Frequency of post obturation pain by using ibuprofen and ibuprofen/dexamethasone infiltration in single visit root canal treatment cases

Mehmood Ahmed Rana, Sadiq Amin Ahmed Rana, Mobeen Akhtar, Muzammil Jamil Ahmed Rana, Muhammad Kashif


Background: Pain after root canal treatment is a challenging problem for the operative dentists over the last few years. The development of pain is dependent on the intensity of tissue damage. Inflammation is characterized by a series of vascular events in response to tissue injury. The release of mediators is responsible for much of the pain. The rationale of this study is to use NSAIDs alone or in combination with dexamethasone to reduce post treatment swelling and pain following endodontic therapy. The objective of the study was to compare the frequency of post obturation pain by using ibuprofen or ibuprofen/ dexamethasone infiltration in single visit endodontic cases.

Methods: This study was carried out in the Operative Dentistry, Department (AFID), Rawalpindi, Pakistan from December 2015 to May 2016 after approval from the Institutional Ethical Review Board. After an informed consent, 128 patients fulfilling inclusion criteria were divided in to two equal groups. In Group A, after root canal treatment, an additional single shot local infiltration of 0.5 mg dexamethasone was given in periapical area. Both the patient groups were prescribed ibuprofen 400 mg three times a day. Patient’s pain response was recorded after 24 hours of treatment, using visual analogue scale. Data was analyzed using SPSS version 17.

Results: After 24 hours, 6 (9.4%) patients showed the pain in group A while 16 (25.0%) patients complained of pain in group B.

Conclusions: The results of this study showed, group A showed less postoperative pain as compared to group B where only ibuprofen was given.


Post obturation pain, Lateral condensation technique, Dexamethasone, Ibuprofen

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Simpson M, Drum M, Nusstein J, Reader A, Beck M. Effect of combination of preoperative ibuprofen/acetaminophen on the success of the inferior alveolar nerve block in patients with symptomatic irreversible pulpitis. J Endod. 2011;37:593–7.

Merry AF, Gibbs RD, Edwards J. Combined acetaminophen and ibuprofen for pain relief after oral surgery in adults: a randomized controlled trial. Br J Anaesth. 2010;104:657–9.

Mehlisch D, Aspley S, Daniels S, Bandy D. Comparison of the analgesic efficacy of concurrent ibuprofen and paracetamol with ibuprofen or paracetamol alone in the management of moderate to severe acute postoperative dental pain in adolescents and adults: a randomized, double-blind, placebo-controlled, parallel-group, single-dose, two-center, modified factorial study. Clin Ther. 2010;32:882–95.

Mehlish D, Aspley S, Daniels S, Southerden K, Christensen K. A single-tablet fixeddose combination of racemic ibuprofen/paracetamol in the management of moderate to severe postoperative dental pain in adult and adolescent patients: a multicenter, two-stage, randomized, double-blind, parallel-group, placebocontrolled, factorial study. Clin Ther. 2010;32:1033–49.

Moore RA, Straube S, Paine J, Derry S, McQuay H. Minimum efficacy criteria for comparisons between treatments using individual patient meta-analysis of acute pain trials: examples of etoricoxib, paracetamol, ibuprofen, and ibuprofen/paracetamol combinations after third molar extraction. Pain. 2011;152:982–9.

Ong CK, Seymour RA, Lirk P, Merry AF. Combining paracetamol (acetaminophen)with nonsteriodal anti-inflammatory drugs: a qualitative systematic review of analgesic efficacy for acute postoperative pain. Anesth Analg. 2010;110:1170–9.

Sniezek PJ, Brodland DG, Zitelli JA. A randomized controlled trial comparing acetaminophen, acetaminophen and ibuprofen, and acetaminophen and codeine for postoperative pain relief after mohs surgery and cutaneous reconstruction. Dermatol Surg. 2011;37:1007–13.

Wells LK, Drum M, Nusstein J, Reader A, Beck M. Efficacy of ibuprofen and ibuprofen/acetaminophen on postoperative pain in symptomatic patients with a pulpal diagnosis of necrosis. JOE. 2011;37:1608-12.

Abdul Munem, Zahur Qayyum. Effect of dexamethasone, Ibuprofen combination on post operative sequel of third molar surgery. PODJ. 2004;24:1.

Linde A, Goldberg M. Dentinogenesis. Crit Rev Oral Biol Med. 2013;4:679-728.

Zhang C, Huang W, Hou BX. Evaluation of homogeneity and density of root canal filling with four obturation techniques. Zhonghua Kou Qiang Yi Xue Za Zhi. 2010;45:673-7.

Mohammadi Z. Lasers as aids for cleaning, shaping, and obturation of the root canal system. Dent Today. 2009;28:81-2, 84, 86.

Pérez Heredia M, ClaveroGonzálezJ, Ferrer Luque CM, González Rodríguez MP. Apical seal comparison of low-temperature thermoplasticized gutta-percha technique and lateral condensation with two different master cones. Med Oral Patol Oral Cir Bucal. 2012;12:175-9.

Gopikrishna V, Parameswaren A. Coronal sealing ability of three sectional obturation techniques--SimpliFill, Thermafil and warm vertical compaction--compared with cold lateral condensation and post space preparation. Aust Endod J. 2015;32:95-100.

Mikrogeorgis G, Molyvdas I, Lyroudia K, Nikolaidis N, Pitas I. A new methodology for the comparative study of the root canal instrumentation techniques based on digital radiographic image processing and analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101:125-31.

Goldberg M, Smith AJ. Cells and extracellular matrices of dentin and pulp: a biological basis for repair and tissue engineering. Crit Rev Oral Biol Med. 2014;15:13-27.

Alonso-Ezpeleta LO, Gasco-Garcia C, Castellanos-Cosano L, Martín- González J, López-Frías FJ, Segura-Egea JJ. Postoperative pain after one-visit root-canal treatment on teeth with vital pulps: Comparison of three different obturation techniques. Med Oral Patol Oral Cir Bucal. 2012;17:721-7.

Mohammadi Z. Lasers as aids for cleaning, shaping, and obturation of the root canal system. Dent Today. 2009;28:81-6.

Al-Negrish AR, Habahbeh R. Flare up rate related to root canal treatment of asymptomatic pulpally necrotic central incisor teeth in patients attending a military hospital. Dent. 2015;34:635-40.

Avery JK. Structural elements of the young and normal human pulp. Oral Surg. 2011;32:113.

Kuştarci A, Akpinar KE, Sümer Z, Er K, Bek B. Apical extrusion of intracanal bacteria following use of various instrumentation techniques. Int Endod J. 2014;41:1066-71.