A Comparison of Pulpectomy Alone Versus Pulpectomy with Trephination for the Relief of Pain

By Moos HL, Bramwell JD, Roahen JO

Date: 06/1996
Journal: JOE


Purpose: to compare two methods of treatment pulpectomy alone or pulpectomy with trephination for the reduction of posttreatment pain in patients presenting with acute periradicular pain of pulpal origin.

•N=   17 patients


•Patients must have presented with clinical diagnosis of acute periradicular periodontitis (APP) or chronic periradicular periodontitis symptoms (CPPS) with significant spontaneous pain and pain to digital percussion.

•The control group (n=11) received the pulpectomy procedure. Patients received  LA of 2% lidocaine with 1:100,000 epinephrine & RD isolation. The experimental group (n=6) received a pulpectomy with trephination. The trephination procedure was done via a small vertical incision near the apex or apices of the offending tooth.

•The cortical plate was penetrated under saline irrigation.

•Visual analog scales were used preoperatively to measure pain intensity and unpleasantness postoperatively.

Most highlighted Results:    

1.Preoperatively, no significant difference between the two treatment groups for pain intensity or unpleasantness.

2.At 4 h postoperatively, the experimental group receiving trephination reported significantly greater pain intensity and unpleasantness than the control group. Likewise, the trephination group reported significantly less pain relief at 4 h postoperatively than the pulpectomy alone group. However, this difference was only statistically significant at the 4-h period.

Clinical significance: 

  •Pulpectomy alone provided significantly better postoperative pain relief at 4 h compared with pulpectomy with trephination. Trephination should not be used prophylactically as an adjunct to pulpectomy in cases of acute periradicular pain of pulpal origin.