The Impact of Different Final Irrigation Activation Techniques on Postoperative Pain in Single Rooted Mandibular Premolar Teeth: Randomised Clinical Trial

Abstract

Objectives The trial was conducted to assess the impact of passive ultrasonic irrigation, XP endo finisher, AF max file, and manual dynamic agitation on postoperative pain and analgesic consumption at 6 h., 12 h., 24 h., 48 h., 72 h., and a week later on single-rooted lower premolar teeth with acute irreversible pulpitis and apical periodontitis. Methods. Seventy patients were contributed in the trial. A total of 64 eligible patients were randomized into four equal groups (n=16 per group). Considering the irrigation activation approach, participants were separated into four groups as follows: Group 1: passive ultrasonic irrigation. Group 2: XP-endo Finisher. Group 3: Fanta AF max file Group 4: Manual dynamic agitation. Following the root canal procedure, the intensity of postoperative discomfort was measured by a verbal rating scale. The frequency and quantity of analgesics used were recorded. Results. Using an analysis of variance (ANOVA), there was a statistically significant difference between the percentage of preoperative and postoperative pain at most of the follow-up period (p<0.001**) in each group. Additionally, a significant difference (p<0.05) in the postoperative pain level and analgesic consumption was found among groups and most of the time intervals. Shapiro-Wilk and Kolmogorov-Smirnov tests, the Chi-square test, Fisher's exact test, and the McNemar test were used. The excessive percentage of postoperative pain and analgesic intake was found in the MDA group, followed by the Max file and the XPF, while the lowest postoperative pain and analgesic intake were related to the PUI group. There was a significant difference (p<0.05) between the PUI and MDA groups in the degree of pain severity and increase in analgesic intake at 72 h. Regarding the percentage of swelling, there was a statistically notable difference (p<0.05) between groups after 24 h time intervals. Conclusions Minimal postoperative pain and minimal analgesic intake were significantly accompanied by passive ultrasonic irrigation, while PUI and analgesic intake were increased in MDA. (EEJ-2025-03-041).