Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt.
Int Endod J. 2020 Sep;53(9):1170-1180. doi: 10.1111/iej.13328. Epub 2020 Jun 15.
This randomized, prospective, controlled trial assessed the effect of occlusal reduction on post-treatment endodontic pain and medication intake following root canal treatment of mandibular posterior teeth with symptomatic irreversible pulpitis with sensitivity to percussion treated in two visits.
Three hundred and eight patients were randomly assigned into two equal groups according to whether occlusal reduction was done or not (n = 154). For all patients, root canal treatment was carried out in two visits without intracanal medication. Patients assessed their pain using the 0-10 numerical rating scale (NRS) 6, 12, 24 and 48 h after the first visit (post-instrumentation) and 6 and 12 h following root canal filling (post-obturation). Patients, also, recorded their medication intake (sham or analgesic), post-instrumentation and post-obturation; patients initially received a sham capsule, but, if pain persisted, an analgesic was prescribed. Data were analysed using Mann-Whitney U-test, Friedman's test, Wilcoxon's rank test and chi-square (χ ) test. The relative risk (RR) and its 95% confidence interval (CI) were calculated for binary data.
Occlusal reduction was associated with lower pain intensity than no occlusal reduction at 12 and 24 h post-instrumentation (P < 0.05). Pain intensity significantly and gradually decreased with both groups at all post-instrumentation and post-obturation time-points compared to preoperative pain (P < 0.05). The RR of moderate-to-severe pain was 0.61 (95% CI: 0.41, 0.91) 12 h post-instrumentation, and the RR of pain incidence, regardless of its level, was 0.75 (95% CI: 0.61, 0.92) 24 h post-instrumentation. There was no significant difference in medication intake (sham or analgesic) between groups (P > 0.05).
Occlusal reduction was effective in reducing the intensity of postoperative pain 12 h and 24 h after root canal instrumentation in the first visit in patients with symptomatic irreversible pulpitis with sensitivity to percussion. Occlusal reduction lowered the risk of moderate-to-severe pain by about 40% 12 h post-instrumentation and the overall risk of pain by 25% 24 h post-instrumentation; yet, it did not affect medication intake.
本随机、前瞻性、对照试验评估了咬合降低对下颌后牙有症状不可复性牙髓炎伴叩诊敏感的根管治疗后治疗后疼痛和药物摄入的影响，这些牙齿在两次就诊中进行根管治疗，不使用根管内药物。
根据是否进行咬合降低，将 308 名患者随机分为两组（n=154）。所有患者均在两次就诊中进行根管治疗，不使用根管内药物。患者在第一次就诊（器械后）后 6、12、24 和 48 小时以及根管填充后 6 和 12 小时使用 0-10 数字评分量表（NRS）评估疼痛。患者还记录了器械后和根管填充后的药物摄入（假或镇痛）；患者最初接受了假胶囊，但如果疼痛持续，则开了镇痛药。使用曼-惠特尼 U 检验、弗里德曼检验、威尔科克森秩检验和卡方（χ ）检验分析数据。对于二项数据，计算了相对风险（RR）及其 95%置信区间（CI）。
与不进行咬合降低相比，器械后 12 和 24 小时时，咬合降低与较低的疼痛强度相关（P<0.05）。与术前疼痛相比，两组在所有器械后和根管填充后时间点的疼痛强度均显著且逐渐降低（P<0.05）。器械后 12 小时时，中度至重度疼痛的 RR 为 0.61（95%CI：0.41，0.91），器械后 24 小时时，无论疼痛程度如何，疼痛发生率的 RR 为 0.75（95%CI：0.61，0.92）。两组间药物摄入（假或镇痛）无显著差异（P>0.05）。
对于有症状不可复性牙髓炎伴叩诊敏感的患者，在第一次就诊中进行根管治疗后 12 和 24 小时，咬合降低可有效降低术后疼痛强度。咬合降低可使器械后 12 小时时中度至重度疼痛的风险降低约 40%，24 小时时疼痛的总体风险降低 25%；然而，它并不影响药物摄入。
