Postoperative pain following root canal treatment with XP-Endo Finisher-assisted irrigant activation: a double-blind...

Postoperative pain is a common occurrence following root canal treatment, with reported incidence ranging from 3% to 58%. Contributing factors include insufficient canal debridement, extrusion of debris, and limitations in irrigation. While mechanical instrumentation aids in reducing microbial load, effective irrigation is essential for cleaning anatomically complex areas. The XP-Endo Finisher (XPF) is an innovative instrument designed to enhance irrigation efficacy. This study aimed to compare postoperative pain outcomes following final irrigation with either the XP-Endo Finisher or conventional needle irrigation in patients diagnosed with symptomatic irreversible pulpitis.

A double-blind randomized controlled trial was conducted on 80 systemically healthy patients aged 18 years and above, presenting with symptomatic irreversible pulpitis and preoperative pain scores ≤ 3 on the Numerical Rating Scale (NRS-11). Participants were randomly assigned to two equal groups: final irrigation using either the XP-Endo Finisher or traditional needle irrigation. Patients with recent analgesic use, non-restorable teeth, or known NSAID allergies were excluded. Root canal therapy was completed in two visits. Postoperative pain levels were recorded at 6 h, 12 h, 24 h, and daily up to 7 days using the NRS-11. Statistical analysis involved descriptive statistics, normality checks, and non-parametric tests for group comparisons.

At 6 h, the difference in pain scores between the groups was not statistically significant (XP-Endo Finisher: 2.40 ± 1.77; Needle: 1.73 ± 1.52; p = 0.090). However, significantly lower pain was reported in the XP-Endo Finisher group at 12 h (p = 0.044) and on day 2 (p = 0.027). No significant differences were observed from day 3 to day 7. Analgesic intake was comparable across both groups (p > 0.05).

The XP-Endo Finisher resulted in reduced early postoperative pain compared to needle irrigation at specific time points, although both methods showed similar outcomes in long-term pain resolution and analgesic consumption. Improved irrigant activation may influence short-term postoperative comfort.

This trial was retrospectively registered with the Kasturba Hospital Institutional Ethics Committee (KH IEC) under registration number 860/2020, dated 19/03/2021. It was also registered in the Clinical Trials Registry - India (CTRI) under registration number CTRI/2021/04/032667, dated 08/04/2021.