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Evaluation of postoperative pain associated with different working length determination methods: a randomised
Gamze Nalci Calik1, Betül Aycan Alim Uysal2, Fatma Begüm Peker3
1Department of Endodontics, Bezmialem Vakif University, Faculty of Dentistry, Istanbul, Türkiye. nalcigamze@gmail.com.
Background:
Postoperative pain is a common concern in endodontic treatment. In teeth with asymptomatic irreversible pulpitis, accurate working length determination is critical for effective root canal therapy and may influence postoperative discomfort. This study compared postoperative pain following root canal treatment in teeth with asymptomatic irreversible pulpitis when working length was determined using one of four electronic apex locators or periapical radiography.
Methods:
A total of 125 patients with asymptomatic irreversible pulpitis in single-rooted, single-canal teeth were included in the analysis. Patients were randomly assigned to five groups according to the working length determination method: Root ZX, Propex Pixi, Woodpex III, Raypex 6, or periapical radiography. A single clinician performed standardised root canal treatment in a single visit. Pain was assessed using the visual analogue scale at 6, 12, 24, and 48 hours postoperatively, and analgesic intake was recorded.
Results:
Postoperative pain gradually decreased over time in all groups. No statistically significant differences in postoperative pain were observed among the five working length determination methods at any postoperative assessment time point (all P > 0.05). Furthermore, postoperative pain was not significantly associated with age, sex, tooth location, and analgesic intake did not differ significantly among the groups.
Conclusion:
Under the standardised clinical conditions of this randomised clinical trial, the method used for working length determination did not significantly influence postoperative pain after single-visit root canal treatment in patients with asymptomatic irreversible pulpitis.
Trial Registration:
This study was retrospectively registered at ClinicalTrials.gov (Identifier: NCT07271797) on November 16, 2025. However, the study protocol, eligibility criteria, primary and secondary outcome measures, and statistical analysis plan were established before patient enrolment.
