Effect of Apical Trephination on Postoperative Pain and Swelling in Symptomatic Necrotic Teeth

By Nist E, Reader A, Beck M.

Date: 05/2001
Journal: JOE

Purpose: to evaluate postoperative pain and swelling after performing an apical trephination procedure in symptomatic necrotic teeth with radiolucencies.

N = 50 adult patients who had a clinical diagnosis of a symptomatic necrotic tooth and currently have spontaneous pain. PARL present but no swelling.


•Conventional RCT was performed. Patients randomly receive a trephination procedure or a mock trephination.

• Location of the perforation was determined by the largest apical radiolucency that was accessible without endangering adjacent anatomical structures. Endo-explorer was used to puncture the alveolar mucosa at the perforation site.

Trephination procedure:  perforator was placed through gingiva& handpiece was activated in short bursts until a break-through feeling was observed. An endodontic spoon excavator was used to curette bone.

Mock trephination: perforator only penetrated gingival tissue (not bone) •After surgery, each patient received ibuprofen; acetaminophen with codeine (30 mg), antibiotics (penicillin or erythromycin), and a 7-day diary to record pain, percussion pain, swelling, and number and type of pain medication taken.

•Patients were asked to rate their pain on a scale from 0 to 3. 0 no pain, 1 mild, 2 moderate, 3 sever.

Most highlighted Results:   

1.The postoperative pain, swelling , percussion ratings  were generally decreased over the 7-day observation period for both groups, no statistically significant difference.

2.Patients with trephination took significantly less acetaminophen with codeine over the 7-day observation period.

3.No statistically significant difference in the mean total number of ibuprofen tablets taken over the 7-day postoperative observation period between groups.

Clinical significance 

Removal of the causative factor (microorganisms within the RCS) is a more important cause for PA inflammation to subside even without surgical management.