Faculty of Dentistry, Department of Endodontics, Yeditepe University, Bagdat Caddesi 238, Göztepe, Istanbul, 34728, Turkey.
Acta Odontol Scand. 2013 May-Jul;71(3-4):733-9. doi: 10.3109/00016357.2012.715199. Epub 2012 Aug 21.
The purpose of this clinical study was to evaluate the general incidence of post-operative pain and flare-ups in patients who were endodontically treated by two endodontics specialists using rotary instruments (Hero 642, Micro Mega, France) with the same treatment protocol.
Records of 382 teeth belonging to 268 patients treated by two endodontics specialists during a 6-month period were kept and evaluated. Post-operative pain between treatment visits was categorized using a pre-established scoring system. Ninety-five patients were males, whereas 173 were females.
Pulpal necrosis without periapical pathosis was determined as the most common indication for endodontic treatment (21.7%) followed by irreversible pulpitis and re-treatment without periapical lesions (18.3%, 18.3%, respectively). The general prevalence of post-operative pain and flare-ups was determined as 8.1%, whereas cases that could be classified as real flare-ups which were severe and required an unscheduled visit (scores 2 and 3) comprised 3.4% of the cases. No statistically significant correlation was determined between gender and post-operative pain and flare-up (p = 0.05). There was a significant correlation between number of appointments and the presence of pain and flare-ups. Teeth undergoing multiple visits had a higher risk of developing post-operative pain and flare-ups compared to those with single appointments with a statistical significance (p = 0.03).
Teeth with pre-operative pain were more prone to developing post-operative pain and discomfort with a statistically significant difference (p = 0.02). While no significant correlation was determined between tooth vitality and pain and flare-ups (p = 0.5), a statistically significant relationship existed between the presence of a periapical pathosis and post-operative pain and flare-ups. Cases with a periapical lesion had a higher risk of developing pain and flare-ups compared to those with no periapical involvement (p = 0.0001). Future studies may focus on the influence of rotary instrumentation systems in more specific groups of cases. Meanwhile; microbiological as well as psychological aspects of flare-ups are topics that warrant further investigation.
本临床研究的目的是评估两位使用旋转器械（法国 Hero 642、Micro Mega）并采用相同治疗方案的牙髓病学专家治疗的患者术后疼痛和发作的总体发生率。
保留并评估了在 6 个月期间由两位牙髓病学专家治疗的 382 颗牙齿的记录。使用既定的评分系统对就诊间的术后疼痛进行分类。95 名患者为男性，173 名患者为女性。
牙髓坏死伴或不伴根尖病变被确定为牙髓治疗最常见的适应证（21.7%），其次是不可逆性牙髓炎和无根尖病变的再治疗（18.3%，18.3%）。术后疼痛和发作的总体发生率为 8.1%，而可归类为严重且需要非计划就诊（评分 2 和 3）的真正发作病例占病例的 3.4%。性别与术后疼痛和发作之间无统计学显著相关性（p=0.05）。就诊次数与疼痛和发作的存在之间存在显著相关性。多次就诊的牙齿发生术后疼痛和发作的风险高于单次就诊的牙齿，具有统计学意义（p=0.03）。
术前有疼痛的牙齿发生术后疼痛和不适的可能性更大，差异有统计学意义（p=0.02）。虽然未发现牙髓活力与疼痛和发作之间存在显著相关性（p=0.5），但存在根尖病变与术后疼痛和发作之间存在显著关系。有根尖病变的病例发生疼痛和发作的风险高于无根尖病变的病例（p=0.0001）。未来的研究可能集中在旋转器械系统对更具体病例组的影响。同时，发作的微生物学和心理方面是值得进一步研究的课题。
