Postendodontic Pain after Pulpotomy or Root Canal Treatment in Mature Teeth with Carious Pulp Exposure: A Multicenter Randomized Controlled Trial

Mohammad Jafar Eghbal, Ali Haeri, Arash Shahravan, Ali Kazemi, Fariborz Moazami, Mohammad Ali Mozayeni, Eshaghali Saberi, Mohammad Samiei, Mehdi Vatanpour, Alireza Akbarzade Baghban, Mahta Fazlyab, Ardavan Parhizkar, Mahboobe Ahmadi, Nazila Akbarian Rad, Shima Bijari, Delaram Bineshmarvasti, Paria Davoudi, Roya Dehghan, Mandana Dehghani, Habibollah Ebrahimi, Nafiseh Emami, Nafiseh Farajian, Rahim Fereidooni, Gelareh Ghobadi, Mostafa Ghodrati, Atefeh Gohari, Azadeh Hashemi, Mohammadreza Hosseini, Elham Karami, Nasir Kheirabadi, Sepideh Kozegari, Hadi Labaf Ghasemi, Alireza Majidi, Parastu Malekzadeh, Vahid Mehrabi, Mehrnush Mohammadi, Leila Moradi Eslami, Atefeh Noghani, Negin Omatali, Negar Pourhatami, Behnam Rahbani Nobar, Saeid Rahmani, Parviz Shafaq, Sara Soofiabadi, Somaye Teimoori, Farzaneh Vatandoost, Saeed Asgary, Mohammad Jafar Eghbal, Ali Haeri, Arash Shahravan, Ali Kazemi, Fariborz Moazami, Mohammad Ali Mozayeni, Eshaghali Saberi, Mohammad Samiei, Mehdi Vatanpour, Alireza Akbarzade Baghban, Mahta Fazlyab, Ardavan Parhizkar, Mahboobe Ahmadi, Nazila Akbarian Rad, Shima Bijari, Delaram Bineshmarvasti, Paria Davoudi, Roya Dehghan, Mandana Dehghani, Habibollah Ebrahimi, Nafiseh Emami, Nafiseh Farajian, Rahim Fereidooni, Gelareh Ghobadi, Mostafa Ghodrati, Atefeh Gohari, Azadeh Hashemi, Mohammadreza Hosseini, Elham Karami, Nasir Kheirabadi, Sepideh Kozegari, Hadi Labaf Ghasemi, Alireza Majidi, Parastu Malekzadeh, Vahid Mehrabi, Mehrnush Mohammadi, Leila Moradi Eslami, Atefeh Noghani, Negin Omatali, Negar Pourhatami, Behnam Rahbani Nobar, Saeid Rahmani, Parviz Shafaq, Sara Soofiabadi, Somaye Teimoori, Farzaneh Vatandoost, Saeed Asgary

Abstract

This equivalence, randomized, clinical trial aimed to compare the postoperative pain of root canal therapy (RCT) with pulpotomy with mineral trioxide aggregate (PMTA) or calcium-enriched mixture (PCEM) in permanent mature teeth. In seven academic centers, 550 cariously exposed pulps were included and randomly allocated into PMTA (n = 188), PCEM (n = 194), or RCT (n = 168) arms. Preoperative "Pain Intensity" (PI) on Numerical Rating Scale and postoperative PIs until day 7 were recorded. Patients' demographic and pre-/intra-/postoperative factors/conditions were recorded/analysed. The arms were homogeneous in terms of demographics. The mean preoperative PIs were similar (P=0.998), the mean sum PIs recorded during 10 postoperative intervals were comparable (P=0.939), and the trend/changes in pain relief were parallel (P=0.821) in all study arms. The incidences of preoperative moderate-severe pain in RCT, PMTA, and PCEM arms were 56.5%, 55.7%, and 56.7%, which after 24 hours considerably decreased to 13.1%, 10.6%, and 12.9%, respectively (P=0.578). The time span of endodontic procedures was statistically different; RCT = 69.73, PMTA = 35.37, and PCEM = 33.62 minutes (P < 0.001). Patients with greater preoperative pain, symptomatic apical periodontitis, or presence of PDL widening suffered more pain (P=0.002, 0.035, and 0.023, resp.); however, other pre-/intra-/postoperative factors/conditions were comparable. Pulpotomy with MTA/CEM and RCT demonstrate comparable and effective postoperative pain relief.

Conflict of interest statement

Saeed Asgary is the inventor of CEM cement (Endodontic Filling Material, USA, 7,942,961, 17 May, 2011). All other authors declare that there are no conflicts of interest regarding the publication of this paper.

Copyright © 2020 Mohammad Jafar Eghbal et al.

Figures

Figure 1
Figure 1
CONSORT flow diagram of participants through each stage of randomized clinical trial.
Figure 2
Figure 2
Pain intensities during the study in the RCT, PMTA, and PCEM arms.
Figure 3
Figure 3
Time to pain-free status in the three study arms.
Figure 4
Figure 4
Pain intensity changes in presence or absence of (a) apical periodontitis or (b) PDL widening/lesion.

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