Effect of intracanal use of nonsteroidal anti-inflammatory agents on posttreatment endodontic pain.

The ability of intracanal use of two nonsteroidal anti-inflammatory agents--diclofenac and ketoprofen--with and without hyaluronidase to control posttreatment pain was compared with that of a placebo control in a double-blind study of 760 subjects. The study was carried out on originally asymptomatic and symptomatic teeth that required endodontic therapy. Endodontic treatment was completed in three visits during which medications were placed into the canal either at the end of the first visit (postextirpation) or the second visit (postinstrumentation). Patients subjectively rated their pain on a scale of 1 to 4 as none, mild, moderate, and severe. The ratings were done preoperatively and at 2, 4, 8, and 12 hours postoperatively on the first day as well as on the second and third days. Statistical analysis of the data revealed that both diclofenac and ketoprofen significantly reduced the mean pain score in originally asymptomatic and symptomatic cases and were significantly superior to the placebo until the end of the study. Postendodontic pain occurred with less frequency when the teeth were treated with diclofenac, but diclofenac-treated and ketoprofen-treated cases were not significantly different at controlling postendodontic pain. An increase in the number of patients who reported complete absence of pain was recorded when hyaluronidase was added to the study medications. However, the difference between the medications and medications-hyaluronidase was not of statistical significance.