Zhai Fei, Zhang Haiying, Zhang Chen, Hou Benxiang
Department of Endodontics, Beijing Stomatological Hospital, Capital Medical University, No. 9 Fanjiacun Road, Beijing, Fengtai District, 100070, China.
Center for Microscope Enhanced Dentistry, Beijing Stomatological Hospital, Capital Medical University, No. 22 Xinrong Street, Beijing, DaXing District, 100162, China.
Head Face Med. 2025 Jul 21;21(1):53. doi: 10.1186/s13005-025-00531-8.
The apical terminus of root canal preparation plays a critical role in minimizing postoperative pain. Yet, significant debate remains regarding the optimal termination point. This prospective clinical study aimed to assess the effect of three different apical termini on postoperative pain in teeth with irreversible pulpitis.
Totally, 128 patients with asymptomatic or symptomatic irreversible pulpitis were consecutively enrolled. Participants underwent root canal preparation with the apical terminus positioned either at the apical foramen (AF) or 0.5 or 1 mm short of it. Pain intensity was rated using an 11-point numerical rating scale (NRS-11) at nine time points. Data were analyzed using repeated measures analysis of variance.
In cases of irreversible pulpitis without preoperative pain (NRS = 0), the pain scores at 72 h after preparation were significantly lower in the AF-1 mm group than in the AF group (P < .05), with none of the patients in the AF-1 mm group reporting pain at this time point (P < .017). In cases of irreversible pulpitis with moderate preoperative pain (NRS = 4-7), the post-preparation pain scores at 4 h was significantly lower than the preoperative pain in all groups (P < .05). The pain scores in the AF-0.5 mm group remained lower than that in the other groups at 4 h, 24 h, 72 h, and 1 week. More patients reported decreased pain 4 h postoperatively in the AF-0.5 mm group than in other groups, with all patients in the AF-0.5 mm group reporting no pain at 1 week. In cases with mild preoperative pain (NRS = 1-3), the pain scores were significantly lower 72 h postoperatively than preoperatively (P < .05), with fewer patients reporting increased pain 24 h postoperatively in the AF-0.5 mm group than other groups.
Positioning the root canal apical terminus 0.5 and 1.0 mm short of the AF in symptomatic and asymptomatic cases of irreversible pulpitis, respectively, was most effective in reducing the severity and duration of postoperative pain. Tailoring apical preparation depth to the pulpal condition-symptomatic or asymptomatic-can optimize patient comfort and support more personalized endodontic care.
根管预备的根尖终点在将术后疼痛降至最低方面起着关键作用。然而，关于最佳终止点仍存在重大争议。这项前瞻性临床研究旨在评估三种不同根尖终点对不可逆性牙髓炎患牙术后疼痛的影响。
总共连续纳入128例无症状或有症状的不可逆性牙髓炎患者。参与者接受根管预备，根尖终点位于根尖孔（AF）处或距根尖孔短0.5或1毫米处。在九个时间点使用11点数字评分量表（NRS-11）对疼痛强度进行评分。使用重复测量方差分析对数据进行分析。
在术前无疼痛（NRS = 0）的不可逆性牙髓炎病例中，AF-1毫米组预备后72小时的疼痛评分显著低于AF组（P <.05），AF-1毫米组此时无患者报告疼痛（P <.017）。在术前有中度疼痛（NRS = 4-7）的不可逆性牙髓炎病例中，所有组预备后4小时的疼痛评分均显著低于术前疼痛（P <.05）。AF-0.5毫米组在4小时、24小时、72小时和1周时的疼痛评分仍低于其他组。与其他组相比，AF-0.5毫米组术后4小时报告疼痛减轻的患者更多，AF-0.5毫米组所有患者在1周时均报告无疼痛。在术前有轻度疼痛（NRS = 1-3）的病例中，术后72小时的疼痛评分显著低于术前（P <.05），与其他组相比，AF-0.5毫米组术后24小时报告疼痛加重的患者更少。
在有症状和无症状的不可逆性牙髓炎病例中，分别将根管根尖终点定位在距AF短0.5和1.0毫米处，在减轻术后疼痛的严重程度和持续时间方面最有效。根据牙髓状况（有症状或无症状）调整根尖预备深度可优化患者舒适度，并支持更个性化的牙髓治疗。
