The Effect of Passive Ultrasonic Irrigation or XP-Endo Finisher on Post-Operative Pain in Patients with Necrotic Teeth with Apical Periodontitis (Randomized Controlled Clinical Trial)

Sherief Elsaka; Wael Hussein; Ahmed Hashem; Amgad Soliman

doi:10.3889/oamjms.2022.9222

Authors

Sherief Elsaka Department of Endodontics, Future University in Egypt, New Cairo, Egypt https://orcid.org/0000-0001-5330-6386
Wael Hussein Department of Endodontics, Future University in Egypt, New Cairo, Egypt https://orcid.org/0000-0002-7592-7404
Ahmed Hashem Department of Endodontics, Ain Shams University, Cairo, Egypt https://orcid.org/0000-0002-1989-2104
Amgad Soliman Department of Endodontics, Future University in Egypt, New Cairo, Egypt https://orcid.org/0000-0002-7592-7404

DOI:

https://doi.org/10.3889/oamjms.2022.9222

Keywords:

Apical periodontitis, Pain, Ultra X, XP-Endo Finisher, Navitip

Abstract

Objective To evaluate the effect of passive ultrasonic irrigation or XP-Endo Finisher on post-operative pain in patients with necrotic teeth with apical periodontitis using (VAS) scale at 6, 12, 24, 48, 72 hours, and 7 day time intervals.

Methods Seventy-eight patients diagnosed with necrotic mandibular first molar with symptomatic apical periodontitis were randomly allocated into 1 of 3 separate groups (n=26); Navitip group (control), XP-Endo Finisher group, or Ultra X group. After a single visit root canal treatment and a specific method of agitation, depending on each group, the patients were given a questionnaire on which the patient would mark the degree of pain in a scale from 0 to 10 at 6, 12, 24, 48, 72 hours and 7 days post-obturation. Data were statistically analyzed with a significance level of P ≤ 0.05.

Results Ultrasonic agitation and XP-Endo Finisher agitation as a final irrigation protocol showed significantly lower pain values than the control group, but there was no significant difference in pain values between the experimental groups.

Conclusion There was significantly less pain associated with ultrasonic and XP-Endo Finisher agitation compared to Navitip irrigation.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Garg A. Textbook of Endodontics. New Delhi: JP Medical Ltd.; 2007. p. 603. DOI: https://doi.org/10.5005/jp/books/10910

Akcay M, Arslan H, Mese M, Durmus N, Capar ID. Effect of photon-initiated photoacoustic streaming, passive ultrasonic, and sonic irrigation techniques on dentinal tubule penetration of irrigation solution: A confocal microscopic study. Clin Oral Investig. 2017;21(7):2205-12. https://doi.org/10.1007/s00784-016-2013-y PMid:27921170 DOI: https://doi.org/10.1007/s00784-016-2013-y

Elnaghy AM, Mandorah A, Elsaka SE. Effectiveness of XP-endo finisher, endoactivator, and file agitation on debris and smear layer removal in curved root canals: A comparative study. Odontology. 2017;105(2):178-83. https://doi.org/10.1007/s10266-016-0251-8 PMid:27206916 DOI: https://doi.org/10.1007/s10266-016-0251-8

Yılmaz K, Tüfenkçi P, Adıgüzel M. The effects of QMix and endoactivator on postoperative pain in mandibular molars with nonvital pulps: A randomized clinical trial. Clin Oral Investig. 2019;23(11):4173-80. https://doi.org/10.1007/s00784-019-02856-6 PMid:30815731 DOI: https://doi.org/10.1007/s00784-019-02856-6

Faul F, Erdfelder E, Lang A-G, Buchner A. G*power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175-91. https://doi.org/10.3758/bf03193146 PMid:17695343 DOI: https://doi.org/10.3758/BF03193146

Berman LH, Hargreaves KM. Cohen’s Pathways of the Pulp. 12th ed. Netherlands: Elsevier; 2020.

Anjaneyulu K, Nivedhitha MS. Influence of calcium hydroxide on the post-treatment pain in Endodontics: A systematic review. J Conserv Dent. 2014;17(3):200-7. https://doi.org/10.4103/0972-0707.131775 PMid:24944439 DOI: https://doi.org/10.4103/0972-0707.131775

Siqueira JF. Microbial causes of endodontic flareups. Int Endod J. 2003;36(7):453-63. https://doi.org/10.1046/j.1365-2591.2003.00671.x PMid:12823700 DOI: https://doi.org/10.1046/j.1365-2591.2003.00671.x

Azim AA, Azim KA, Abbott PV. Prevalence of inter-appointment endodontic flare-ups and host-related factors. Clin Oral Investig. 2017;21(3):889-94. https://doi.org/10.1007/s00784-016-1839-7 PMid:27179654 DOI: https://doi.org/10.1007/s00784-016-1839-7

Hepsenoglu YE, Eyuboglu TF, Özcan M. Postoperative pain intensity after single-versus two-visit nonsurgical endodontic retreatment: A randomized clinical trial. J Endod. 2018;44(9):1339-46. https://doi.org/10.1016/j.joen.2018.05.017 PMid:30054099 DOI: https://doi.org/10.1016/j.joen.2018.05.017

Article R, Al Rahabi M. Rethinking postoperative pain after nonsurgical root canal treatment: Understanding, prevention, and management-review. Acta Sci Dent Sci 2018;2(9):40-5.

Ince B, Ercan E, Dalli M, Dulgergil CT, Zorba YO, Colak H. Incidence of postoperative pain after single- and multi-visit endodontic treatment in teeth with vital and non-vital pulp. Eur J Dent. 2009;3(4):273-9. PMid:19826598 DOI: https://doi.org/10.1055/s-0039-1697444

Eldin MM, Roshdy NN, Fouda MY. A comparative assessment of the effect of pretreatment dexamethasone versus placebo on post-endodontic pain and success of inferior alveolar nerve block in mandibular molars with symptomatic irreversible pulpitis: A blinded randomized clinical trial therapeutic study. Acta Sci Dent Sci. 2020;4(5):60-6. https://doi.org/10.31080/ASDS.2020.04.0836 DOI: https://doi.org/10.31080/ASDS.2020.04.0836

Alves FR, Andrade-Junior CV, Marceliano-Alves MF, Pérez AR, Rôças IN, Versiani MA, et al. Adjunctive steps for disinfection of the mandibular molar root canal system: A correlative bacteriologic, micro-computed tomography, and cryopulverization approach. J Endod. 2016;42(11):1667-72. https://doi.org/10.1016/j.joen.2016.08.003 PMid:27641947 DOI: https://doi.org/10.1016/j.joen.2016.08.003

Azim AA, Aksel H, Zhuang T, Mashtare T, Babu JP, Huang GT. Efficacy of 4 irrigation protocols in killing bacteria colonized in dentinal tubules examined by a novel confocal laser scanning microscope analysis. J Endod. 2016;42(6):928-34. https://doi.org/10.1016/j.joen.2016.03.009 PMid:27130334 DOI: https://doi.org/10.1016/j.joen.2016.03.009

Chen JE, Nurbakhsh B, Layton G, Bussmann M, Kishen A. Irrigation dynamics associated with positive pressure, apical negative pressure and passive ultrasonic irrigations: A computational fluid dynamics analysis. Aust Endod J. 2014;40(2):54-60. https://doi.org/10.1111/aej.12027 PMid:25244218 DOI: https://doi.org/10.1111/aej.12027

van der Sluis LW, Versluis M, Wu MK, Wesselink PR. Passive ultrasonic irrigation of the root canal: A review of the literature. Int Endod J. 2007;40(6):415-26. https://doi.org/10.1111/j.1365-2591.2007.01243.x PMid:17442017 DOI: https://doi.org/10.1111/j.1365-2591.2007.01243.x

Seltzer S, Naidorf IJ. Flare-ups in endodontics: I. Etiological factors. J Endod. 1985;11(11):472-8. https://doi.org/10.1016/S0099-2399(85)80220-X PMid:3868692 DOI: https://doi.org/10.1016/S0099-2399(85)80220-X

Romualdo PC, de Oliveira KM, Nemezio MA, Küchler EC, Silva RA, Nelson-Filho P, et al. Does apical negative pressure prevent the apical extrusion of debris and irrigant compared with conventional irrigation? A systematic review and meta-analysis. Aust Endod J. 2017;43(3):129-37. https://doi.org/10.1111/aej.12162 PMid:28150896 DOI: https://doi.org/10.1111/aej.12162

Carvalho MC, Zuolo ML, Arruda-Vasconcelos R, Marinho AC, Louzada LM, Francisco PA, et al. Effectiveness of XP-endo finisher in the reduction of bacterial load in oval-shaped root canals. Braz Oral Res. 2019;33:e021. https://doi.org/10.1590/1807-3107bor-2019.vol33.0021 PMid:31508722 DOI: https://doi.org/10.1590/1807-3107bor-2019.vol33.0021

Xin Y, Yang J, Song KY. In vitro evaluation of the effectiveness of XP-endo Finisher file on smear layer removal after root canal instrumentation. Hua Xi Kou Qiang Yi Xue Za. 2019;37(1):48-52. https://doi.org/10.7518/hxkq.2019.01.009 PMid:30854818

Nangia D, Nawal RR, Yadav S, Talwar S. Influence of final apical width on smear layer removal efficacy of xp endo finisher and endodontic needle: An ex vivo study. Eur Endod J. 2020;5(1):18-22. https://doi.org/10.14744/eej.2019.58076 PMid:32342033 DOI: https://doi.org/10.14744/eej.2019.58076

Gündoğar M, Sezgin GP, Kaplan SS, Özyürek H, Uslu G, Özyürek T. Postoperative pain after different irrigation activation techniques: A randomized, clinical trial. Odontology. 2021;109(2):385-92. https://doi.org/10.1007/s10266-020-00553-5 PMid:32915346 DOI: https://doi.org/10.1007/s10266-020-00553-5

Yusufoglu SI, Keskin NB, Saricam E, Bozkurt DA. Comparison of apical debris extrusion using EDDY, passive ultrasonic activation and photon-initiated photoacoustic streaming irrigation activation devices. Aust Endod J. 2020;46(3):400-4. https://doi.org/10.1111/aej.12429 PMid:32881182 DOI: https://doi.org/10.1111/aej.12429

Avaliable from: https://pdf.medicalexpo.com/pdf/fkg-dentaire/xp-endo-finisher/72216-182285.html.

Sarıyılmaz E, Keskin C. Apical extrusion of debris and irrigant using xp-endo finisher, endoactivator, passive ultrasonic irrigation or syringe irrigation. Meandros Med Dent J. 2018;19(2):127-31. https://doi.org/10.4274/meandros.24008 DOI: https://doi.org/10.4274/meandros.24008

Al-Nahlawi T, Hatab TA, Alrazak MA, Al-Abdullah A. Effect of intracanal cryotherapy and negative irrigation technique on postendodontic pain. J Contemp Dent Pract. 2016;17(12):990-6. PMid:27965485 DOI: https://doi.org/10.5005/jp-journals-10024-1969

Hanafy M, Kamel W, Nour El Din M. Effect of xp-endo finisher on post-instrumentation pain after using different niti rotary systems. Al Azhar Dent J Girls. 2020;7(2):157-64. https://doi.org/10.21608/ADJG.2020.7531.1078 DOI: https://doi.org/10.21608/adjg.2020.7531.1078

Ž ivković S, Nešković J, Jovanović-Medojević M, Popović-Bajić M, Živković-Sandić M. XP-endo Finisher: A new solution for smear layer removal. Stomatol Glas Srb. 2019;62(3):122-9. https://doi.org/10.1515/sdj-2015-0013 DOI: https://doi.org/10.1515/sdj-2015-0013

Bao P, Shen Y, Lin J, Haapasalo M. In vitro efficacy of xp-endo finisher with 2 different protocols on biofilm removal from apical root canals. J Endod. 2017;43(2):321-5. https://doi.org/10.1016/j.joen.2016.09.021 PMid:27939826 DOI: https://doi.org/10.1016/j.joen.2016.09.021

Moldauer BI. Comparison of the xp-endo finisher file system and passive ultrasonic irrigation (pui) on smear layer removal after root canal instrumentation Effectiveness of two irrigation methods on smear layer removal. J Dent Oral Health. 2017;4(1):1-7. https://doi.org/M10.17303/jdoh.2017.101 DOI: https://doi.org/10.17303/jdoh.2017.101

Kfir A, Moza-Levi R, Herteanu, Weissman A, Wigler R. Apical extrusion of debris during the preparation of oval root canals: A comparative study between a full-sequence SAF system and a rotary file system supplemented by XP-endo finisher file. Clin Oral Investig. 2018;22(2):707-13. https://doi.org/10.1007/s00784-017-2144-9 PMid:28608053 DOI: https://doi.org/10.1007/s00784-017-2144-9

Azimian S, Bakhtiar H, Azimi S, Esnaashari E. In vitro effect of XP-endo finisher on the amount of residual debris and smear layer on the root canal walls. Dent Res J (Isfahan). 2019;16(3):179-184. PMid:31040874 DOI: https://doi.org/10.4103/1735-3327.255740

De-Deus G, Belladonna FG, de Siqueira Zuolo A, Perez R, Carvalho MS, Souza EM, et al. Clin Oral Investig. 2019;23(7):3087-93. https://doi.org/10.1007/s00784-018-2729 PMid:30417226 DOI: https://doi.org/10.1007/s00784-018-2729-y

Singh RD, Khatter R, Bal RK, Bal CS. Intracanal medications versus placebo in reducing postoperative endodontic pain-a double-blind randomized clinical trial. Braz Dent J. 2013;24(1):25-9. https://doi.org/0.1007/s00784-018-2729-y PMid:30417226 DOI: https://doi.org/10.1590/0103-6440201302039

Shetty VP, Naik BD, Pachlag AK, Yeli MM. Comparative evaluation of the amount of debris extruded apically using conventional syringe, passive ultrasonic irrigation and endoirrigator plus system: An in vitro study. J Conserv Dent. 2017;20(6):411-4. https://doi.org/10.4103/JCD.JCD_200_17 PMid:29430092 DOI: https://doi.org/10.4103/JCD.JCD_200_17

Khalap ND, Kokate S, Hegde V. Ultrasonic versus sonic activation of the final irrigant in root canals instrumented with rotary/reciprocating files: An in-vitro scanning electron microscopy analysis. J Conserv Dent. 2016;19(4):368-72. https://doi.org/10.4103/0972-0707.186451 PMid:27563189 DOI: https://doi.org/10.4103/0972-0707.186451