Comparison Between Low-level Laser Therapy, Intracanal Cryotherapy and Their Combination, on Post-endodontic Pain Level

January 11, 2022 updated by: Ahmed Adel Ibrahim Khalaf, Misr International University

Evaluation of Post-Endodontic Pain Control Using Low- Level Laser Therapy in Comparison to Intra-canal Cryotherapy: A Randomized Placebo-controlled Clinical Trial

Statement of the problem: Postoperative pain following endodontic treatment is a common complication that might require analgesics for pain relief. Low-level laser therapy (LLLT) and Intracanal Cryotherapy (ICCT) are both recommended as non-pharmacological and non-invasive treatment modalities for management of painful situations. Aim of the study: This study is conducted to clinically evaluate and compare the effect of both LLLT and ICCT on post-endodontic pain (PEP) over 5 days in molars with symptomatic apical periodontitis (SAP) using visual analog scale (VAS). Materials & Methods: This parallel arm, randomized clinical trial will involve 95 systemically free patients with SAP in molars. The patients will be randomly allocated to 5 equal groups as follows: control (no intervention), placebo (mock laser therapy), LLLT, ICCT and a combination of both. Postoperative pain levels after 6 hrs, 12 hrs, on 2nd day and 5th day are going to be assessed on the VAS and shall be noted. Data collected will be tabulated and statistically analysed.

Study Overview

Detailed Description

Selection of patients:

Ninty-five patients shall be selected from the regular pool of patients visiting Misr International University Dental Clinic Complex. After application of inclusion and exclusion criteria, preoperative and percussion pain shall be recorded on a 10-cm VAS by the patients. Percussion will be performed by tapping on the occlusal surfaces of the teeth with the back of a mirror handle. It will be assessed prior to the root canal treatment by the operator who shall be performing the root canal treatment. Diagnosis of the tooth as symptomatic apical periodontitis will be done according to the book Cohen's Pathways of the Pulp. Clinical symptoms are going to be defined as follows:

  1. Severe preoperative pain (VAS >6)
  2. Severe percussion pain (VAS > 6) Patients with all inclusion criteria will be offered to participate in the study.

Grouping of samples:

Each selected patient will get a unique serial code that is previously distributed among the 5 groups randomly. Nineteen patients in each as follows; Group 1: Control (no intervention), Group 2: Placebo (mock laser therapy), Group 3: LLLT, Group 4: ICCT and Group 5: Combination of both LLLT and ICCT. New patients will be incorporated in the study in place of lost patients.

Method:

After the patient signs the attached consent form, profound anesthesia and rubber dam application shall be ensured. Standard chemo-mechanical preparation parameters (Master Apical File: size #25 to #40 k-files depending on anatomical features of the roots) shall be followed. Obturation will be performed using lateral compaction technique. In Group 4 and Group 5, cold saline with temperature ranging from 2-4 °C, will be used as a final rinse using a conventional syringe. LLLT using diode laser (EPIC™ BIOLASE) with wavelength 940nm will be applied towards the tissues surrounding the roots of treated molars in Group 3 and 5 after completing obturation and sealing the access cavity. In Group 2, the diode laser tip shall be placed at approximately 10 mm from the tissue around the apices of the treated roots; however, it won't be activated.

Data collection:

All patients will be instructed to complete a survey at home. Pain is going to be evaluated based upon a questionnaire filled by the patient after 6 hrs, 12 hrs, on 2nd day and 5th day after root canal treatment. Any of the patients taking analgesics after the treatment, shall be advised to note this in the questionnaire. The information collected from the questionnaires covers the occurrence and the intensity of PEP. The intensity of pain will be evaluated on a numeric rating scale (VAS) of 0 for "no pain" to 10 for "unbearable pain". Patients will return the filled questionnaire on the 5th day after treatment and they shall be assured via telephone contact.

Blinding:

Outcome assessors and statistician will be blinded. Both the participants and principal investigators can't be blinded owing to the use of two obviously different methods, LLLT and ICCT or no intervention.

Study Type

Interventional

Enrollment (Actual)

95

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

      • Cairo, Egypt
        • Misr International University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 40 years (Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Patients having a molar tooth with symptomatic apical periodontitis indicated for root canal treatment.
  • Systemically free patients. ASA I
  • Teeth with mature apex.
  • Teeth without root resorption.

Exclusion Criteria:

  • Patients with other pulpal diagnoses.
  • Medically compromised patients.
  • Pregnant females.
  • Patients taking analgesics or anti-inflammatory drugs.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
No Intervention: Control
Routine root canal treatment
Placebo Comparator: Low-Level Laser Placebo
Patient informed that laser will be applied but device won't be turned on
Diode laser (EPIC™ BIOLASE) with wavelength 940nm
Experimental: Low-Level Laser Therapy
Low-Level Laser Therapy following root canal treatment
Diode laser (EPIC™ BIOLASE) with wavelength 940nm
Experimental: Intracanal Cryotherapy
Cold saline irrigation before obturation
Irrigation with cold saline 2-4 C
Experimental: Combination of LLLT and ICCT
Both cold saline irrigation before obturation and Low-level laser Therapy after root canal treatment
Diode laser (EPIC™ BIOLASE) with wavelength 940nm
Irrigation with cold saline 2-4 C

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Post-endodontic pain
Time Frame: 5 days
Score on Visual Analogue scale, ranging from 1 (No pain) to 10 (Worst pain)
5 days

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

June 24, 2019

Primary Completion (Anticipated)

May 30, 2022

Study Completion (Anticipated)

July 30, 2022

Study Registration Dates

First Submitted

July 2, 2019

First Submitted That Met QC Criteria

July 2, 2019

First Posted (Actual)

July 5, 2019

Study Record Updates

Last Update Posted (Actual)

January 12, 2022

Last Update Submitted That Met QC Criteria

January 11, 2022

Last Verified

January 1, 2022

More Information

Terms related to this study

Other Study ID Numbers

  • MisrIU

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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