Comparative Evaluation of Postoperative Pain Following Nonsurgical Root Canal Treatment Using Calcium Hydroxide,...

Postoperative pain remains one of the most common complications following nonsurgical root canal treatment, and the choice of intracanal medication may influence the severity and duration of postoperative discomfort. This study compared the effectiveness of calcium hydroxide, Bio-C Temp (Angelus Indústria de Produtos Odontológicos S.A., Londrina, Brazil), and Odontopaste (Australian Dental Manufacturing Pty. Ltd., Brisbane, QLD, Australia) in controlling postoperative pain.

This prospective clinical study was conducted on 180 participants who required nonsurgical root canal treatment and were equally divided into three groups (60, 33.3%, each): calcium hydroxide, Bio-C Temp, and Odontopaste. Root canal treatment was performed using a standardized protocol. Postoperative pain was assessed using a 100-mm visual analog scale (VAS) at 24 hours, 48 hours, 72 hours, and seven days. The secondary outcomes included analgesic consumption, time to first analgesic intake, interappointment flare-up, postoperative swelling, and percussion tenderness. Data were analyzed using one-way analysis of variance (ANOVA), Kruskal-Wallis test, chi-square test, linear mixed-effects model, Kaplan-Meier survival analysis, and multivariable linear regression, with statistical significance set at P < 0.05.

Baseline demographic and clinical characteristics were comparable among the three groups (all P > 0.05). Postoperative pain decreased significantly over time in all groups; however, the Bio-C Temp group consistently demonstrated the lowest VAS scores. At 24 hours, mean VAS scores were 45.5 ± 9.6, 41.1 ± 10.5, and 42.0 ± 8.9 for calcium hydroxide, Bio-C Temp, and Odontopaste, respectively (P = 0.030). At 48 hours, Bio-C Temp showed significantly lower pain (16.1 ± 8.4) than calcium hydroxide (26.9 ± 9.6) and Odontopaste (20.9 ± 8.9) (P < 0.001). Similar findings were observed at 72 hours (16.3 ± 9.8, 8.1 ± 8.1, and 9.5 ± 7.5, respectively; P < 0.001) and seven days (10.5 ± 8.4, 4.9 ± 6.3, and 8.8 ± 8.5, respectively; P < 0.001). Linear mixed-effects analysis demonstrated significant effects of the treatment group (P < 0.001), time (P < 0.001), and group × time interaction (P = 0.023). Bio-C Temp required significantly fewer analgesic tablets (median: 2) than calcium hydroxide (median: 3) (P < 0.001) and showed the longest median time to the first analgesic intake (16.4 hours). It also had the lowest incidence of interappointment flare-up, postoperative swelling, and percussion tenderness. Multivariable regression identified that Bio-C Temp (B = -7.789, P < 0.001) and Odontopaste (B = -6.308, P < 0.001) were independent predictors of lower postoperative pain than calcium hydroxide.

All three intracanal medicaments effectively reduced postoperative pain after nonsurgical root canal treatment. However, Bio-C Temp demonstrated superior clinical performance, providing significantly lower pain scores, reduced analgesic consumption, delayed analgesic requirements, and fewer postoperative complications than calcium hydroxide and Odontopaste. Therefore, Bio-C Temp may be considered a promising intracanal medicament for improving postoperative patient comfort during endodontic treatment.