Effect of Rotary and Reciprocating File System on Postoperative Pain in Single Visit Endodontic treatment: A Randomised Clinical Trial

Abstract

Introduction: In modern times, endodontic intervention is preferred and tooth extraction is becoming increasingly rare. Root Canal Therapy (RCT) is well-established, with success rates exceeding 90%. A key contributor to post-endodontic pain is the extrusion of debris into the periapical region, which causes inflammation and nerve compression. The amount of debris extruded varies with instrumentation techniques and no current technology completely prevents it. Rotary and reciprocating Nickel-Titanium (NiTi) instruments, each with distinct designs and kinematics, play a critical role in managing this complication. Aim: To evaluate postoperative pain using rotary and reciprocating file systems in single visit endodontics. Materials and Methods: This prospective, parallel-group, single-centre, double-blinded, equivalence, randomised clinical study was conducted at the Department of Conservative Dentistry and Endodontics, School of Dental Sciences, Krishna Vishwa Vidyapeeth (Deemed To be University), Karad, Maharashtra, India, from October 2023 to March 2024, with the aim of comparing postoperative pain following endodontic therapy using two reciprocating systems, WaveOne Gold (WOG) and E-Flex Rec, versus two rotary systems, Mtwo and XP Endo Shaper (XPES). A total of 80 patients with symptomatic irreversible pulpitis were enrolled and randomly assigned to four groups, each treated with one of the four endodontic file systems. Patients were randomised into four groups: 1A-Mtwo (Dentsply-Maillefer, Ballaigues, Switzerland); 1B-XP Endo Shaper (XPS; FKG Dentaire SA, La Chaux-de-Fonds, Switzerland); 2A-Eighteeth E-Flex Rec File; and 2B-WOG (Dentsply Sirona, York, PA). Postoperative pain scores were measured using the Visual Analogue Scale (VAS) at 24, 48 and 72 hours and seven days post-treatment. Statistical analysis was conducted using One-way Analysis of Variance (ANOVA) with Tukey’s post-hoc test and Chi-square tests for categorical data using Statistical Package for Social Sciences (SPSS) software version 21.0, with p-values<0.05 considered significant. Results: According to the study’s findings, postoperative pain was significantly higher in the rotary file systems compared to the reciprocating file systems at all time intervals (p-value<0.001). The mean ages were 39.00±12.70 years for Group 1A, 34.70±9.48 years for Group 1B, 42.15±12.59 years for Group 2A, and 39.10±13.65 years for Group 2B. Additionally, the consumption of analgesics was significantly higher in the rotary file systems compared to the reciprocating file systems at 24 hours (p-value=0.001) and 48 hours (p-value=0.003), highlighting the importance of file design and kinematics in managing postoperative pain. Conclusion: Compared to the rotary systems (XPES and Mtwo), the use of the reciprocating instrumentation systems (WOG and E-Flex) demonstrated noticeably less postoperative pain, both in terms of intensity and duration.

Keywords

• nickel-titanium instruments
• root canal therapy
• sodium hypochlorite
• visual analogue scale