Clinical Study Evaluating the Effect of Apical Foramen Enlargement and Irrigant Activation Techniques on Post-Endodontic Pain
As part of its commitment to supporting scientific research and advancing academic productivity, a joint research team from the International University for Science and Technology and the University of Damascus has published a scientific study entitled “The Effect of Apical Foramen Enlargement and Irrigant Activation Techniques on Post-Endodontic Pain in Necrotic Teeth: A Clinical Study” in BMC Oral Health, a journal published by Springer Nature.
The journal is indexed in Scopus and Web of Science and is ranked in the first quartile (Q1) according to the SCImago Journal Rank (SJR) in the field of dentistry.
The study addresses an important topic in endodontics by evaluating the impact of contemporary treatment procedures on the level of pain experienced by patients following root canal treatment.
Specifically, the study investigated the effect of apical foramen enlargement in combination with two advanced irrigant activation techniques—Passive Ultrasonic Irrigation (PUI) and the XP-Endo Finisher—on postoperative pain in single-rooted, single-canal teeth with necrotic pulps and associated periapical lesions.
The aim was to identify treatment approaches that maximize patient comfort without compromising treatment effectiveness.
The study employed a single-blind randomized clinical trial design involving 60 patients with asymptomatic single-rooted, single-canal teeth presenting with pulp necrosis and radiographic evidence of periapical lesions. Participants were randomly allocated to four groups according to whether apical foramen enlargement was performed and the irrigant activation technique used.
Standardized protocols for root canal preparation, irrigation, and obturation were applied across all groups.
Postoperative pain intensity was assessed using the Visual Analog Scale (VAS) at 8 hours, 24 hours, 48 hours, 3 days, and 1 week after completion of treatment.
The findings demonstrated no statistically significant differences in postoperative pain levels among the four groups at any of the evaluation time points. Pain intensity reached its highest level during the first 8 hours after treatment and then gradually declined over the course of the first week, following a similar pattern in all groups regardless of whether apical foramen enlargement was performed or which irrigant activation technique was used.
The study concluded that apical foramen enlargement and the use of advanced irrigant activation techniques—either Passive Ultrasonic Irrigation (PUI) or the XP-Endo Finisher—do not increase postoperative pain in single-rooted, single-canal teeth with necrotic pulps and associated periapical lesions. These findings support the incorporation of these procedures into endodontic treatment protocols when performed according to established scientific principles, without adversely affecting patient comfort.
The authors also recommended conducting further clinical studies with larger and more diverse patient populations and longer follow-up periods to validate these findings and investigate the long-term effects of these treatment procedures.