Restorative Dentistry & Endodontics

Calcium hydroxide intracanal medication effects on pain and flare-up: a systematic review and meta-analysis: Ahmed Mohamed Ibrahim, Siza Yacoub Zakhary, Suzan Abdul Wanees Amin; Restor Dent Endod 2020;45(3):e26. Published online May 22, 2020; DOI: https://doi.org/10.5395/rde.2020.45.e26

Abstract PDF Supplementary Material PubReader ePub: Objectives
This study aimed to systematically review the pain and flare-up effects of calcium hydroxide (CH) as intracanal medication (ICM) in non-vital mature teeth.
Materials and Methods
Electronic-databases searching for published and grey literature and manual searching were conducted. Only randomized clinical trials (RCTs) were included comparing CH to other ICMs in non-vital mature teeth. The risk of bias was assessed using the RoB 2.0 Cochrane tool. The main outcomes were pain and flare-up. Qualitative and quantitative analysis, wherever applicable, was performed. The certainty of evidence (CoE) was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE).
Results
Sixteen articles were included in 6 comparisons at different time points for different outcomes. CH reduced pain risk than no ICM within the 1–14-days interval (p < 0.05) and than triple-antibiotic paste within the first day (p < 0.05) and was similar to corticosteroid/antibiotics combination (p > 0.05). Chlorhexidine (CHX) or CH/CHX, however, reduced pain levels than CH alone (p < 0.05). CH showed higher flare-up risk than CHX (p < 0.05). CoE, however, ranged from very low to moderate.
Conclusion
Most comparisons for different outcomes are based on very few studies, mostly low-powered, with an overall low CoE. Thus, the available evidence is considered insufficient to either support or refute CH effectiveness or to recommend one ICM over another. Therefore, further well-designed, larger RCTs are required.
Trial Registration
PROSPERO database Identifier: CRD42016041953

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Surgical management with intentional replantation on a tooth with palato-radicular groove: Jorge Forero-López, Luis Gamboa-Martínez, Laura Pico-Porras, Javier Laureano Niño-Barrera; Restor Dent Endod 2015;40(2):166-171. Published online December 22, 2014; DOI: https://doi.org/10.5395/rde.2015.40.2.166

Abstract PDF PubReader ePub: A palato-radicular groove (PRG) is a developmental anomaly primarily found in the maxillary lateral incisors. It is a potential communication path between the root canal and the periodontium that decreases the survival prognosis of the affected tooth, therefore compromising the stability of the dental structure in the oral cavity. The aim of this case report is to present an original technique where a PRG was treated by means of intracanal disinfection, PRG sealing with glass ionomer, replantation with intentional horizontal 180 degree rotation of the tooth, and an aesthetic veneer placed to provide adequate tooth morphology. The clinical and biological benefits of this novel technique are presented and discussed.

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The effect of calcium hydroxide on post-treatment pain: Wook Nam, Sang-Hyuk Park, Gi-Woon Choi; J Korean Acad Conserv Dent 2006;31(2):86-95. Published online March 31, 2006; DOI: https://doi.org/10.5395/JKACD.2006.31.2.086

Abstract PDF PubReader ePub

The purpose of this clinical study is to assess whether calcium hydroxide as an intracanal medication affects post-treatment pain in teeth especially odontogenic pain which comes from inflammation of the pulp and periradicular tissues when compared with no intracanal medication.

From 213 patients who has been treated 237 root canals due to significant pain (moderate-to-severe), we recorded their age, sex, treated tooth, degree of pain, pre-operative states of the tooth. We classified patients into 2 test group; Group 1 (not gain intracanal Ca(OH)₂), Group 2 (gain intracanal Ca(OH)₂). Through the survey from the patients, we let them write down the occurrence and degree of post-treatment pain in 4hours, 2days, 7days after treatment as none, mild, moderate or severe. The followings were evaluated; the overall incidence of flare-ups, the overall incidence of post-treatment pain in each group at each time period, the incidence of post-treatment pain in each group at each time period as related to pre-operative states of the teeth. These were compared statistically with Chi-square analysis (p < 0.05).

Under the condition of this investigation, no difference was observed in the incidence of post-treatment pain between the two groups. Therefore, Ca(OH)₂ as intracanal medication had no effect on preventing or decreasing the post-treatment pain.

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