Influence of occlusal reduction on postoperative pain following single-visit root canal treatment in mandibular molars: a randomized controlled trial
Article information
Abstract
Objectives
Postoperative pain is a frequent complication following root canal treatment, and occlusal reduction (OR) has been suggested as a means to minimize such discomfort. However, existing evidence regarding its effectiveness remains inconclusive. This study aimed to evaluate the influence of OR on postoperative pain following single-visit root canal treatment in mandibular molars. It also examined whether preoperative pain intensity affects the postoperative response to OR.
Methods
A total of 280 eligible patients with irreversible pulpitis in their first or second mandibular molars were enrolled and stratified into four groups based on their preoperative pain intensity using the visual analogue scale (VAS): 0, no pain; 1–3, mild; 4–7, moderate; and 8–10, severe. Each group was further allocated into OR or no occlusal reduction (NOR) subgroups using block randomization. Standardized endodontic procedures were performed under rubber dam isolation. Postoperative pain was recorded at 24 hours, 48 hours, and 1 week using the same VAS scale. Data were analyzed using the chi-square tests (p ≤ 0.05).
Results
Overall, a statistically significant difference between OR and NOR was found at the 48-hour interval, favoring OR. Stratified analysis showed significant pain reduction at 24 hours in the moderate pain category and near-significant differences in the severe pain group at both 24 hours and 48 hours.
Conclusions
OR reduced early postoperative pain most noticeably in patients presenting with moderate to severe preoperative pain, whereas its effect was minimal in asymptomatic or mildly symptomatic cases.
INTRODUCTION
Postoperative pain following root canal treatment (RCT) remains a frequent and significant concern in endodontic practice, with incidence rates reported from 25% to 40% [1,2]. Although the primary goal of endodontic therapy is to eliminate infection and preserve the tooth in a symptom-free state, postoperative discomfort can substantially affect patient satisfaction and the perceived success of treatment [3]. So it is no overstatement when Gupta et al. [4] postulated that ‘patients might regard postoperative pain and flare-ups as a yardstick by which the operator’s abilities are assessed.’ Consequently, understanding and minimizing postoperative pain has become an imperative aspect of evidence-based endodontic care.
Single-visit root canal treatment has gained wide clinical acceptance because of its advantages, including reduced chair time, fewer interappointment flare-ups, and greater patient convenience [5–7]. However, since instrumentation, irrigation, obturation, and occlusal loading all occur within a single appointment, the risk of postoperative pain may be influenced by multiple procedural and biological factors occurring in close succession.
Postoperative endodontic pain is multifactorial. It results primarily from acute periapical inflammation triggered by mechanical, chemical, or microbial irritation beyond the apical foramen [8], leading to the release of inflammatory mediators such as prostaglandins, bradykinin, and leukotrienes [9]. Procedural factors including extrusion of debris, over instrumentation, irrigation dynamics, and obturation protocols have all been associated with varying degrees of postoperative discomfort [10].
Among procedural variables, occlusal load has long been proposed to influence postoperative pain. Occlusal reduction (OR) involves the deliberate removal of occlusal contacts—both in centric occlusion and excursive movements—to decrease mechanical loading on a treated tooth. The principle is that after root canal therapy, periapical tissues can become inflamed and sensitized. Therefore, excessive occlusal force may exacerbate this inflammation by mechanically stimulating nociceptors present in the periodontal ligament. OR may also decrease the pressure caused by the inflamed periapical tissues, alleviating the effect of mechanical allodynia [11]. In this context, OR may also be viewed as a form of mechanical or occlusal “unloading,” whereby functional occlusal forces transmitted to inflamed periapical tissues are temporarily minimized to reduce postoperative discomfort.
Despite its clinical rationale, the literature remains inconclusive regarding the true benefit of OR. Some authors have reported a significant reduction in postoperative pain [12–14], while others have found no meaningful difference between reduced and unreduced groups [15–17]. This literary equipoise highlights the need for further well-designed clinical trials to clarify whether OR genuinely influences postoperative pain or if it is a myth perpetuated by tradition.
Accordingly, the present study primarily aims to evaluate the influence of OR on postoperative pain following single-visit RCT in mandibular first and second molars with asymptomatic and symptomatic irreversible pulpitis. Its secondary objective is to determine whether preoperative pain intensity affects postoperative pain outcomes and if occlusal relief influences it. The null hypothesis reads as: ‘OR has no statistically significant influence on postoperative pain following single-visit RCT, irrespective of preoperative pain intensity.’
METHODS
This was a single-blinded, prospective, randomized, parallel-group, single-center clinical trial conducted in the Postgraduate Clinic of the Department of Conservative Dentistry and Endodontics at CSI College of Dental Sciences & Research, between February 2025 and October 2025. The study followed the ethical principles of the latest version of the Declaration of Helsinki (2024) and was designed and reported in compliance with the updated CONSORT 2025 guidelines for randomized clinical trials [18]. This study received approval from the Institutional Ethics Committee (CSICDSR/IEC/0301/2024) and was prospectively registered with the Clinical Trials Registry of India (CTRI/2025/01/079047).
Sample size calculation
The sample size was calculated using G*Power software for Windows (ver. 3.1.9.7) with a medium standardized effect size (Cohen’s d = 0.50), an α-error probability of 0.05, a power of 0.95, and an allocation ratio = 1 [19], giving us a recommended size of 210 with 105 participants in each group. After accounting for the possibility of dropouts, a final sample size of 280 with 140 participants for each type of intervention was determined.
Participants and eligibility criteria
Patients who met the following inclusion and exclusion criteria were recruited after obtaining written informed consent. All the participants were required to be able to comprehend and utilize a 10-point visual analogue scale (VAS) for pain assessment and be willing to verbally communicate their symptoms and how they were feeling.
1. Inclusion criteria
• Systemically healthy adult patients aged 18–70 years (American Society of Anesthesiologists physical status classification [ASA] I and II)
• Mandibular first and second molars diagnosed with asymptomatic or symptomatic irreversible pulpitis
• Periapical index (PAI) score ≤ 2
• Patients providing informed consent and willing to comply with follow-up
• Patients requiring and willing to receive full coverage crowns following RCT
2. Exclusion criteria
• Immunocompromised or systemically compromised patients (ASA > II)
• Re-RCTs or intentional RCTs
• Teeth lacking opposing dentition and with significant malocclusions like crossbite, scissor bite, deep bite, etc.
• Teeth with insufficient occlusal height, where OR would be detrimental to the tooth’s dimensions
• Severely curved (>30°) or aberrant root morphology
• Pregnant or lactating women
• Patients with allergies to any of the materials used in the study
• Bruxism or parafunctional habits contributing to excessive occlusal load and lost vertical dimension
If patients were initially recruited for the study but clinically required two visits for precise/sufficient management, they were excluded from the study. New patients were then recruited to replace them.
Preoperative assessment and stratification
Demographic details and idiosyncrasies were recorded for each eligible patient. Baseline pain intensity was scored using a modified 10-point VAS before local anesthesia was administered on the day of the procedure. Based on their preoperative VAS scores, 280 patients were stratified into four groups: no pain (VAS 0, n = 70), mild pain (VAS 1–3, n = 70), moderate pain (VAS 4–7, n = 70), and severe pain (VAS 8–10, n = 70).
These groups were further divided into two subgroups each: OR (n = 35) and no OR (NOR) (n = 35), such that both interventions were given to every type of preoperative pain category. Across all four groups, there was a total of 140 participants who received the intervention and 140 who did not receive the intervention.
Randomization and blinding
Patients were recruited into each group based on their preoperative VAS. Further allocation into their intervention group (OR or NOR) was done via block randomization. The randomization sequence was generated using a computer-based random number generation software (Random Allocation Software ver. 2.0) by an independent researcher who was not involved in the clinical procedure or data analysis. The operator who performed all the procedures was aware of the assigned intervention, whereas both the participants and the researcher interviewing them after the procedure remained blinded, rendering the study single-blinded in design.
Root canal procedure
All the procedures were completed by a single, experienced operator. Single-visit RCT was initiated after administering 1.8 mL of 2% lignocaine with 1:80,000 adrenaline (Lignox; Warren Pharmaceuticals Pvt Ltd., Mumbai, India). Following rubber dam isolation, access opening was done using sterile burs from the Mani Endo Access Diamond Bur kit (MANI Inc., Tochigi, Japan). If patients reported any pain or discomfort during the procedure, they were administered either supplemental injections (intrapulpal or intraligamentary) or an additional inferior alveolar nerve block.
The working length was established using E-Pex Apex Locator (Eighteeth, Changzhou, China) with size #10 K files (MANI Inc.) and was cross-verified radiographically. Initial glide path preparation was performed manually until sizes #20 K or #25 K files. Canal lubrication and smear layer removal were obtained using ethylenediaminetetraacetic acid 10% and carbamide peroxide 15% (Endoprep RC; Anabond Stedman Pharmaceuticals, Chennai, India). Biomechanical preparation was performed using Woodpecker EndoPace Brushless Endomotor (IDS Denmed, New Delhi, India) and the NeoEndo S rotary file system (Orikam Healthcare India Pvt. Ltd., Gurgaon, India) until a size of 25/0.06, 0.5 mm short of the apex.
Intermittent irrigation was performed using copious amounts of saline mixed with 2% w/v povidone-iodine (Puradine; Leeford Healthcare Ltd., Mumbai, India) through a 25-gauge beveled needle (Dispo Van; Hindustan Syringes and Medical Devices, New Delhi, India), positioned 1–2 mm short of the working length, with a controlled flow rate of approximately 1 mL/min to reduce the likelihood of apical debris extrusion. After final irrigation, the canals were dried with paper points and obturated with 25/0.06 single cone Neoendo Gutta Percha Points (Orikam Healthcare India Pvt. Ltd.) and zinc oxide eugenol sealer. The gutta-percha was sheared, and the chamber was dried and disinfected to receive the final post-endodontic restoration.
Occlusal reduction protocol
Post-endodontic restoration of the cavity was done using the Te-Econom Plus composite system (Ivoclar Vivadent AG, Schaan, Liechtenstein). Participants in the OR group of every preoperative pain category received a standardized reduction of approximately 1.5–2 mm using a high-speed handpiece and an SF-13 bur (Frank Dental GmbH, Hainburg, Germany) under continuous water coolant. The range was to ensure that all the cusps (both functional and nonfunctional cusps, as well as the marginal ridges) were not in contact during both centric and excursive movements. The amount of reduction was cross-verified using the sizes 1.5 mm (blue) and 2.0 mm (green) from the autoclavable MiK PrepGauge Silicone Strips kit (MiK Dental, Mumbai, India). The reduction almost mimicked a crown preparation clearance. All the participants who received OR were recalled according to their convenience after a minimum of 2 weeks, for crown preparation and the placement of full coverage crowns.
No occlusal reduction protocol
Post-endodontic restoration of the cavity was done until cuspal contacts and anatomy were completely re-established using the same composite system. The restoration was checked for iatrogenic high points and then polished. To ensure that all the patients in every preoperative pain category who received NOR were unaware whether their teeth had been reduced or not, a high-speed handpiece with copious amounts of water was activated inside the patient’s mouth without contacting the occlusal surface to simulate the procedure used in the OR group. If iatrogenic high points were present, their elimination was sufficient to recreate the same. If the patients in this category also required full coverage crowns owing to mutilated preoperative clinical conditions, they were recalled after 2 weeks for crown preparation.
Outcome measures
Pain levels were recorded at 24 hours, 48 hours, and 1 week posttreatment using the same 10-point VAS via structured telephonic interviews. Each patient was reminded of the scale before rating their pain. The nature of pain and a trigger factor (if any) was also recorded and categorized as spontaneous continuous, spontaneous occasional, and stimulus-based (during mastication or thermal stimuli).
All patients were prescribed ketorolac 10 mg (Ketorol DT; Dr. Reddy’s Laboratories Ltd., Hyderabad, India) as rescue medication and instructed to take it only in case of considerable pain. Analgesic consumption was to be reported and documented. Alternate phone numbers were also noted so that the participants could be efficiently contacted.
Statistical analysis
Data analysis was performed using IBM SPSS Statistics software ver. 24.0 (IBM Corp., Armonk, NY, USA). The distribution of pre- and postoperative pain scores was assessed using the Shapiro-Wilk test. As the data were non-normally distributed and ordinal in nature (VAS scores), nonparametric tests were employed for all inferential analyses. Between-group comparisons of postoperative pain scores between the OR and NOR groups were performed using the Mann-Whitney U test. Within-group changes in postoperative pain scores over time were analyzed using the Wilcoxon signed-rank test. Baseline demographic variables and the prevalence and distribution of postoperative pain triggers were analyzed using the chi-square test. A p-value ≤0.05 was considered statistically significant.
RESULTS
The overall process of participant enrollment, stratification, allocation, follow-up, and analysis has been illustrated in Figure 1. Baseline demographic distribution and clinical characteristics of patients in the OR and NOR groups are presented in Table 1. The two groups were comparable with respect to age, sex distribution, and type of mandibular molar treated, indicating successful randomization and homogeneity between groups.
CONSORT 2025 flow diagram showing participant enrollment, stratified randomization, allocation, follow-up, and analysis. VAS, visual analogue scale; OR, occlusal reduction; NOR, no occlusal reduction.
Baseline demographic distribution and clinical characteristics of patients in the OR and NOR groups
The comparison of postoperative pain scores between the OR and NOR groups at different time intervals is shown in Table 2. At baseline, no statistically significant difference in preoperative VAS scores was observed between the two groups (p = 0.959). At 24 hours postoperatively, mean pain scores were lower in the OR group compared with the NOR group; however, this difference did not reach statistical significance (p = 0.155). At 48 hours, patients in the OR group reported significantly lower postoperative pain scores than those in the NOR group (p = 0.031). At the 1-week follow-up, all patients in both groups reported complete resolution of pain (VAS 0), with no difference between groups (p > 0.999). Within-group comparisons of postoperative pain scores over time are presented in Table 3. Both OR and NOR groups demonstrated a statistically significant reduction in postoperative pain between 24 hours and 48 hours, and between 48 hours and 1 week (all p < 0.001). These findings indicate a consistent and significant decline in pain intensity over time.
Comparison of pain scores between the OR and NOR groups
Within-group comparison of postoperative pain scores over time
Between-group comparisons of postoperative pain at 24 hours stratified by preoperative pain intensity are shown in Table 4. In patients with moderate preoperative pain (VAS 4–7), the OR group demonstrated significantly lower postoperative pain scores compared with the NOR group at 24 hours (p = 0.024). No statistically significant differences were observed in patients with no pain (VAS 0) or mild pain (VAS 1–3). In patients with severe preoperative pain (VAS 8–10), lower mean postoperative pain scores were observed in the OR group; however, this difference did not reach statistical significance (p = 0.055). This suggests that the effect of OR may be more pronounced among patients presenting with higher preoperative pain intensities, particularly during the early postoperative period. Patients with no preoperative pain (VAS 0) or mild pain (VAS 1–3) showed negligible postoperative discomfort regardless of occlusal intervention. Between-group comparisons at 48 hours stratified by preoperative pain intensity are presented in Table 5. Although the OR group consistently demonstrated lower mean pain scores across moderate and severe preoperative pain categories, these differences were not statistically significant (p = 0.099 and p = 0.051, respectively). Between-group comparison at the 1-week follow-up was not included, as all participants in both groups reported complete resolution of pain (VAS 0), precluding meaningful statistical analysis.
Between-group comparison of pain scores at 24 hours
Between-group comparison of pain scores at 48 hours
Figure 2 illustrates the distribution of postoperative pain across the four preoperative pain categories at 24 hours and 48 hours. The graphical pattern reflects a progressive decline in reported pain across time for both groups, with visibly lower pain frequencies among OR cases, especially in the moderate and severe pain categories at 48 hours. The 1-week interval was excluded from the graphical representation since all patients reported a VAS score of 0 by that time.
Graph depicting the postoperative pain trend across the four categories of pain at 24-hour and 48-hour time intervals. VAS, visual analogue scale; OR, occlusal reduction; NOR, no occlusal reduction.
To further explore the clinical relevance of postoperative pain, VAS scores were dichotomized into “pain” (VAS 1–10) and “no pain” (VAS 0) categories, as shown in Figure 3. This approach enabled a clearer distinction between symptom presence and absence by minimizing subjective variability in intermediate scores. At 24 hours postoperatively, pain was reported by 96 patients in the OR group and 100 patients in the NOR group, while 44 patients and 40 patients, respectively, remained pain-free. By 48 hours, the number of patients reporting pain decreased more markedly in the OR group (n = 29) compared with the NOR group (n = 44), whereas the majority—111 patients in OR and 96 patients in NOR—reported no pain. An alternative dichotomization (VAS 0–1, no pain; VAS 2–10, pain) was also tested to account for borderline responses where a VAS score of 1 may be of significant consideration to some, while others may perceive it as ‘no pain/discomfort’ (depending on the patient’s pain threshold and perception of recovery). The distribution pattern remained consistent under this adjusted model, confirming the robustness of the observed trend.
Graph depicting the dichotomized postoperative pain trend for both occlusal reduction (OR) and no occlusal reduction (NOR) groups at 24 hours and 48 hours, where a visual analogue scale (VAS) score of 0 was considered as ‘no pain’ and VAS scores of 1–10 were taken as ‘pain.’
The prevalence and distribution of postoperative pain triggers were analyzed using the chi-square test to evaluate whether any particular trigger mechanism was significantly associated with postoperative pain (Table 6). Among the 196 patients who reported postoperative discomfort (VAS 1–10), the majority of cases were stimulus-based (78.6%), followed by spontaneous occasional pain (18.9%) and spontaneous continuous pain (2.6%). Although this distribution did not reach statistical significance (p = 0.078), the findings indicate that postoperative pain was provoked predominantly by a functional stimulus such as mastication (occlusal contact) rather than occurring spontaneously.
Overall prevalence of the type of trigger mechanism among the patients who reported postoperative pain (n = 196)
DISCUSSION
This study evaluated the influence of OR on early postoperative pain after single-visit RCTs in mandibular first and second molars. To the best of the authors’ knowledge, no previous randomized trial of occlusal adjustment after single-visit RCT has deliberately reserved a distinct arm of pain-free teeth (preoperative VAS = 0) to test whether occlusal manipulation affects the onset of postoperative discomfort in previously asymptomatic cases. This design, therefore, allowed assessment of both prophylactic and therapeutic roles of OR in the same trial population.
Mandibular molars were selected as they represent some of the most clinically demanding teeth. Epidemiologic data identify the mandibular first molar as the most frequently treated tooth endodontically, primarily because it is the first permanent tooth to erupt and thus highly susceptible to decay [20]. They are also subject to the highest occlusal loads during mastication [21], making them suitable for evaluating the influence of OR on postoperative pain. Furthermore, their complex root canal anatomy and multifactorial treatment challenges [22] make the findings more clinically relevant and generalizable than studies limited to single-rooted teeth.
The findings demonstrate that OR produced a transient decrease in early postoperative pain, with statistical significance at 48 hours (p = 0.031). The effect was most pronounced among patients with moderate preoperative pain, whereas those with mild or no preoperative symptoms exhibited negligible differences between interventions. In patients presenting with severe preoperative pain, OR was associated with lower postoperative pain scores at both 24 and 48 hours but failed to achieve statistical significance (p = 0.055 and p = 0.051, respectively). Although these differences did not reach statistical significance, it is noteworthy that the consistently lower pain scores observed suggest a potential biological effect that may warrant further investigation in larger cohorts. This trend aligns with the broader evidence that preoperative pain intensity is one of the strongest predictors of postoperative symptoms [17,23]. Patients presenting with elevated baseline nociceptive drive are more likely to benefit from the mechanical unloading achieved through OR.
The biological plausibility of these findings can be explained through mechanisms of peripheral and central sensitization. Inflammatory mediators and bacterial lipopolysaccharides within the pulp and periapical tissues sensitize nociceptors by up-regulating transient receptor potential vanilloid-1 channels, amplifying peripheral excitability [4,24]. Repeated afferent stimulation of sensitized fibers can subsequently induce central sensitization—a persistent state of hyperexcitability within spinal and trigeminal nociceptive pathways that sustains pain perception even after local inflammation subsides [25]. OR may alleviate peripheral mechanical loading on the inflamed periodontal ligament and periapical tissues, thereby reducing stimulus-driven nociceptive input to the central nervous system. This neurophysiological unloading likely explains why the therapeutic benefit of OR is most evident during the early, stimulus-evoked phase of healing.
The current evidence on OR remains heterogeneous. Rosenberg et al. [12] reported that total OR reduced postoperative pain in vital teeth with preoperative tenderness, whereas Parirokh et al. [17] observed no significant difference in such cases. A recent systematic review by Nguyen-Nhon et al. [11] concluded that OR may reduce postoperative pain in symptomatic teeth but highlighted a substantial heterogeneity among trials. Variations in case selection, irrigation protocols, intracanal medicaments, and timing of definitive restoration likely explain the inconsistent outcomes reported in earlier literature.
Irrigation was performed with sterile saline [26,27] because solutions such as sodium hypochlorite (NaOCl) and chlorhexidine (CHX) can independently influence postoperative outcomes owing to their tissue-damaging capacity and potential cytotoxicity when extruded apically. High concentrations of NaOCl have been linked to an increased incidence of postoperative discomfort [28]. CHX has been shown to reduce the survival rates of fibroblasts, myoblasts, and osteoblasts, thus affecting periapical healing [29]. Although NaOCl and CHX are valued for their abilities of tissue dissolvability and antimicrobial substantivity, using a biologically inert solution like saline ensured that any differences in postoperative pain reflected the mechanical and not the chemical effects of the treatment.
While this approach of removing confounding variables strengthened the study’s internal validity, it represents a limitation in terms of external generalizability, particularly in clinical settings where NaOCl and CHX are considered standard irrigants. Similarly, a zinc oxide eugenol-based sealer was used to maintain procedural uniformity and avoid the variable biological responses associated with newer bioceramic sealers. Thus, the findings should be interpreted within the context of the materials used in this study.
Multiple-visit RCTs introduce confounding factors such as interappointment leakage, medicament effects, and downtime. Conducting treatments in a single visit eliminates these factors, ensuring that postoperative pain can be accurately attributed to the variable under investigation. Moreover, it simplifies logistics and follow-up, which likely contributed to the absence of dropouts in the present trial. Our findings support a patient-centered approach to OR rather than a universal rule. For teeth with no or mild preoperative pain, routine OR appears unnecessary. When treating patients with higher pain intensities or those who express elevated anxiety or low pain tolerance, selective occlusal unloading may offer tangible early relief. Allowing patients to participate in the decision aligns with the principles of shared decision-making increasingly advocated in endodontic care.
The term ‘occlusal reduction’ is conventionally used to describe the removal of occlusal contacts, most often in a restorative or prosthodontic context. When the same procedure is undertaken with the aim of minimizing postoperative discomfort rather than facilitating tooth preparation, the authors suggest that the term ‘mechanical-’ or ‘occlusal unloading’ may better reflect its therapeutic intent. From a linguistic and clinical perspective, ‘reduction’ carries an operative and somewhat aggressive implication, whereas ‘unloading’ emphasizes the purposeful removal of occlusal stress transmitted to inflamed and sensitized periapical tissues more conservatively. Adopting this terminology could help distinguish between preparative and pain-modulating purposes of occlusal adjustment and align future endodontic literature with the underlying biomechanical rationale rather than the procedural technique.
Pain perception is subjective and shaped by psychosocial and cognitive factors. Dental anxiety, catastrophizing, and prior negative experiences can elevate pain reporting even when objective inflammation is comparable. Consequently, two patients experiencing similar tissue conditions may record markedly different VAS scores [30]. To address potential subjectivity, this study performed dichotomized analyses using two different models: pain (1–10) vs no pain (0), and pain (2–10) vs no pain (0, 1). Both models yielded consistent trends, reinforcing the reproducibility of the findings.
Strengths of this trial include stratified randomization based on preoperative pain intensity, standardized OR of 1.5–2 mm verified using calibrated gauges, and complete follow-up. However, the single-center design, inability to blind the operator, and reliance on self-reported pain scores rather than objective biomarkers represent inherent limitations. Although stratification improved clinical interpretability, subgroup analyses inevitably reduced statistical power, which may explain the absence of statistical significance in the severe pain category despite consistent directional trends. In addition, the study was limited to teeth diagnosed with irreversible pulpitis, excluding cases with necrotic pulp or established periapical pathosis, and other clinical characteristics, such as the nature of the pain, presence of tenderness, and thermal sensitivity, were not independently stratified, potentially contributing to variability in pain perception. Consequently, the findings cannot be extrapolated to all endodontic conditions. Future research should include multicenter designs, other endodontic pathologies, retreatment cases, analgesic consumption patterns, extended follow-up beyond the acute postoperative phase, and exploration of neurophysiological or molecular correlates underlying pain modulation following occlusal unloading.
CONCLUSIONS
OR following a single-visit RCT in teeth with irreversible pulpitis resulted in a modest but considerable reduction in early postoperative pain, especially in patients with elevated preoperative pain. For asymptomatic or minimally symptomatic teeth, the procedure is unnecessary. When indicated, however, it can be a simple adjunct to improve patient comfort—particularly in individuals who report higher dental anxiety or lower pain thresholds.
Notes
CONFLICT OF INTEREST
No potential conflict of interest relevant to this article was reported.
FUNDING/SUPPORT
The authors have no financial relationships relevant to this article to disclose.
ACKNOWLEDGMENTS
The authors would like to acknowledge and thank our peers, colleagues, and mentors for their guidance, support, and supervision.
AUTHOR CONTRIBUTIONS
Conceptualization: Sherwood IA, Kanesalingavelan S. Data curation: Chandrasekaran P, Abirami AA. Formal analysis, Project administration, Supervision, Validation: Sherwood IA. Investigation, Resources: Kanesalingavelan S. Methodology, Visualization: Kanesalingavelan S, Deepika KG G, Sherwood IA. Writing - original draft: Kanesalingavelan S, Deepika KG G. Writing - review & editing: Sherwood IA, Chandrasekaran P, Abirami AA. All authors read and approved the final manuscript.
DATA SHARING STATEMENT
The datasets are not publicly available but are available from the corresponding author upon reasonable request.
DISCLOSURE OF GENERATIVE AI IN SCIENTIFIC WRITING
No artificial intelligence was used for the conception, design, conduct, analysis, interpretation, or reporting of this study. Any assistance was solely to improve grammar, language, and readability of the manuscript.