Postoperative pain associated with root canal treatment when using the XP-Endo Finisher to agitate the irrigant - a randomized controlled double-blind clinical trial

Although root canal treatment alleviates pain, postoperative pain afterroot canal treatment is a common problem (Gondim et al. 2010) and has been reported to range from 3% to 58% (Albashairehet al.1998, Sathorn et al. 2008). The aetiology of postoperativepain following root canal treatment is multifactorial. It may be due toinadequate cleaning and shaping of the canal system, presence of periapicalpathosis, apical extrusion of debris, missed canals, over-instrumentation, and/orextrusion of irrigating solutions and intracanal medicaments (Seltzer 1986, Harrisonet al. 1983, Siqueira et al. 2002). To prevent periapical tissue damage and reduce postoperativepain, a safe irrigation delivery system is desirable. Conventionalirrigation with a syringe and needle remains a widely accepted technique; however,it has been shown to be incapable of cleaning areas that are difficult toaccess such as the apical third of the canal and isthmus regions (Lee et al. 2004). Also, when needleirrigation is used an apical stagnation zone is created beyond the tip of theneedle where, irrigant exchange does not take place (Glulabivala et al. 2010) and as a result itseffectiveness is reduced. As a consequence, a number ofirrigation activation techniques, such as manual agitation, sonic or ultrasonicactivation and negative pressure systems, have been proposed to improve the movementof irrigants (agitation) within the canal and thus their efficacy within theroot canal system (Haapasalo et al.2010, Glulabivala et al. 2010, Mazo et al. 2012).It has been reported that irrigation devices have an effect on apicalextrusion of debris and irrigants (Mitchell etal. 2011, Boutsioukis et al. 2014)and have the potential to increase postoperative discomfort. This study evaluated postoperative pain after activation of the final irrigantsolution using XP Endo Finisher compared to traditional needle irrigationin teeth with symptomatic irreversible pulpitis and in teeth with necroticpulps and apical periodontitis.