Postendodontic pain following occlusal reduction in mandibular posterior teeth with symptomatic irreversible pulpitis and sensitivity to percussion: a single-centre randomized controlled trial.

Ahmed, Y E; Emara, R S; Sarhan, S M; El Boghdadi, R M; El-Bayoumi, M A A; El-Far, H M M; Sabet, N E; Abou El-Nasr, H M; Gawdat, S I; Amin, S A W

AIM This randomized, prospective, controlled trial assessed the effect of occlusal reduction on postendodontic pain and medication intake following root canal treatment of mandibular posterior teeth with symptomatic irreversible pulpitis with sensitivity to percussion treated in two visits. METHODOLOGY Three hundred and eight patients were randomly assigned into two equal groups according to whether occlusal reduction was done or not (n=154). For all patients, root canal treatment was carried out in two visits without intracanal medication. Patients assessed their pain using the 0-10 numerical rating scale (NRS) 6h, 12h 24h, 48h after the first visit (Postinstrumentation) and 6h and 12h following root canal filling (Postobturation). Patients, also, recorded their medication intake (Sham or analgesic) postinstrumentation and postobturation; patients initially received a sham capsule, but, if pain persisted, an analgesic was prescribed. Data were analysed using Mann-Whitney U-test, Friedman's test, Wilcoxon's rank test and Chi2 (χ2 ) test. The Relative Risk (RR) and its 95% confidence interval (CI) were calculated for binary data. RESULTS Occlusal reduction was associated with less pain intensity than no occlusal reduction at 12h and 24h postinstrumentation (p<0.05). Pain intensity significantly and gradually decreased with both groups at all postinstrumentation and postobturation timepoints compared to preoperative pain (p<0.05). The RR of moderate-to-severe pain was 0.61 (95% CI: 0.41, 0.91) 12h postinstrumentation and the RR of pain incidence, regardless of its level, was 0.75 (95% CI: 0.61, 0.92) 24h postinstrumentation. There was no significant difference in medication intake (sham or analgesic) between groups (p>0.05). CONCLUSIONS Occlusal reduction was effective in reducing the intensity of postoperative pain 12h and 24h after root canal instrumentation in the first visit in patients with symptomatic irreversible pulpitis with sensitivity to percussion. Occlusal reduction lowered the risk of moderate-to-severe pain by about 40% 12h postinstrumentation and the overall risk of pain by 25% 24h postinstrumentation; yet, it did not affect medication intake.