Effect of bite adjustment done a day before single visit root canal treatment on pain and painkiller use in patients with painful tooth infection.

Not yet recruiting

Conditions: Chronic apical periodontitis,

Registration Number: CTRI/2025/06/089503

Lead Sponsor: Rutuja

Brief Summary: One of the most challenging concerns for a dentist is endodontic pain. As per current [International Association for the Study of Pain](https://www.bing.com/ck/a?!&&p=599e36bdb85b877ef2be5377fbdb51668fe827ce2214c4dab178bc70c0f3b626JmltdHM9MTczOTU3NzYwMA&ptn=3&ver=2&hsh=4&fclid=03738b62-7c9f-64d1-2820-9e18789f6617&psq=iasp+full+form&u=a1aHR0cHM6Ly93d3cuaWFzcC1wYWluLm9yZy8&ntb=1) [IASP] definition of pain, pain is defined as ‘An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage’ as recommended by the Subcommittee on Taxonomy and adopted by the IASP Council in 1979. This definition is in accord with the plight caused by dental pain.

Acute Periapical inflammation is attributed to be the most common cause of post-endodontic pain. It may arise as a consequence of irreversible pulpitis and can also develop postoperatively as a result of mechanical, chemical, and/or microbial insults.Post-endodontic pain is a frequent complication following root canal treatment, with incidence rates ranging from 3% to as high as 80%, peaking within the first 24 hours.

This pain is typically attributed to the apical extrusion of infected debris and irrigants.

A thorough and meticulous diagnosis is a prerequisite for appropriate decision making. Postoperative pain is a significant concern for both patients and dentists, often influencing treatment satisfaction and recovery. Pain prevention strategies can be applied at multiple stages: pre-operative, perioperative (or intraoperative), and post-operative. These strategies encompass anxiety reduction, effective local anaesthesia, biologically informed operative and post-operative procedures, and the pre-emptive use of analgesics. Additionally, adjunctive measures such as incision and drainage, occlusal reduction, and trephination can be employed. The research results found that the most influential factor in predicting post endodontic pain is the absence of occlusal contacts, with an odds ratio=3.3 [ 95% C.I.= 1.9-5].

Occlusal reduction works by diminishing the mechanical stimulation of sensitized nociceptors. Reducing the strain on the PDL’s nociceptors is believed to alleviate pressure on the inflamed peri-radicular tissues, thereby relieving pressure and postoperative discomfort. As a pain preventive strategy, occlusal reduction is known to be significantly effective in certain cases. Occlusal surface reduction before root canal treatment has been recommended to prevent postoperative pain in teeth that already exhibit preoperative pain and/or pain on percussion. It can also be utilized as a relief strategy in emergency situations, if painful symptoms arise after the treatment.

Nevertheless, there are only a few randomized clinical trials on this topic, and their results are often inconsistent. Most earlier studies have examined the impact of occlusal reduction on post-operative pain in teeth with symptomatic irreversible pulpitis with/without symptomatic apical periodontitis. However, a recent systematic review and meta-analysis highlight the necessity for future research on occlusal surface reduction before root canal treatment to prevent postoperative pain in teeth with necrotic pulp and apical periodontitis. Thus, this study aims to assess how occlusal reduction performed 24 hours prior to single visit endodontic therapy affect pain intensity and medication usage post treatment. This study will thus contribute to improved clinical practices in endodontics by providing evidence-based recommendations regarding occlusal management after root canal therapy.

This randomized controlled trial aims to assess postoperative pain and need for analgesic consumption in patients undergoing occlusal reduction 24 hours prior to single visit root canal treatment in mandibular molars diagnosed with symptomatic apical periodontitis. Recognizing that pain perception is a complex and subjective experience influenced by numerous physical and psychological factors, this study will employ Visual Analog Scale [VAS] for pain assessment. The VAS, a 100 mm horizontal line anchored by descriptive terms at each end, will be used to quantify patient’s pain levels. Patients will be asked to mark their perceived pain at specified intervals: 6, 12, 24, 48 and 72 hours post-treatment. This methodology aims to evaluate effectiveness of occlusal reduction performed prior to single visit root canal treatment on postoperative pain and analgesic consumption.

Detailed Description: Not available

Recruitment & Eligibility

Status: Not Yet Recruiting

Sex: All

Target Recruitment: 80

Inclusion Criteria

Mandibular molars diagnosed with symptomatic apical periodontitis, confirmed by pulp vitality test and radiographic examination, requiring endodontic treatment, will be selected for study from regular patient pool.
The treatment procedure will be thoroughly explained to the patient in their native language to ensure comprehension.
Informed written consent will be obtained prior to participation, adhering to ethical standards and ensuring patient autonomy.

Exclusion Criteria

Pregnant patients, medically compromised patients [with immunosuppressive, systemic diseases, patients on medications], teeth without antagonist tooth/ presence of parafunctional habits, Temporormandibular disorders, teeth with radiographically evident periapical radiolucency, teeth with poor periodontal conditions, previously root canal treated teeth, tooth with more than 25 percent functional cusp structure loss mesiodistally or involving more than half of even single cusp.

Study & Design

Study Type: Interventional

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
To evaluate effectiveness of occlusal reduction done 24 hours prior to single visit endodontic therapy on postoperative pain in permanent mandibular first molars with symptomatic apical periodontitis	6, 12, 24, 48 and 72 hours postoperative

Secondary Outcome Measures

Name	Time	Method
To evaluate effectiveness of occlusal reduction done 24 hours prior to single visit endodontic therapy on analgesic intake in permanent mandibular first molars with symptomatic apical periodontitis	6, 12, 24, 48 and 72 hours postoperative

Trial Locations

Locations (1): Nair Hospital Dental College
🇮🇳
Mumbai, MAHARASHTRA, India
Nair Hospital Dental College
🇮🇳Mumbai, MAHARASHTRA, India
Dr Rutuja
Principal investigator
07972720856
rutujadighe1711@gmail.com