Comparative Evaluation of Postoperative Pain and Clinical Success Following Rotary and Reciprocating Instrumentation in Teeth with Symptomatic Irreversible Pulpitis: A Randomized Clinical Trial.

INTRODUCTION

The aim of this study was to evaluate the clinical success rate and the effects of different root canal shaping systems (hand files, reciprocating, and rotary) on postoperative pain in patients with symptomatic irreversible pulpitis (SIP) in vital mandibular molars.

METHODS

A total of 63 patients with a Numerical Rating Scale pain score ≥7 and SIP in mandibular first or second molars were included. Patients were randomly divided into 3 groups (n = 21) and root canal shaping was performed using reciprocating or rotary files; preparation using hand files served as the control. Irrigation was performed using sodium hypochlorite and EDTA, calcium hydroxide was used for temporary medication. In all cases, obturation was completed using AH Plus Bioceramic sealer in a second appointment one week later. Postoperative pain was assessed using the Numerical Rating Scale at 6, 12, and 24 hours after the emergency appointment, and on days 2 through 7 and day 30, postoperatively. Clinical success was evaluated clinically and radiographically after 6 and 12 months.

RESULTS

Although the postoperative pain decreased over time in all groups (P < .05), it did not differ significantly between the groups (P > .05). Despite the lack of significance, the hand file group reported higher pain levels at most follow-up intervals. Clinical success was 96.8% at 6 months and 85.7% at 12 months, respectively, with a significant correlation observed between the level of root canal filling and treatment success at 12 months (P < .05). No significant difference between the instrument systems in terms of success was observed.

CONCLUSIONS

In symptomatic and severely painful vital teeth, the hand files, reciprocating and rotary systems showed comparable levels of postoperative pain.