Evaluation of Post Obturation Pain Associated With Calcium Hydroxide-based Root Canal Sealers and Resin-based Root Canal Sealer: a Single Visit Root Canal Treatment

Modern endodontics offers advancements in technologies, procedures and materials.Post‐obturation pain is defined as pain of any degree that occurs after initiation ofroot canal treatment1 and its occurrence was noted to vary between 3 and 58%.2 3 Thecauses of postoperative pain is related to post obturation pain and can be classified asmechanical, chemical and/or microbiological injuries to the peri‐radiculartissues.Factors identified that contribute to post‐operative pain after single‐ visitroot canal treatment consist of the following: age, sex, tooth type or location.Intraoperative factors include the physical properties of endodontic instruments used inthe initial treatment, features of irrigation protocol like chemical solutions andconcentrations, microbiological stability and resistance, histopathological state of thetissues surrounding the tooth, etc.6 During the obturation phase of root canal therapy,the endodontic sealer makes direct and local contact with the reshaped periapical tissuesthrough the apical foramen and any supplementary lateral canals. By understanding thefactors that contribute to postoperative pain, dental practitioners may better chooseprocedures and supplies that have been shown to reduce the occurrence of this symptom.7Pain perception is mainly a subjective and variable experience that depends on manypsychological and physical factors. The visual analog scale (VAS) is usually used as ameasure of pain intensity in clinical researches due to its simplicity. The VAS intensityrating consisted of a 100‐mm length line with two end points as no pain and worst pain. 8An ideal root canal sealer should be capable of creating an effective bond to the GP androot canal walls to prevent microleakage at the interface.9 Biocompatibility andbioactivity are essential properties for root canal sealers, as these materials are inclose proximation with the surrounding tissues and affect the repair.10 If the sealersare biocompatible and soluble in tissue fluid, minimal extrusions could be tolerated bythe peri‐radicular tissues.11 Sealers placed in the root canals interfere withperiodontal tissues through the apical foramina, lateral canals, or leaching and canpotentially affect the healing process in the periodontium Thus, the local inflammationcaused by root canal obturation materials may result in postoperative pain. The intensityof inflammatory reactions depends on a number of different factors, including thecomposition of the sealer. 12 Therefore, root canal sealers may have a role in thediscomfort felt after having a root canal. Pain sensations and flare‐ups may be triggeredby root canal sealers due to the stimulation of trigeminal nociceptors in vitro and theaccompanying immunologic response, as proposed by Ruparel et al13 The un‐polymerizedresidues remain due to formation of oxygen inhibition layer in the mixture of AH Plussealer, which is responsible for maintaining its toxic effect.14 Sealapex is one ofcalcium hydroxide based root canal sealer having cytotoxic potential. After settingSealapex becomes unstable and disintegrates.15 Khatri S1 in his study stated that AH Pluswas associated with the highest pain intensity post 12 hours evaluation 5.00±1.124. Thissignifies the increased toxic effect of AH Plus sealer then Sealapex. AH Plus containsboth epoxy resins and amines which have toxic effect. A randomized controlled clinicalinvestigation by Ates et al16 including both vital and non‐vital mandibular premolars andmolars found a 68% and 59% prevalence of patients experiencing discomfort in teeth filledwith AH Plus sealer.The aim of this in‐vivo study is to compare and evaluate the effect of AH Plus andSealapex sealers on postoperative pain. Given the conflicting findings and lack of datain the endodontic literature on this issue, we decided to investigate the connectionbetween endodontic sealers and postoperative discomfort. The purpose of this randomizedclinical trial was to evaluate the effectiveness of two root canal sealer AH Plus andsealapex in reducing postoperative pain and the need for analgesics following root canaltreatment.