Effects of 3 different emergency interventions on postoperativepain incidence in symptomatic irreversible pulpitis cases

This study aimed to compare the post-operative pain incidence related to three different intervention methods (total pulpectomy, partial pulpectomy and pulpotomy) in patients with symptomatic pulpitis who were urgently referred to our clinic with severe pain in molar teeth, and to determine the most effective emergency intervention method that will provide pain relief in a relatively short period of time. The study included 66 patients with acute symptomatic irreversible pulp in posterior maxillary and mandibular teeth, between the ages of 18-60 years of both sexes, who were urgently referred to Baskent University Faculty of Dentistry for toothache. The patients were randomly divided into 3 groups. The groups were determined as follows: Group 1 (n=22): Total pulpectomy, Group 2 (n=22): Partial pulpectomy, Group 3 (n=22): Pulpotomy. The entire root canal systems of the patients included in Group 1 were removed, and the canals were filled with calcium hydroxide. In patients included in Group 2, however, only the widest canal (palatal canal at maxillary molar, distal canal at mandibular molar) was extirpated. In patients included in Group 3, the pulp chamber was completely removed and a sterile cotton pellet was placed in the pulp chamber after controlling the bleeding. In all 3 groups, the input cavity was closed with Intermediate Restorative Material (IRM). All patients were prescribed ibuprofen 600 mg as standard. The time of procedures performed in each group was recorded. The preoperative and postoperative pain was measured using Visual Analogue Scale (VAS). The preoperative pain levels of patients were recorded under the supervision of a physician. Once the anesthetic effect disappeared, the patients were given a detailed form for marking their pain levels at 1st, 3rd, and 7th days. In the form given, the patients were also asked whether or not they had pain starting due to a hot and cold stimulus, whether or not they had pain during chewing and whether or not they took painkiller after treatment, and were asked to indicate the date and number of painkillers taken if they took any. The demographic characteristics and dental localizations of patients (lower jawbone-upper jawbone) were found to be statistically similar. When the lengths of the treatment period were compared, the pulpotomy treatment was found to be the treatment completed within the shortest time, followed by the partial pulpectomy and total pulpectomy treatments. Comparing the groups due to the changes occurred in the VAS scores between any two follow-up periods, the VAS scores were found to be statistically significantly decreased, respectively in the total pulpectomy group compared to the pulpotomy group, in day 3 compared to day 1 and in day 7 compared to day 1 in day 7 after the anesthesia effect disappeared (p<0,001). Even though it was seen from the data obtained during the pre-treatment period and after the effect of anesthesia disappeared that there was no statistically significant difference between the groups in terms of reduction of pain, in group comparisons, an earlier relief was observed in pain in pulpotomy and partial pulpectomy groups when the anesthetic effect disappeared, compared to the total pulpectomy group. Between any two follow-up period, no statistically significant difference was found between the groups in terms of feeling pain during chewing, the frequencies of healing in case of hot & cold sensitivity and the number of median painkillers taken.