Evaluation of the relationship of different irrigation activation systems with post-endodontic treatment pain: Prospective a clinical trial

Aim: The aim of this study is to compare the postoperative pain levels in devitalized mandibular premolar teeth treated with either root canal treatment (KT) or retreatment (RT), as well as to evaluate the postoperative pain levels on days 1, 3, 5, and 7 using a Visual Analog Scale (VAS) in relation to three different irrigation activation techniques applied in both groups: Photon-Induced Photoacoustic Streaming (PIPS), Passive Ultrasonic Activation (PUI), and Sonic Activation (SA). Material and Methods: A total of 111 systemically healthy individuals with a single-rooted, single-canaled devitalized premolar tooth in the mandibular region were included in the study. All procedures were performed in a single session by the same operator. The patients were divided into six groups: SA (KT) Group 1a, PUI (KT) Group 1b, PIPS (KT) Group 1c, SA (RT) Group 2a, PUI (RT) Group 2b, and PIPS (RT) Group 2c. Postoperative pain levels were recorded using the VAS at the following time intervals: 0–24 hours, 1–3 days, 3–5 days, and 5–7 days, based on the highest pain intensity reported within each interval. Results: The results showed that postoperative pain levels significantly decreased at all time intervals, except on day 7, in devital mandibular premolars treated with both KT and RT. On day 3, pain and analgesic use were significantly higher in the SA group than in the PUI and PIPS groups (p < 0.05). RT procedures lasted significantly longer than RCT (p = 0.007), and PIPS and PUI required more time than SA (p = 0.003). Conclusion: These results suggest that the PIPS and PUI systems may offer advantages over the SA group in terms of postoperative pain management and the need for analgesics. Keywords: PIPS, Postoperative Pain, Root Canal Treatment, Sonic Activation, Ultrasonic Activation, Visual Analog Scale