Comparative evaluation of the depth of penetration and postoperative pain associated with the use of continuous chelation using HEBP and standard irrigation protocol in the endodontic treatment of adult permanent nonvital teeth: A randomized controlled trial

Abstract

Aim: To evaluate and compare the apical depth of penetration and postoperative pain associated with the use of 9% 1-Hydroxyethylidene-1, 1-Bisphosphonate (HEBP) along with 3% sodium hypochlorite (NaOCl) as continuous chelation and standard irrigation protocol in endodontic treatment of adult permanent nonvital teeth. Methods: In this parallel arm double-blind single-center randomized controlled trial, standard irrigation protocol was compared to continuous chelation protocol (HEBP/NaOCl combination) with respect to the apical depth of penetration of irrigant and the postoperative pain. Forty-six patients aged between 18 and 45 years presenting with nonvital teeth requiring root canal treatment were randomly divided into two groups (n = 23) based on irrigation regime. After the final irrigation protocol, the apical depth of penetration of the irrigant was evaluated using a radiovisiography and radiopaque dye. Postoperative pain levels were evaluated at 6 h and 24 h after treatment using the numerical rating scale. Results: The results revealed that there was no statistically significant difference between the two groups in terms of the apical depth of penetration of the irrigant. While, with respect to postoperative pain, a statistically significant difference was found between the two groups at 24 h, with lower pain values observed in the continuous chelation group. Conclusion: The use of soft chelating agents like HEBP in continuous chelation has the apical depth of penetration comparable to that of ethylenediaminetetraacetic acid (EDTA) in standard irrigation protocol with lower postoperative pain at 24 h. Therefore, HEBP with NaOCl in continuous chelation can be seen as a viable, economical, and less technique-sensitive alternative to the use of EDTA for an effective three-dimensional disinfection of the root canal system up to the apical third of the root, which can be easily incorporated into daily clinical practice.

Keywords

• 1-hydroxyethylidene-1
• 1-bisphosphonate
• postendodontic pain
• continuous chelation
• etidronic acid
• postoperative pain