Comparison of the effects of three different intracanal drugs on postoperative pain and flare-up incidence in the retreatment cases

This study aims to compare the effects of three different intracanal medicaments on the incidence of postoperative pain and flare-up in the asymptomatic retreatment cases. One hundred eight patients with asymptomatic single-rooted and single-canal teeth without spontaneous pain or swelling, who had previously undergone endodontic treatment but still had radiological endodontic problems, were randomly and equally divided into three groups. Stratified randomization was performed for each group to the gender and the age of the patients. In this study, following the intracanal space was regained by performing the standard retreatment procedures and then intracanal medicaments were applied to the root canal. The used intracanal medicaments were the calcium hydroxide (Ca(OH)2), chlorhexidine gel (CHX), calcium hydroxide and chlorhexidine gel combination. Post-treatment pain levels were recorded at 6th and 12th hours and at 1-2-3-4-5-6-7th days using visual analog scale (VAS). In addition, clinical examinations of the patients were performed on the 2nd and 7th days to evaluate clinical sensitivity in percussion, spontaneous pain, swelling, and antibiotic requirements of the patients. There is no statistically significant difference between the groups in terms of VAS scores at all times following the intracanal medicament application (p> 0.05). However, the incidence of pain levels in the CHX gel group were higher for 7 days compared to the other groups. Flare-up was observed in only 1 patient in the CHX gel group, and no flare-up was observed in the other groups. In addition, the lowest VAS scores at 48th hour and after were observed in Ca(OH)2 + CHX gel group, and postoperative pain was not observed on the 7th day in this group. When the correlation between age and postoperative pain incidence was evaluated; significantly more pain was observed in patients between the ages of 35 and 49 at the 12th hour, 3.-4.-7th days (p <0.05). When the correlation between the presence of fistula and postoperative pain incidence was evaluated; It was found that patients without fistula had significantly higher pain values at 24 hours (p <0.05). When the correlation between the presence of coronary restoration and pain incidence was evaluated, it was observed that patients with coronary restoration had more pain only at the 6th hour (p <0.05). When the relationship between the primary root canal filling level and postoperative pain incidence was evaluated; at the 24th and 48th hours, the groups with short and extruded root canal fillings were statistically significantly more pain incidence than the group with acceptable root canal filling levels (p <0.05). However, there was no significant correlation between gender, presence of periapical lesions and the postoperative pain (p> 0.05). In conclusion, the data of this study revealed that there was no statistically significant difference between three different intracanal medicaments in terms of postoperative pain and flare-up incidence. The similar pain incidence of the patients indicates that all three medicaments are clinically preferable in retreatment cases in terms of postendodontic pain values. Since there are few clinical studies in the literature investigating the effect of intracanal medicaments on postendodontic pain in retreatment cases, it will be clinically beneficial to support our findings with new studies.