Inflammatory Mediator Levels and Postoperative Pain Following Root Canal Shaping with Different Apical Actions: A...

Endodontic kinematics are associated with varying levels of inflammatory response and postoperative pain. The effect of apical motion algorithms in integrated endodontic motors on this relationship has not been clinically evaluated. This study aimed to evaluate the effects of root canal preparation with continuous rotation (CR) and 2 different apical action algorithms on periapical inflammation mediator and patient-reported pain outcomes.

Sixty-six patients with asymptomatic pulpitis, symptomatic irreversible pulpitis, and normal pulps to be exposed for prosthetic preparation requiring endodontic treatment were randomly assigned to three groups: CR, auto apical reverse (AAR) and auto apical slow-down. Root canal instrumentation was performed and apical exudate samples were collected on postoperative Days 0 and 3 are analyzed for inflammatory mediators, including substance P (SP), tumor necrosis factor-α, interleukin-1β and interleukin-6. Preoperative and postoperative Day 3 visual analog scale pain scores were recorded.

SP levels on Day 0 (P < .001) and Day 3 (P = .001) were significantly higher in the AAR group. No significant differences were found between the groups regarding postoperative pain scores. When cytokines were assessed in terms of percent change, only tumor necrosis factor-α showed a significant increase in the auto apical slow-down group compared to the CR group (P = .035).

This study demonstrated that different apical actions influence the levels of inflammatory mediators in periapical tissues. AAR was found to be associated with higher SP release on both sampling times. However, the variations in mediator levels didn't translate into differences in pain outcomes. Further research is needed to clarify the effects of apical actions on inflammation, pain, and overall clinical outcomes.