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    Instrumentation kinematics does not affect bacterial reduction, post-operative pain, and flare-ups: A randomized clinical trial. International endodontic journal AIM:This randomized clinical trial aimed to assess the effect of instrumentation kinematics (reciprocation or continuous rotation) on bacterial reduction, post-operative pain, and incidence of flare-ups after root canal treatment of single-rooted mandibular premolars with asymptomatic apical periodontitis. METHODOLOGY:Sixty-six patients were included in this prospective, parallel, randomized clinical trial. Patients were randomly allocated into two groups (N = 33) according to the kinematics of the shaping instrument: WaveOne Gold (WO) used in reciprocation or One Shape (OS) used in continuous rotation. Under complete asepsis, bacterial samples were taken before (S1) and after (S2) a standard cleaning and shaping protocol. Evaluation of bacterial reduction was done by both culture technique and quantitative real-time polymerase chain reaction (qPCR) analysis. Post-operative pain was evaluated using the visual analogue scale (VAS) after 24, 48, and 72 h following treatment, while flare-ups were recorded as a binary outcome (Yes/No). Independent and paired t-tests were used for inter- and intra-group comparisons for bacterial count data, respectively. For post-operative pain score, inter-group comparisons were analyzed using the Mann-Whitney U-test while intra-group comparisons were analyzed using Friedman test followed by pairwise comparisons utilizing the Wilcoxon signed rank test with Bonferroni correction. The significance level was set at p ≤ .05 within all tests. RESULTS:All the allocated participants received the intervention and were analysed. The comparison between culture and qPCR methods showed that qPCR analysis demonstrated significantly higher pre-instrumentation baseline bacterial count (p < .05). The percentage of bacterial reduction, detected by either method, significantly decreased after instrumentation using either rotation or reciprocation kinematics (p < .05). However, the difference between the WOG or OS files was statistically non-significant (p > .05). The intra-group comparisons showed a significant reduction in post-operative pain with time (p < .05) for both groups. However, the inter-group comparison demonstrated that the difference in post-operative pain after the use of either WOG or OS was statistically non-significant (p > .05). The incidence of flare-ups between both groups was also not-significant (p = 1). CONCLUSIONS:Shaping kinematics, either rotation or reciprocation motions, had no impact on bacterial reduction and the incidence of post-operative pain and flare-ups after root canal preparation of single-rooted premolars with asymptomatic apical periodontitis. 10.1111/iej.13695
    Pain and flare-up after endodontic treatment procedures. Sipavičiūtė Eglė,Manelienė Rasmutė Stomatologija Flare-ups can occur after root canal treatment and consist of acute exacerbations of an asymptomatic pulpal and/or periradicular pathologic condition. The causative factors of interappointment pain encompass mechanical, chemical, and/or microbial injury to the pulp or periradicular tissues. Microorganisms can participate in causation of interappointment pain in the following situations: apical extrusion of debris; incomplete instrumentation leading to changes in the endodontic microbiota or in environmental conditions; and secondary intraradicular infections. Interappointment pain is almost exclusively due to the development of acute inflammation at the periradicular tissues in response to an increase in the intensity of injury coming from the root canal system. The mechanical irritation of apical periodontal tissue is caused by overinstrumentation of the root canal and filling material extrusion through the apical foramen. Incorrectly measured working length of the root canal has inherent connection with these causative factors of endodontic flare - up. This review article discusses these many facets of the flare-up: definition, incidence causes and predisposing factors.