Clinical Effects of Amoxicillin-clavulanate and Calcium Hydroxide as Intracanal Medicament on Inter appointment Pain among Symptomatic Apical Periodontitis
DOI:
https://doi.org/10.51985/JBUMDC2021047Keywords:
Amoxicillin-clavulanate, Calcium Hydroxide, Flareup, Pain, Symptomatic Apical PeriodontitisAbstract
ABSTRACT
Objective: To compare the clinical effects of Antibiotic amoxicillin-clavulanate and calcium hydroxide on inter appointment
pain in cases of Symptomatic Apical Periodontitis.
Methodology: It was a single blind randomized controlled trial study performed in operative Dentistry Department of
Liaquat University of Medical and Health Sciences Jamshoro. This study was conducted from 02-Jan-2017 to 27-June-
2017. Total n=324 patients with symptomatic apical periodontitis were targeted. Patients were randomly allocated into two
groups. Total n=162 patients in group1 treated with Antibiotic amoxicillin-clavulanate and n=162 patients in group 2 of
calcium hydroxide. Procedure was performed by single operator. Clinical effect was assessed if pain present or absent after
24 hours and 7 days on recalled visit and was labeled as positive when there was no pain (0-3 on VAS) and as negative
when there was pain (4-10 on VAS). Data of the study was analyzed by using the SPSS version 20. Mean and standard
deviation was calculated for quantitative variables like age and pre and postoperative pain. Frequency and percentages
were calculated for type of tooth. Both groups were compared by using Chi- square test for clinical effect.
Results: The average age of the patients was 39.807.36 years. There were 50% male and 50% female. Clinical effectiveness
was significantly high in group 1 than group 2 [79.01% vs. 65.43% p=0.006].
Conclusion: The findings of this study are encouraging that patients in which Amoxicillin-clavulanate was used as intracanal
medicament appeared to show a greater decrease in pain levels over the observation period when compared to the control
group.
References
Schwendicke F, Göstemeyer G. Single-visit or multiple-visit
root canal treatment: systematic review, meta-analysis and
trial sequential analysis. BMJ Open. 2017;7(2):e013115.
Wong AWY, Zhang S, Li SKY, Zhu X, Zhang C, Chu CH.
Incidence of post-obturation pain after single-visit versus
multiple-visit non-surgical endodontic treatments. BMC Oral
Health. 2015;15(1). Available from: DOI: https://doi.org/
1186/s12903-015-0082-y
Karamifar K, Tondari A, Saghiri MA. Endodontic Periapical
Lesion: An Overview on the Etiology, Diagnosis and Current
Treatment Modalities. Eur Endod J. 2020;5(2):54–67.
Krause TA, Liewehr FR, Hahn C-L. The antimicrobial effect
of MTAD, sodium hypochlorite, doxycycline, and citric acid
on Enterococcus faecalis. J Endod. 2007;33(1):28–30.
Brookes ZLS, Bescos R, Belfield LA, Ali K, Roberts A.
Current uses of chlorhexidine for management of oral disease:
a narrative review. J Dent. 2020;103:103497.
Teresa Arias-Moliz M, Ruiz-Linares M, Maria Ferrer-Luque
C. Irrigating Solutions in Root Canal Treatment. EndoEndodontic Pract Today. 2019;13(2):131–46.
Prada I, Micó-Muñoz P, Giner-Lluesma T, Micó-Martínez P,
Muwaquet-Rodríguez S, Albero-Monteagudo A. Update of
the therapeutic planning of irrigation and intracanal medication
in root canal treatment. A literature review. J Clin Exp Dent.
;11(2):e185–93.
Srikumar GP V, Sekhar KS, Nischith KG. Mixture tetracycline
citric acid and detergent – A root canal irrigant. A review. J
Oral Biol Craniofacial Res. 2013;3(1):31–5.
Singla MG, Garg A, Gupta S. MTAD in endodontics: an
update review. Oral Surgery, Oral Med Oral Pathol Oral
Radiol Endodontology. 2011;112(3):e70–6.
Boutsioukis C, Arias-Moliz MT. Irrigating Solutions, Devices,
and Techniques. In: Endodontic Materials in Clinical Practice.
John Wiley & Sons, Ltd; 2021. p. 133–80.
Azim AA, Azim KA, Abbott P V. Prevalence of inter
appointment endodontic flare-ups and host-related factors.
Clin Oral Investig. 2017;21(3):889–94.
Mostafa MEHAA, El-Shrief YAI, Anous WIO, Hassan MW,
Salamah FTA, El Boghdadi RM, et al. Postoperative pain
following endodontic irrigation using 1.3% versus 5.25%
sodium hypochlorite in mandibular molars with necrotic
pulps: a randomized double-blind clinical trial. Int Endod J.
;53(2):154–66.Singh RD, Khatter R, Bal RK, Bal CS. Intracanal medications
versus placebo in reducing postoperative endodontic pain -
A double-blind randomized clinical trial. Braz Dent J.
;24(1):25–9.
Ruparel NB, Austah ON, Diogenes A. Current and Future
Views on Disinfection for Regenerative Strategies. In: Duncan
HF, Cooper PR, editors. Clinical Approaches in Endodontic
Regeneration: Current and Emerging Therapeutic Perspectives.
Cham: Springer International Publishing; 2019. p. 121–38.
DOI: https://doi.org/10.1007/978-3-319-96848-3_7
MidhatAbdul Gader Hussein H, Elkhodary S, Mohamed
Ahmed G. Influence of Calcium Hydroxide Chlorhexidine
Combination Vs. Calcium Hydroxide as Intra Ca-nal
Medicaments on Postoperative Flare -Up Following two-Visit
Endodontic Retreatment Cases: Single Blinded Randomized
Clinical Trial. Acta Sci Dent Scienecs. 2019;3(10):117–25.
Basrani B, Santos JM, Tjäderhane L, Grad H, Gorduysus O,
Huang J, et al. Substantive antimicrobial activity in
chlorhexidine-treated human root dentin. Oral Surg Oral Med
Oral Pathol Oral Radiol Endod. 2002;94(2):240–5.
Yoldas O, Topuz A, Isçi AS, Oztunc H. Postoperative pain
after endodontic retreatment: single- versus two-visit treatment.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod.
;98(4):483–7.
Southard SR, Drisko CL, Killoy WJ, Cobb CM, Tira DE. The
effect of 2% chlorhexidine digluconate irrigation on clinical
parameters and the level of Bacteroides gingivalis in
periodontal pockets. J Periodontol. 1989;60(6):302—309.
DOI: https://doi.org/10.1902/jop.1989.60.6.302
Mor C, Rotstein I, Friedman S. Incidence of interappointment
emergency associated with endodontic therapy. J Endod.
;18(10):509—511. DOI: https://doi.org/10.1016/S0099-
(06)81353-1
Segura-Egea JJ, Cisneros-Cabello R, Llamas-Carreras JM,
Velasco-Ortega E. Pain associated with root canal treatment.
Int Endod J. 2009;42(7):614–20.
Harrison JW, Baumgartner CJ, Zielke DR. Analysis of
interappointment pain associated with the combined use of
endodontic irrigants and medicaments. J Endod.
;7(6):272–6.
Torabinejad M, Shabahang S, Aprecio RM, Kettering JD. The
antimicrobial effect of MTAD: an in vitro investigation. J
Endod. 2003;29(6):400—403. DOI: https://doi.org/10.1097/
-200306000-00005
Shabahang S, Torabinejad M. Effect of MTAD on Enterococcus
faecalis-contaminated root canals of extracted human teeth.
J Endod. 2003;29(9):576–9.
Newberry BM, Shabahang S, Johnson N, Aprecio RM,
Torabinejad M. The Antimicrobial Effect of Biopure MTAD
on Eight Strains of Enterococcus faecalis: An In Vitro
Investigation. J Endod. 2007;33(11):1352–4.
Davis JM, Maki J, Bahcall JK. An in vitro comparison of the
antimicrobial effects of various endodontic medicaments on
Enterococcus faecalis. J Endod. 2007;33(5):567–9
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