clinical purposes or indicated during the treatment process.
Exclusion criteria
* Pregnancy or breastfeeding. * Previous endodontic treatment of the study tooth. * Severe canal calcification. * Suspected root fracture or crack. * Internal or external root resorption. * Periodontal probing depth of 5 mm or greater. * Previous surgical intervention in the relevant region. * Inability to negotiate the root canal. * Inability to establish a reliable working length.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Pain Intensity | 8 hours, 24 hours, 3 days, 5 days, and 7 days after root canal treatment | Postoperative pain intensity was assessed using a 100-mm visual analog scale (VAS), where 0 mm indicated no pain and 100 mm indicated unbearable pain. Participants recorded the highest pain experienced during each predefined postoperative interval. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants Who Used Any Postoperative Analgesic Medication | From completion of root canal treatment through Day 7 | Participants were classified as having postoperative analgesic use if they reported taking at least one dose of any analgesic medication after root canal treatment during the 7-day follow-up period. The outcome was assessed as the number of participants with any postoperative analgesic use in each treatment arm. |
| Baseline Periapical Lesion Volume | Baseline, before root canal treatment | Periapical lesion volume was measured in cubic millimeters (mm³) on clinically indicated pre-treatment CBCT scans using manual three-dimensional segmentation with ITK-SNAP software. One baseline lesion-volume value was obtained for each participant with an evaluable CBCT scan. |
Countries
Turkey (Türkiye)
Contacts
PRINCIPAL_INVESTIGATORFatma Pertek Hatipoğlu
Recep Tayyip Erdogan University
Outcome results
None listed