Journal of Pharmacy And Bioallied Sciences
Journal of Pharmacy And Bioallied Sciences Login  | Users Online: 920  Print this pageEmail this pageSmall font sizeDefault font sizeIncrease font size 
    Home | About us | Editorial board | Search | Ahead of print | Current Issue | Past Issues | Instructions | Online submission




 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 6  |  Page : 1506-1512  

Assessment of postoperative pain after single-visit root canal treatment using Wave One® and One Shape® single file system: A clinical study


Department of Conservative Dentistry and Endodontics, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India

Date of Submission28-Mar-2021
Date of Acceptance09-May-2021
Date of Web Publication10-Nov-2021

Correspondence Address:
Pooja Jain
Department of Conservative Dentistry and Endodontics, Dr. D. Y. PatilDental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Sant Tukaram Nagar, Pimpri, Pune, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.jpbs_267_21

Rights and Permissions
   Abstract 


Background: Wave One® (WO) and One Shape® (OS) are among the common endodontic file systems having rotary and reciprocating movement of instrument, respectively. The study evaluated the postoperative pain after single-visit root canal treatment using single file rotary and reciprocating system. Materials and Methods: The present study was conducted in the department of conservative dentistry and endodontics on 68 teeth of patients aged between 20 and 45 years. Sixty-eight teeth were divided into two study groups. In Group A, instrumentation with OS file systems (n = 34) was done with subgroup A1 having patients without periapical lesion (n = 17) and subgroup A2 having patients with periapical lesion (n = 17). In Group B, instrumentation with WO file systems (n = 34) was done with subgroup B1 having patients without periapical lesion (n = 17) and subgroup B2 having patients with periapical lesion (n = 17). The root canal shaping procedures were performed according to the manufacturer's instructions for each instrument system. Presence of postobturation pain was accessed by visual analog scale (VAS) scale (0–10), where 0 showed no pain, 1–3 mild pain, 4–6 moderate pain, 7–9 severe pain, and 10 worst possible pain. Results: The intensity of pain was measured with VAS score in patients without periapical lesions and with periapical lesions using WO and OS file system on the 1st, 2nd, 3rd, and 7th day. VAS score was found to be nonsignificant on the 1st, 2nd, 3rd, and 7th day in both groups (P > 0.05). Intergroup comparison of VAS score was found to be nonsignificant (P > 0.05). Conclusion: Both systems were found to have similar effect with respect to postoperative pain. However, WO single file system presented less pain as compared to OS system in cases with periapical lesion. Large sample studies are required to substantiate the result obtained in this study.

Keywords: One Shape®, single file system, single-visit endodontics, Wave One®


How to cite this article:
Jain P, Sanjyot M, Bhosale S. Assessment of postoperative pain after single-visit root canal treatment using Wave One® and One Shape® single file system: A clinical study. J Pharm Bioall Sci 2021;13, Suppl S2:1506-12

How to cite this URL:
Jain P, Sanjyot M, Bhosale S. Assessment of postoperative pain after single-visit root canal treatment using Wave One® and One Shape® single file system: A clinical study. J Pharm Bioall Sci [serial online] 2021 [cited 2022 Jun 26];13, Suppl S2:1506-12. Available from: https://www.jpbsonline.org/text.asp?2021/13/6/1506/330053




   Introduction Top


The basic principles of endodontic therapy are the removal of irritants of root canal, root canal system obturation, and maintenance of natural dentition.[1] Despite revolutionary modifications in root canal treatment (RCT), literature showed that there is variation in intensity and frequency of pain after endodontic treatment.[2] Postobturation pain prevalence which is although of short duration is thwarting both for patient and for a dental surgeon and is infuriating, especially if there was no symptom in tooth previous to treatment.[3]

There is a myth among general population that single-visit endodontic treatment induces more postoperative pain, discomfort, and flare-up. Several studies revealed that single-visit RCT performed in vital pulp cases had reproduced good outcome.[4] There are more chances of flare-up, discomfort, and postoperative pain with single-visit endodontic treatment as compared to multiple visit endodontic treatment.[5],[6]

Common method of instrumentation in bio-mechanical preparation of the root canal is in “rotary motion,” but a method of “reciprocating” motion is developed to reduce the risks associated with rotary movement of instruments. Reciprocating method uses clockwise and counterclockwise motion of the files minimizing manual instrumentation, hence reducing the risk of file breakage in the canal.[7]

Recently, various single file systems with the capability to prepare root canals with only one instrument have been introduced. Wave One (WO) and One Shape (OS) are one among the common systems having rotary and reciprocating movement of instrument, respectively.[8] The OS file (Micro Mega) is used in continuous clockwise rotation. WO by Dentsply is another single file system using reciprocating kinematics. The reciprocating motion of these instruments varies in clockwise and counterclockwise rotations.[9] Hence, the purpose of this study was to evaluate the postoperative pain after single-visit RCT using single file rotary and reciprocating system.


   Materials and Methods Top


The present study was conducted in the department of conservative dentistry and endodontics. The study protocol was approved by the institutional ethics committee. This study was conducted on 68 teeth. Inclusion criteria were single-rooted teeth requiring RCT, asymptomatic teeth, patient aged between 20 and 45 years. Exclusion criteria comprised patients with hypoplastic teeth, deciduous teeth, single root having more than one canal, opposing prosthesis, periapical lesion >2 mm, and teeth with calcified canals.

Sixty-eight teeth were divided into two study groups as follows:

  • Group A - Instrumentation with OS file systems (n = 34)


    • Subgroup A1 = Patients without periapical lesion (n = 17)
    • Subgroup A2 = Patients with periapical lesion (n = 17).


  • Group B - Instrumentation with WO file systems (n = 34)


    • Subgroup B1 = Patients without periapical lesion (n = 17)
    • Subgroup B2 = Patients with periapical lesion (n = 17).


In all patients, thorough case history was taken and intraoral examination was done. Patients requiring RCT were screened with digital radiographs to confirm the presence of only one root canal and periapical lesion. Access cavity preparation was done using round diamond abrasive point # ISO BR 41 and nonend cutting tapered fissure bur #EX24. Patency of root canal was checked by introducing # 10 file into the canal. Working length was measured.

The root canal shaping procedures were performed according to the manufacturer's instructions for each instrument system. In OS Endodontic File System, file #25/0.06 was used in a slow in and out pecking motion at 350–450 rpm and torque 2.4 N. Ethylenediaminetetraacetic acid (EDTA) gel was used as a lubricant. The flutes were cleaned after every 3 pecks. The instrument was worked till the working length until the apical portion of the root was cleaned adequately. Canals were irrigated with 5% NaOCl after each instrumentation. Final flush with 17% EDTA followed by normal saline was done.

For WO Endodontic File System, the primary file (#25/0.08) in the WO file system was used. The file was used at a speed of 250 rpm and torque 2 N in and out pecking motion.

Master cone was selected and confirmed with intraoral periapical radiograph. Lateral condensation technique was followed, and again, digital radiograph was taken to confirm good quality obturation without voids. Temporary restoration with Cavit (3M ESPE) was placed in access cavity. Postoperative instructions were given. A questionnaire was given to patient to be filled with respect to postobturation pain on the 1st, 2nd, 3rd, and 7th day. Presence of postobturation pain was accessed by visual analog scale (VAS) scale (0–10), where 0 showed no pain, 1–3 mild pain, 4–6 moderate pain, 7–9 severe pain, and 10 worst possible pain. The results were statistically analyzed by using “Mann–Whitney U-test” and “Freidman's test.”


   Results Top


The intensity of pain was measured with VAS score in patients without periapical lesions using rotary single file system on the 1st, 2nd, 3rd, and 7th day. The present study revealed that the number of patients with no pain in Group A1 without periapical lesions was 10 and in Group B1 was 11. Worst pain was seen in 1 in Group A and 2 in Group B on 1st day. Both the groups showed decrease in number of patients with worst pain, severe pain, and moderate pain on the 2nd, 3rd, and 7th day. Group A had 14 patients and Group B had 13 patients with no pain on the 7th day. Postoperative pain using VAS score was found to be nonsignificant on the 1st, 2nd, 3rd, and 7th day in both groups (P > 0.05) [Table 1], [Table 2], [Table 3] and [Graph 1], [Graph 2], [Graph 3], [Graph 4].
Table 1: Intragroup comparison of pain in teeth with and without periapical lesions using One Shape® single file system (Group A1/A2)

Click here to view
Table 2: Intragroup comparison of pain in teeth with and without periapical lesions using Wave One® (reciprocating) single file system (Group B1/B2)

Click here to view
Table 3: Intergroup comparison of pain in teeth without periapical lesions in Group A1 and Group B1

Click here to view



We found that three patients in Group A and 5 in Group B had no pain and six patients each had worst pain in both groups on the 1st day. The number of patients with worst pain reduced to 4 in Group A and 5 in Group B on the 2nd day which further reduced to 2 in Group A and 3 in Group B on the 3rd day. On the 7th day, no patient had worst pain in both groups. Four patients each had moderate pain in both groups, while 7 and 6 patients had mild pain in Group A and B, respectively. Six patients in Group A and 7 patients in Group B had no pain. Intergroup comparison of VAS score was found to be nonsignificant (P > 0.05) [Table 4] and [Graph 5], [Graph 6], [Graph 7], [Graph 8].
Table 4: Intergroup comparison of pain in teeth with periapical lesions in Group A2 and Group B2

Click here to view




   Discussion Top


RCT or endodontic therapy is a common treatment option in many cases for eradication of pain. The RCT significantly reduces the severity of pain. In few instances, there is variation in severity of pain immediate after treatment. The severity of pain immediately following treatment may show higher level as compared to pain level before the treatment. This results from penetration of pulpal tissues, dentinal debris, microorganisms, and irrigants to the periapical tissues during RCT, leading to periradicular inflammation.[10]

Any injury to the periapical tissue during RCT promotes more intensive secretion of inflammatory mediators, such as prostaglandins, serotonin, leukotrienes, histamine, and bradykinin, which are considered to be mediators of pain.[11]

The endodontic treatment may be multiple visits or single visit. There are certain criteria to be followed for performing single-visit endodontics. There has been debate for many years regarding rationale of single-visit and multiple visit endodontics. One opinion for less postoperative pain in single-visit endodontics is due to immediate obturation after root canal preparation and hence preventing penetration of medications, irrigants, and repeated instrumentation which is considered precipitating factors for postoperative pain.[12]

In the present study, we evaluated and compared postoperative pain in single-visit RCT using OS (rotary) and WO (reciprocating) single file systems. Many techniques such as visual analog, verbal, functional, colored analog, numerical, finger-reach rating scales, cortical-evoked potentials, and calibrated questionnaires have been used to assess pain intensity.[13] In the present study for pain assessment, a modified VAS was used in both groups.

We observed that in Group A (OS single file system) subgroup A1 (i.e. without periapical lesion) patients on the 1st day, 10 (58.8%) patients out of 17 had no pain which became 15 (82.3%) on the 7th day. There was no patient of moderate, severe, and worst pain on the 7th day.

Similarly, in Group A (OS single file system) subgroup A2 (i.e. with periapical lesion), we assessed postoperative pain on the 1st, 2nd, 3rd, and 7th day. There were 3 (17.6%) patients with no pain and 6 (35.2%) patients with worst pain on 1st day. On the 7th day, the number of patients with no pain increased to 6 (35.2%) and there was no patient with worst pain. However, there were more patients who had postoperative pain in this subgroup as compared to A1 subgroup. This shows that OS (rotary) single file system is effective in controlling pain in Group A patients with no periapical lesions. Our results are in agreement with Neelakantan et al.[3] In their study, there were 507 patients treated with RECIPROC system and 462 treated with OS. Both systems offered statistical significant difference in terms of incidence of postoperative pain. This can be postulated by the concept that teeth with periapical lesions have more pain as compared to teeth without lesions due to release of pain mediators such as bradykinin and leukotrienes.[14]

In Group B (WO single file system) subgroup B1 (i.e. without periapical lesion), teeth were instrumented with WO (reciprocating) single file system. It was observed that on 1st day, 11 (64.7%) patients had no pain and only 2 (11.7%) patients had worst pain. With the progression of days, the number of patients with worst pain, severe pain, and moderate pain decreased significantly, and on the 7th day, 14 (82.3%) patients had no pain. Our results are in agreement with Ramazani et al.[15]

In subgroup B2 (i.e. with periapical lesion), WO (reciprocating) single file system was used to instrument root canal. There was significant difference of VAS scale on different days on comparison between Group A patients with Group B, i.e. teeth with no periapical lesions and teeth with periapical lesions in both groups. This shows that OS (rotary) single file system is effective in controlling pain in Group A patients with no periapical lesions. Our results are in agreement with Kherlakian et al.[16] This shows that reciprocating system is better in terms of controlling pain as compared to single rotary file system. However, De Melo Ribeiro et al.[17] in their study found that self-adjusting file system in the apical third, created cleaner inner canal walls when compared to a rotary system. The results of this study demonstrated similar pain values in both the reciprocating and rotary instrumentation groups.

The flexibility of OS instrument insures a perfect follow of curvature and canal path. It has cross-sections which is capable of showing its cutting ability in three zones of the canal.[18] WO nickel-titanium file system works in a reciprocating motion. There is rotation of the instrument initially is in a counterclockwise direction resulting in penetration and cutting of the dentin.[19] The resultant debris is not pushed periapically but removed through the root canal, thus reducing postoperative pain.


   Conclusion Top


Both systems were found to be effective in controlling postoperative pain. However, WO single file system had less pain as compared to OS system. Large sample studies are required to substantiate the results obtained in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Chan D. Single visit endodontic treatment in the management of pulpal disease. J Dent Res Rev 2016;3:2.  Back to cited text no. 1
  [Full text]  
2.
Singh S, Garg A. Incidence of post-operative pain after single visit and multiple visit root canal treatment: A randomized controlled trial. J Conserv Dent 2012;15:323-7.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Neelakantan P, Sharma S. Pain after single-visit root canal treatment with two single-file systems based on different kinematics--A prospective randomized multicenter clinical study. Clin Oral Investig 2015;19:2211-7.  Back to cited text no. 3
    
4.
Netto de souza M, Saavedra F, Júnior JS, Machdo R, Silva EJ, Vansan LP. Endodontists perceptions of single and multiple visit root canal treatment: A survey in Florianópolis- Brazil. RSBO 2014;11:13-8.  Back to cited text no. 4
    
5.
Shen Y, Cheung GS, Bian Z, Peng B. Comparison of defects in ProFile and ProTaper systems after clinical use. J Endod 2006;32:61-5.  Back to cited text no. 5
    
6.
Burklein S, Hinschitza K, Dammaschke T, Schafer E. Shaping ability and cleaning effectiveness of two single-file systems in severely curved root canals of extracted teeth: Reciproc and wave one versus mtwo and protaper. Int Endod J 2012;45:449-61.  Back to cited text no. 6
    
7.
Plotino G, Grande NM, Testarelli L, Gambarini G. Cyclic fatigue of Reciproc and Wave One reciprocating instruments. Int Endod J 2012;45:614-8.  Back to cited text no. 7
    
8.
Risso PA, Cunha AJ, Araujo MC, Luiz RR. Post obturation pain and associated factors in adolescent patients undergoing one- and two- visit root canal treatment. J Dent 2008;36:928-34.  Back to cited text no. 8
    
9.
Wang C, Xu P, Ren L, Dong G, Ye L. Comparison of post-obturation pain experience following one-visit and two-visit root canal treatment on teeth with vital pulps: a randomized controlled trial. Int Endod J 2010;43:692-7.  Back to cited text no. 9
    
10.
El Mubarak AH, Abu-bakr NH, Ibrahim YE. Postoperative pain in multiple-visit and single-visit root canal treatment. J Endod 2010;36:36-9.  Back to cited text no. 10
    
11.
Gábor Peth O, Reeh PW. Sensory and signaling mechanisms of bradykinin, eicosanoids, platelet-activating factor, and nitric oxide in peripheral nociceptors. Physiol Rev 2012;92:1699-775.  Back to cited text no. 11
    
12.
Pak JG, White SN. Pain prevalence and severity before, during, and after root canal treatment: A systematic review. J Endod 2011;37:429-38.  Back to cited text no. 12
    
13.
Pettiette MT, Delano EO, Trope M. Evaluation of success rate of endodontic treatment performed by students with stainless steel K files and nickel titanium hand files. J Endod 2001;27:124-7.  Back to cited text no. 13
    
14.
Karova E, Topalova-Pirinska S. Waveone and one shape files: Survival in severely curved artificial canals. Glob J Med Res J Dent Otolaryngol 2014;4:1-7.  Back to cited text no. 14
    
15.
Ramazani N, Mohammadi A, Amirabadi F, Ramazani M, Ehsani F. In vitro investigation of the cleaning efficacy, shaping ability, preparation time and file deformation of continuous rotary, reciprocating rotary and manual instrumentations in primary molars. J Dent Res Dent Clin Dent Prospects 2016;10:49-56.  Back to cited text no. 15
    
16.
Kherlakian D, Cunha RS, Ehrhardt IC, Zuolo ML, Kishen A, da Silveira Bueno CE. Comparison of the incidence of postoperative pain after using 2 reciprocating systems and a continuous rotary system: A prospective randomized clinical trial. J Endod 2016;42:171-6.  Back to cited text no. 16
    
17.
De Melo Ribeiro MV, Silva-Sousa YT, Versiani MA, Lamira A, Steier L, Pécora JD, et al. Comparison of the cleaning efficacy of self-adjusting file and rotary systems in the apical third of oval-shaped canals. J Endod 2013;39:398-401.  Back to cited text no. 17
    
18.
Liu R, Hou BX, Wesselink PR, Wu MK, Shemesh H. The incidence of root microcracks caused by 3 different single-file systems versus the ProTaper system. J Endod 2013;39:1054-6.  Back to cited text no. 18
    
19.
Jain N, Pawar M, Gupta A. Incidence and severity of postoperative pain after canal instrumentation with reciprocating system, continuous rotary single file system, versus SAF system. ENDO (Lond Engl) 2016;10:153-60.  Back to cited text no. 19
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
    Materials and Me...
   Results
   Discussion
   Conclusion
    References
    Article Tables

 Article Access Statistics
    Viewed338    
    Printed8    
    Emailed0    
    PDF Downloaded48    
    Comments [Add]    

Recommend this journal