A Comparative Evaluation of The Effect of Low-Level LASER Therapy, LASER-Activated Irrigation and Preoperative Aceclofenac on Post Endodontic Pain After Single Visit Root Canal Treatment - A Randomized Controlled Trial.

Pain after endodontic treatment is a common side effect with significant effect on the quality of life of the patients. Pretreatment analgesia is providing analgesia to patients before endodontic treatment is started. This technique can decrease the establishment of central and peripheral sensitization, which has the potential to reduce postoperative pain and postoperative analgesic intake. The controlled-release formulation of Aceclofenac allows the drug to be effective over an extended period. It also reduces repeated administration of the drug and allows for better patient compliance.  Laser-activated irrigation (LAI) generates optical cavitation in the irrigant, causing the formation of vapor bubbles. LAI is very effective in debris removal from canal complexities which occurs exceedingly fast, causing a very rapid turbulence in the liquid throughout the whole canal. Moreover, LAI showed reduced postoperative pain and discomfort following endodontic treatment in single visit which was attributed to the technique’s low intra-canal pressure, which does not exceed the pressure in the apical tissues or the 5.88 mmHg central venous pressure. Low-level LASER therapy (LLLT)  increases endogenous endorphins (β-endorphin) and decreases the activity of C-fibers and bradykinin, and thus creates an analgesic effect. LLLT application also increases phagocytic activity, number and diameter of lymphatic vessels, decreases the permeability of blood vessels, thus reducing edema and post-operative symptoms. This treatment is nowadays called “photobiomodulation”, also referred to as “LLLT” in literature. Thus, this study compares the various modalities for pain reduction like low-level LASER Therapy, LASER-activated irrigation and administration of preoperative Aceclofenac.