The Incidence of Postoperative Pain After Using Different Types of Sealers (A Randomized Clinical Trial)

Primary local anesthesia

Tooth will be anaesthetized using Local anesthesia containing Articaine with epinephrine 1:100,000.

Supplemental local anesthesia

if needed

Removal Of Caries and Access Cavity

• Access cavity will be performed using a carbide round steel bur and tapered diamond stone until complete deroofing.

Rubber dam isolation of tooth

Rubber dam isolation of tooth using certain clamps .

Bleeding control

bleeding is controlled by using excavator for the removing the pulp tissue . using a piece of cotton soaked with Sodium hypochlorite. using local anesthesia with vasoconstrictor if needed and if suitable for the patient.

Canal negotiation

Coronal patency of the coronal and the Middle part of the canal using file #10 Apical patency of the apical part of the canal using #10

Coronal flaring

Coronal flaring using Orifice opener of a certain Rotary system in and out motion first then brushing motion touching all the canal walls

Working Length Determination (W.L)

Working length determination (W.L) using #10 K File , working length is recorded using apex locator and confirmatory radiograph.

Glide path

Glide path of the canal Using #10 ,15 ,20 ,25 K files till becoming Super-Loose Inside the Canal at the recorded w.l to create a path for the rotary file .

Irrigation

Irrigation using 5.25% sodium hypochlorite introduced using side vented needle

Cleaning and shaping using rotary system

Cleaning and shaping using rotary system plus irrigation and apical patency between every rotary file .

Second w.l determination

Second w.l determination using electronic apex locator before using final finishing rotary file .

Apical gauging

Establish the depth of apical constriction - this is the zero reading on your apex locator. your working length will be 0.5mm - 1mm short of this. After cleaning and preparing the canal system to your working length, passively insert 02 taper hand files, starting from #15. If the file goes past the apical constriction (your working length + 0.5-1mm), then choose the next largest file and repeat. When a file passively binds short of the apical constriction, that will be the upper limit of the apical constriction diameter. The smaller file before that would be the lower limit. Apical gauging helps with: Choosing the best master cone that closely matches canal length and taper Achieving true tug back - as opposed to false tug back! Minimising gutta percha extrusions during obturation

Activation of the irrigant

Activation of the irrigant using Manual Dynamic Agitation and Ultra x or eddy tips for activation

Master cone check

Master cone check Clinically and confirmatory radiograph

application of resin based sealer inside the canal in the resin based sealer group

application done by inserting inside the canal by spreader or master cone

application of the sillicon based sealer inside the canal in the sillicon based group

application done by injection inside the canal

Obturation

done by lateral condensation technique

Visual Analogue Scale (VAS)

Pain is evaluated using visual analogue scale (VAS) which is a pain rating scale. Scores are based on measures that are self-reported of symptoms that are recorded through a single handwritten mark placed at one point along the length of a 10-cm line representing a continuum between the two ends of the scale; on the left end of the scale (0 cm) means "no pain" and the on the right end of the scale (10 cm) "worst pain"

Postoperative pain

after 6 hours of endodontic treatment

Postoperative pain

after 12 hours of endodontic treatment

Postoperative pain

after 24 hours of endodontic treatment

Postoperative pain

after 48 hours of endodontic treatment

Postoperative pain

after 72 hours of endodontic treatment