Comparison of Post-operative Pain After Use of Endo-activator and Conventional Irrigation During Endodontic Treatment in Symptomatic Periapical Periodontitis: a Randomized Control Trial

Adequate cleaning of root canal system, along with complete eradication of infected, necrotic pulp remnants, persistent microorganisms, and complete sealing of root canal space is key to successful root canal treatment. Activated irrigation is a method that is used to agitate and increase efficacy of irrigant flow to irregularities of root canal spaces as lateral canals and isthmus by chemo-mechanical or various other energy forms and it is one of the irrigation methods used in this study. It has been shown that EndoActivatorTM system produces the effectual irrigation in all spaces of root canal including as lateral canals, isthmuses and the chances of extrusion of irrigant is less than that compared by means of conventional irrigation methods.Thirty seconds use of activated irrigation solution appeared to be more effective in disinfecting root canal compared with an standard irrigation regimen. The most relevant preferred method of activating the irrigant is by using a non-cutting oscillating ultrasonic tip.

NaOCl is the widely used irrigation solution during chemo-mechanical instrumentation as it has a broad range of antibacterial effect and a high capacity of organic tissue dissolution. It has the dissolution capacity when used in concentrations as low as 2.5%, resulting in decreased antibiofilm effect and removal of organic part of smear layer. Similarly, use of EDTA during the preparation removes the organic part of smear layer resulting in exposure of dentinal tubule and for better penetration of NaOCl for disinfection.1 The same protocol and irrigation techniques were followed in our study to maximize the benefit of NaOCl and EDTA during endodontic treatment.

Many studies have examined effects of different various irrigation methods in relation with endodontic procedures on post-operative pain that corroborate with results of this current study. In this study, working length was determined by use of apex locator i.e. electronic measurement device for root canal length which was then confirmed by digital radiograph. This protocol was followed to ensure that preparation was confined within root canal space, and prevent chances of over instru¬mentation that is considered to be one of those major leading cause of post-operative pain.

The Endoactivator System results in minimal extrusion of irritants and irrigate simulated lateral canals at 4.5 and 2 mm from desired working length as compare to that with conventional methods resulting in better irrigation and decreased post-operative pain among different variables.The highest values of post-operative pain were recorded after 6 hours of treatment that potentially decreased in the follow-up periods until almost disappeared after the time interval of one week. In studies evaluation regarding duration of post-operative pain after root canal treatment was noted in regard with above mentioned aggrement.

Studies by Gondim et al and Topçuoğlu et al also reported lower values of pain in Endovac group com¬pared to conventional needle irrigation showing sig¬nificantly marked results after 6 hours followed by 48 hours-time interval. The chances of extrusion of debris apically was greater resulting in increased level of pain with conventional needle-syringe irrigation due to positive pressure of conventional irrigation.