Journal of Conservative Dentistry
Home About us Editorial Board Instructions Submission Subscribe Advertise Contact e-Alerts Login 
Users Online: 6979
Print this page  Email this page Bookmark this page Small font sizeDefault font sizeIncrease font size

Table of Contents   
Year : 2016  |  Volume : 19  |  Issue : 4  |  Page : 311-316
Influence of three Ni–Ti cleaning and shaping files on postinstrumentation endodontic pain: A triple-blinded, randomized, controlled trial

1 Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospitals, Chennai, Tamil Nadu, India
2 Department of Endodontics, Whites Apollo Dental Centers, Chennai, Tamil Nadu, India

Click here for correspondence address and email

Date of Submission29-Mar-2016
Date of Decision10-May-2016
Date of Acceptance11-Jun-2016
Date of Web Publication18-Jul-2016


Aim: This randomized, controlled trial evaluated the incidence of postinstrumentation pain on using two different rotary Ni–Ti and one reciprocating Ni–Ti cleaning and shaping systems.
Materials and Methods: Asfter sample size estimation, a total of 152 patients were randomized to three groups (Group WO [WaveOne], Group PU [ProTaper Universal], and Group Mt [Mtwo]). Selection of patients was based on root curvature, periapical lesion, vitality, gender, and diagnosis of the patient. A similar clinical protocol was followed and endodontic treatment was performed. Pre- and post-instrumentation pain scores (2, 4, 6, 8, 12, 36, and 48 h) were recorded using visual analog scale score. Kruskal–Wallis test was done for overall comparison of the groups. Bonferroni-corrected Mann–Whitney test was done for pair-wise comparisons and Friedman test was done to compare pain between time points in each file system (P< 0.05).
Results: All preinstrumentation pain values were higher than postinstrumentation pain values (P < 0.05). At 48 h, patients in Group WO experienced more pain compared to the other two groups. Pain scores of nonvital teeth were significantly higher when compared to vital teeth. Among nonvital teeth, patients in Group WO had early onset of pain at 6 h and lasted till 48 h, whereas pain started at 12 h and lasted till 36 and 48 h for Group Mt and Group PU, respectively.
Conclusion: Patients treated with WaveOne files experienced more pain when compared to the other files. Nonvital teeth experienced more pain compared to vital teeth. Group Mt had the lowest postinstrumentation pain.

Keywords: Cleaning and shaping; debris extrusion; Mtwo; postinstrumentation pain; reciprocation; WaveOne

How to cite this article:
Krithikadatta J, Sekar V, Sudharsan P, Velumurugan N. Influence of three Ni–Ti cleaning and shaping files on postinstrumentation endodontic pain: A triple-blinded, randomized, controlled trial. J Conserv Dent 2016;19:311-6

How to cite this URL:
Krithikadatta J, Sekar V, Sudharsan P, Velumurugan N. Influence of three Ni–Ti cleaning and shaping files on postinstrumentation endodontic pain: A triple-blinded, randomized, controlled trial. J Conserv Dent [serial online] 2016 [cited 2022 Jun 28];19:311-6. Available from:

   Introduction Top

The primary objective of cleaning and shaping is to debride the intraradicular contents and render the space suitable for obturation. During this process, irritation to the periapex is inevitable, thus causing postinstrumentation pain. In endodontics, postoperative pain is defined as pain of any degree that occurs after initiation of root canal therapy.[1] Although the success of endodontic treatment is highly related to the elimination or reduction of postendodontic pain, many clinical studies have reported varying degrees of postoperative pain, ranging from 25% to 40%.[2],[3],[4] Even though microorganisms are usually regarded as the most common cause of postoperative pain, other causes include mechanical or chemical injury to the periradicular tissues.[2],[3],[4],[5] During root canal preparation, irrigants, dentin chips, pulp tissue, and microorganisms may get extruded into the periradicular tissues, triggering an acute inflammatory reaction. This leads to the release of chemical mediators and changes in local adaptation and periapical tissue pressure causing postoperative pain. Studies evaluating the apical extrusion of debris have stated that instrumentation techniques and instruments used are the main contributing factor associated with the extrusion of debris.[6],[7],[8]

Reciprocating file systems were developed as a single file system with M-wire technology which uses a reciprocating motion to cut and proceed into the root canal. Data on reciprocating files proved that these files have a better resistance to file separation and less incidence of dentinal damage.[9],[10] Studies on debris extrusion using reciprocating and rotary files are controversial. Variability has been observed between different rotary systems in terms of debris extrusion which can be due to differences in cross-sectional geometry, cutting blade design, taper, flute depth, tip, and sequence of files, kinematics, and cutting efficacy.[11] Furthermore, it has previously been suggested that the reciprocating movement per se might play a role in packing the debris into the irregularities of the root canal space, pushing them beyond the apical foramen.[12] Different Ni–Ti rotary systems may yield different patterns of neurogenic inflammation response in the periodontal ligament as a consequence of different amounts of irritant extruded from the root canal space. However, the threshold amount of debris required for inducing pain in a patient is unknown. On literature search, there is a lack of clinical evidence comparing the postoperative pain after using different Ni–Ti systems employing varied file design and motion kinematics (WaveOne, ProTaper, and Mtwo). The objective of this study was to understand the influence of different motion kinematics on postinstrumentation pain. The null hypothesis of this study was that there was no difference in postinstrumentation pain after using any file systems. Hence, the aim of this study was to compare the postinstrumentation pain following the use of WaveOne, ProTaper, and Mtwo Ni–Ti files.

   Materials and Methods Top

This study was intended according to the revised Consolidated Standards of Reporting Trials statement.[13] The study protocol was approved by the Ethics in Clinical Research Committee of Meenakshi University, Chennai, India (Ref no: MADC/IRB/2014/000). A pilot study was done to obtain estimates for sample size calculation. The sample size was calculated as 49 in each group (allocation ratio 1:1:1) using G * power 3.1.2 software (SPSS version 0.17; SPSS Inc., Chicago, IL, USA) with alpha error left at 5% and statistical power of 80% with a dropout rate of 10% in each group. A total of 183 patients were screened for selection criteria in the dental outpatient unit at the Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospitals. Patients aged between 18 and 55, diagnosed of asymptomatic irreversible pulpitis, symptomatic irreversible pulpitis, or pulp necrosis with or without apical periodontitis (acute or chronic) in premolars and molars with fully matured roots were enrolled in this study. Curved root canals of more than 25°, calcified root canals, periapical radiolucency of more than 2 mm, complex root canal morphology, teeth with abscess/cellulitis, and medically compromised patients were excluded from the study. Pulp vitality was diagnosed using thermal tests and electronic pulp tester (Parkell, Edgewood, NY, USA). The extent and dimensions of periapical radiolucency (paralleling technique) were assessed along the greatest diameter using Schick CDR Software (Sirona, Long Island city, NY, USA). Measurements were performed in triplicate to avoid bias. The level of pre- and post-instrumentation pain was recorded as a continuous data using simple visual analog scale (VAS) scoring. The VAS consisted of a line of 10 cm length anchored by two extremes with 0 cm signifying no pain and 10 cm representing the worst pain imaginable. Patients who experienced a preinstrumentation pain score of more than 6 cm were excluded from this trial.

Consent forms were obtained from all patients. Baseline parameters such as age, gender, vitality status of the tooth, and preinstrumentation pain scores were recorded prior to treatment. The design used in this study was a randomized, triple-blinded, triple arm parallel trial. Stratification and randomization designs were used to address confounding factors. The confounding factors identified in the study were vitality status and the presence of lesion. Computer generated randomization sequence was carried out by the statistician who was not involved in the study. Bias in the trial was further reduced by masking the patients and the outcome assessmentor to the intervention. Parallel groups included Group WO (WaveOne; Dentsply Maillefer, Ballaigues, Switzerland), Group PU (ProTaper Universal; Dentsply Maillefer, Ballaigues, Switzerland), and Group Mt (Mtwo; VDW, Munich, Germany) where the new intervention was Group WO. The randomized order of interventions with Ni–Ti files was concealed in opaque individual envelopes by the staff nurse, which were later opened by the operator at the time of endodontic treatment. The principal investigator, patients, and outcome assessmentor were blinded to the study.

Root canal procedure

Root canal procedure was done for patients under local anesthetic administration (lidocaine hydrochloride and epinephrine 1:80,000; Xilonibsa, Inibsa, Spain) and rubber dam isolation. Access cavity was prepared and working length was determined with Root ZX apex locator (J Morita Europe GVBH, Frankfurt, Germany) and confirmed with digital radiographs. Apical patency and glide path were maintained in all the cases with a 10 size K file (Mani, Utsunomiya, Tochigi, Japan). Cleaning and shaping in Group WO were done with WaveOne primary or large reciprocating file as a single file system. ProTaper rotary files and Mtwo rotary files were used in a sequential order until master apical file in Group PU and Group Mt, respectively. Irrigation with 5% NaOCl was performed using a side vented needle (Maxi-I-probe; Dentsply, Tulsa, OK, USA), at 1 mm short of working length between each file. Based on the initial apical binding files, the master apical file ranged from ISO sizes #20 to #30 in narrow canals and from ISO sizes #30 to #40 in wide canals. Ethylenediaminetetraacetic acid (17%) solution was used for smear layer clearance. A final flush with 2% chlorhexidine solution was performed. Calcium hydroxide (Ca[OH]2) was given as an intracanal medicament for all the patients and temporized with Cavit (3M Deutschland GmbH, Neuss-Germany). The treated tooth was relieved from occlusion. The patients were treated by 4 final year postgraduate students who are calibrated and trained to use different shaping systems.

All patients were prescribed ibuprofen 400 mg as an escape medicine in the event of severe pain. The patients were contacted through phone calls by the outcome assessor and the VAS scoring was recorded at 2, 4, 6, 12, 24, 36, and 48 h, respectively.

Statistical analysis

Nonparametric statistical analysis was planned in this study. Kruskal–Wallis test was done for overall comparison of three file systems. Bonferroni-corrected Mann–Whitney test was performed for pairwise comparison. Friedman test was done to compare between time points in each file system. Data were analyzed using the SPSS 17.0 for Windows (SPSS Inc., Chicago, IL, USA) statistical package. Subgroup analysis for independent variables (sex, vitality status, and presence of lesion) was done using Bonferroni-corrected Mann–Whitney test (P< 0.05). Relative risk (RR) of experiencing pain postinstrumentation was calculated for 12, 24, and 48 h.

   Results Top

A total of 183 patients were screened, out of which 31 patients did not meet the inclusion criteria and 152 patients participated in the study [Figure 1]. The study was conducted from September 2013 to June 2014. Statistical analysis of baseline parameters had no significant difference among them [Table 1]. The overall incidence of postinstrumentation pain at various time periods is shown in [Table 2]. The postinstrumentation pain values were lower than preinstrumentation values and the difference was statistically significant (P< 0.05). The postinstrumentation pain values remained insignificant at different time points within the same group. There was no statistically significant difference in postinstrumentation pain between groups with regards to gender. The pain scores at 48 h were significantly higher in Group WO when compared to Group Mt and PU (P< 0.05). There was no statistical difference between Group Mt and PU at 48 h. Pulp vitality was not a significant factor leading to pain at the end of 2 and 4 h between groups. However, there was a significant difference in pain between vital and nonvital pulp status at 6 h and the same trend continued till 48 h, irrespective of file systems used (P< 0.05). Pain scores of nonvital tooth in Group WO had comparatively high pain value that started at 6 h and continued till 48 h, whereas the pain scores of nonvital teeth in Group PU and Mt started at 12 h and lasted till 48 h and 36 h, respectively (P< 0.05). The RR of developing postinstrumentation pain was higher with WaveOne when compared to Mtwo (RR = 1.8 95% CI 1.3–2.7) and ProTaper (RR = 1.7 95% CI 1.2–2.5) at the end of 48 h [Table 3].
Figure 1: A Consolidated Standards of Reporting Trial diagram showing the flow of participants through each stage of trial

Click here to view
Table 1: Preendodontic baseline parameters

Click here to view
Table 2: Overall incidence of postinstrumentation pain at different time intervals

Click here to view
Table 3: The relative risk of developing postinstrumentation pain at different time intervals for the groups studied

Click here to view

   Discussion Top

The success of endodontic therapy depends not merely on their efficacy and proper completion but also on minimal patient discomfort. In recent decades, the discussion on reciprocating file systems has gained attention. Few in-vitro studies proved that the extrusion of debris is more with reciprocating files when compared to continuous rotary files. However, no attempt was made to simulate the presence of vital pulp or periapical tissues when determining the debris extrusion.[14],[15] Results could change in a clinical situation because of the presence of periapical tissues, which act as a natural barrier to prevent debris extrusion. Hence, this study compared the postinstrumentation pain on using two different rotary file systems (ProTaper, Mtwo) and one reciprocating file system (WaveOne). This study rejects the null hypothesis and has shown that there is a difference of pain values among the groups.

WaveOne reciprocating files were selected for this trial as a new intervention to evaluate the influence of motion kinematics for reduction of postinstrumentation pain. ProTaper was selected in this study to assess the influence of variable taper along the length of the file in causing postinstrumentation discomfort. Mtwo has been proved to have a better cyclic fatigue resistance, shaping ability in curved root canals, and less debris extrusion when compared to other conventional Ni–Ti files.[16],[17],[18] On literature search, WaveOne rotary files extruded more debris when compared to other continuous rotary files in in-vitro studies.[14] However, the clinical data on reciprocating systems does not compare this file system with constant taper files.[19] Moreover, the published data on postoperative pain using WaveOne reciprocating files were recorded following endodontic treatment in a single visit. This could confound the effect of obturation on posttreament pain.[20],[21],[22]

Neglecting apical patency may cause risk of loss of length, canal transportation, other accidents such as ledges and improper irrigation and disinfection in the apical third of the canal.[23] Arias et al. compared the incidence of postoperative pain with or without apical patency and reported that the apical patency has no role in postoperative pain.[24] A similar finding was observed with the extent of foraminal enlargement.[25] Hence, apical patency was maintained with K 10# file in all the patients to ensure disinfection of apical one-third.

Irrigation technique was thought as a potential confounder. Concomitantly, side-vented needles have shown to cause minimal debris extrusion and hence employed in this study.[6] Ca[OH]2 was given as an intracanal medicament for all cases irrespective of vitality status. Dispute may arise on specific recommendations on using Ca[OH]2 in vital or nonvital cases. Walton et al. have reported that the use of Ca[OH]2 as an intracanal medication was unrelated to the incidence and/or severity of posttreatment pain.[26]

Pain perception is purely subjective depending on patient's threshold and variable experience modulated by multiple physical and psychological factors. In the current study, simple VAS was used as a result of its ease, valid, and reliable scale to measure pain.[27]

Statistical analysis of the baseline parameter showed no significant difference among the groups, thus confirming equal and homogeneous distribution of the samples among the three groups (successful randomization). The principal investigator, outcome assessor, and the patients were blinded in this clinical trial. The operators were not blinded in this trial but were not aware of the instrumentation system until the moment of cleaning and shaping (allocation concealment). This step helped to reduce operator-dependent variations.

Gender has been suggested to play a role in other pain studies. In the endodontic literature, females have shown to experience higher levels of postoperative pain compared to males.[28] However, in our study, gender did not play a role in postinstrumentation pain.

The results of this study showed a significant reduction in postinstrumentation pain score values when compared to preoperative pain values irrespective of file system used. This concept is supported by many previous studies proving that endodontic procedure of a diseased tooth helps in alleviation of symptomatic pulpitis.[29] At 48 h, patients in Group WO experienced more discomfort when compared to patients in Group Mt followed by Group PU. The risk of developing postinstrumentation pain was almost twice with WaveOne file system compared to other two file systems. The possible reasons for the debris extrusion may be due to the cross-sectional geometry of the file, instrumentation technique, motion of the file, irrigation system, or anatomy of the root. The latter two confounders were eliminated by randomization. ProTaper and WaveOne files are characterized by a triangular or modified triangular cross-section resulting in a lower cutting efficiency with smaller chip space. This design may enhance debris transportation toward the apex when used in combination with a reciprocal motion.[12] ProTaper and WaveOne systems have a similar file cross-section; however, patients in Group WO experienced more pain compared to Group PU. The difference in motion of kinematics between the two file systems could be the underlying reason.

On comparison of teeth with regards to vitality, nonvital teeth experienced more pain compared to vital teeth across all groups. Extrusion of infected pulp tissue has shown to trigger an acute inflammatory response.[30] Moreover, the direct interaction of extruded bacteria and host cells can result in postinstrumentation pain. At 2 and 4 h, there was no statistical difference among nonvital and vital tooth in all groups. The lack of pain initially could be attributed to the influence of anesthesia. For nonvital teeth, among the three experimental groups, patients in WO Group experienced early onset of pain at 6 h and lasted until 48 h implying that this file system can complicate postinstrumentation pain. Patients with nonvital teeth in Group Mt and Group PU had the onset of pain at 12 h and lasted up to 36 and 48 h, respectively. Patients with nonvital teeth in Group Mt experienced lesser pain following instrumentation as compared to other groups. Even though the influence of several factors was studied in this trial, multivariate comparison was not possible due to insignificant odd's ratio for a majority of factors.

The results of the study can be extrapolated to posterior teeth with mild to moderately curved canals and in the absence periapical lesion. The influence of root canals with curvature >25 degrees, effect on anterior teeth, and presence of periapical lesion needs be explored in future trials.

   Conclusions Top

Under the limitations of this study, it can be concluded that WaveOne reciprocating files cause more postinstrumentation pain followed by ProTaper and Mtwo. Caution should be exercised on instrument selection for appropriate cases such as nonvital pulp with curved root canals.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Sathorn C, Parashos P, Messer H. The prevalence of postoperative pain and flare-up in single- and multiple-visit endodontic treatment: A systematic review. Int Endod J 2008;41:91-9.  Back to cited text no. 1
Torabinejad M, Cymerman JJ, Frankson M, Lemon RR, Maggio JD, Schilder H. Effectiveness of various medications on postoperative pain following complete instrumentation. J Endod 1994;20:345-54.  Back to cited text no. 2
Albashaireh ZS, Alnegrish AS. Postobturation pain after single- and multiple-visit endodontic therapy. A prospective study. J Dent 1998;26:227-32.  Back to cited text no. 3
DiRenzo A, Gresla T, Johnson BR, Rogers M, Tucker D, BeGole EA. Postoperative pain after 1- and 2-visit root canal therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;93:605-10.  Back to cited text no. 4
Siqueira JF Jr., Rôças IN, Favieri A, Machado AG, Gahyva SM, Oliveira JC, et al. Incidence of postoperative pain after intracanal procedures based on an antimicrobial strategy. J Endod 2002;28:457-60.  Back to cited text no. 5
Yeter KY, Evcil MS, Ayranci LB, Ersoy I. Weight of apically extruded debris following use of two canal instrumentation techniques and two designs of irrigation needles. Int Endod J 2013;46:795-9.  Back to cited text no. 6
Fairbourn DR, McWalter GM, Montgomery S. The effect of four preparation techniques on the amount of apically extruded debris. J Endod 1987;13:102-8.  Back to cited text no. 7
Kustarci A, Akpinar KE, Er K. Apical extrusion of intracanal debris and irrigant following use of various instrumentation techniques. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:257-62.  Back to cited text no. 8
Ye J, Gao Y. Metallurgical characterization of M-Wire nickel-titanium shape memory alloy used for endodontic rotary instruments during low-cycle fatigue. J Endod 2012;38:105-7.  Back to cited text no. 9
Ashwinkumar V, Krithikadatta J, Surendran S, Velmurugan N. Effect of reciprocating file motion on microcrack formation in root canals: An SEM study. Int Endod J 2014;47:622-7.  Back to cited text no. 10
Koçak S, Koçak MM, Saglam BC, Türker SA, Sagsen B, Er Ö. Apical extrusion of debris using self-adjusting file, reciprocating single-file, and 2 rotary instrumentation systems. J Endod 2013;39:1278-80.  Back to cited text no. 11
Bürklein S, Schäfer E. Apically extruded debris with reciprocating single-file and full-sequence rotary instrumentation systems. J Endod 2012;38:850-2.  Back to cited text no. 12
Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, et al. CONSORT 2010 explanation and elaboration: Updated guidelines for reporting parallel group randomised trials. BMJ 2010;340:c869.  Back to cited text no. 13
Nayak G, Singh I, Shetty S, Dahiya S. Evaluation of apical extrusion of debris and irrigant using two new reciprocating and one continuous rotation single file systems. J Dent (Tehran) 2014;11:302-9.  Back to cited text no. 14
Karatas E, Arslan H, Kirici DÖ, Alsancak M, Çapar ID. Quantitative evaluation of apically extruded debris with twisted file adaptive instruments in straight root canals: Reciprocation with different angles, adaptive motion and continuous rotation. Int Endod J 2016;49:382-5.  Back to cited text no. 15
Schäfer E, Erler M, Dammaschke T. Comparative study on the shaping ability and cleaning efficiency of rotary Mtwo instruments. Part 1. Shaping ability in simulated curved canals. Int Endod J 2006;39:196-202.  Back to cited text no. 16
Vadhana S, SaravanaKarthikeyan B, Nandini S, Velmurugan N. Cyclic fatigue resistance of RaCe and Mtwo rotary files in continuous rotation and reciprocating motion. J Endod 2014;40:995-9.  Back to cited text no. 17
Pedullà E, Grande NM, Plotino G, Gambarini G, Rapisarda E. Influence of continuous or reciprocating motion on cyclic fatigue resistance of 4 different nickel-titanium rotary instruments. J Endod 2013;39:258-61.  Back to cited text no. 18
Nekoofar MH, Sheykhrezae MS, Meraji N, Jamee A, Shirvani A, Jamee J, et al. Comparison of the effect of root canal preparation by using WaveOne and ProTaper on postoperative pain: A randomized clinical trial. J Endod 2015;41:575-8.  Back to cited text no. 19
Pasqualini D, Corbella S, Alovisi M, Taschieri S, Del Fabbro M, Migliaretti G, et al. Postoperative quality of life following single-visit root canal treatment performed by rotary or reciprocating instrumentation: A randomized clinical trial. Int Endod J 2015. doi: 10.1111/iej.12563.  Back to cited text no. 20
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. 21
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. 22
Arora M, Sangwan P, Tewari S, Duhan J. Effect of maintaining apical patency on endodontic pain in posterior teeth with pulp necrosis and apical periodontitis: A randomized controlled trial. Int Endod J 2016;49:317-24.  Back to cited text no. 23
Arias A, Azabal M, Hidalgo JJ, de la Macorra JC. Relationship between postendodontic pain, tooth diagnostic factors, and apical patency. J Endod 2009;35:189-92.  Back to cited text no. 24
Silva EJ, Menaged K, Ajuz N, Monteiro MR, Coutinho-Filho Tde S. Postoperative pain after foraminal enlargement in anterior teeth with necrosis and apical periodontitis: A prospective and randomized clinical trial. J Endod 2013;39:173-6.  Back to cited text no. 25
Walton RE, Holton IF Jr., Michelich R. Calcium hydroxide as an intracanal medication: Effect on posttreatment pain. J Endod 2003;29:627-9.  Back to cited text no. 26
Holdgate A, Asha S, Craig J, Thompson J. Comparison of a verbal numeric rating scale with the visual analogue scale for the measurement of acute pain. Emerg Med (Fremantle) 2003;15:441-6.  Back to cited text no. 27
Walton R, Fouad A. Endodontic interappointment flare-ups: A prospective study of incidence and related factors. J Endod 1992;18:172-7.  Back to cited text no. 28
Levin LG, Law AS, Holland GR, Abbott PV, Roda RS. Identify and define all diagnostic terms for pulpal health and disease states. J Endod 2009;35:1645-57.  Back to cited text no. 29
Trowbridge HO, Emling RC. Inflammation. A Review of the Process. 5th ed. Chicago: Quintessence; 1997.  Back to cited text no. 30

Correspondence Address:
Dr. Jogikalmat Krithikadatta
Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospitals, Chennai - 600 095, Tamil Nadu
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0972-0707.186442

Rights and Permissions


  [Figure 1]

  [Table 1], [Table 2], [Table 3]

This article has been cited by
1 Post-endodontic pain with different engine-driven endodontic instruments in multi-visit root canal therapy: A systematic review and meta-analysis
DelphineP Antony, AravindK Subramanian, MalliS Nivedhitha, Pradeep Solete, Arthi Balasubramaniam
Journal of International Oral Health. 2022; 14(1): 1
[Pubmed] | [DOI]
2 The influence of different NiTi instrumentation techniques on postoperative pain after single-visit root canal treatment
Gözde Kandemir Demirci, Seniha Miçoogullari Kurt, Burcu Serefoglu, Mehmet E. Kaval, Mehmet K. Çaliskan
Australian Endodontic Journal. 2021;
[Pubmed] | [DOI]
3 Comparative evaluation of different instrumentation techniques on post endodontic pain in single visit root canal treatment: A randomized controlled trial
Anchal Aggarwal, Ruchika Dewan
Endodontology. 2020; 32(4): 175
[Pubmed] | [DOI]
4 Comparative evaluation of different laser modalities on post endodontic pain in single visit root canal treatment: A randomized controlled trial
Anchal Aggarwal, Ruchika Dewan
Endodontology. 2020; 32(3): 142
[Pubmed] | [DOI]
5 Post-operative pain after using sodium hypochlorite and chlorhexidine as irrigation solutions in endodontics: Systematic review and meta-analysis of randomised clinical trials
ChristineM Martins, NatháliaE da Silva Machado, BiancaV Giopatto, VictorE de Souza Batista, JulianeA Marsicano, GrazielaG Mori
Indian Journal of Dental Research. 2020; 31(5): 774
[Pubmed] | [DOI]


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

    Materials and Me...
    Article Figures
    Article Tables

 Article Access Statistics
    PDF Downloaded344    
    Comments [Add]    
    Cited by others 5    

Recommend this journal