Effect of trephination on postoperative pain and sweling in symptomatic necrotic teeth

By Houck V, Reader A, Beck M, Nist E, Weaver J.

Date: 04/2000
Journal: Oral Surg Oral Med Oral Patho

Summary: 

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

N=   50 adult patients with symptomatic necrotic tooth and currently had spontaneous pain.

Materials/Methods:

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

The area of perforation was determined by the horizontal line of the buccal gingival margins of the adjacent teeth and a vertical line that passed though the interdental papilla.

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); 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 mean postoperative percussion pain, swelling & medication taken generally decreased over the 7-day observation period for both groups with no statistically significant difference

2.A trephination procedure did not significantly reduce postoperative pain, percussion pain, swelling, or the number of analgesic medications taken in symptomatic necrotic teeth with radiolucencies.

Clinical significance: 

  •Trephination procedure with a perforator, files, and a spoon excavator did not significantly reduce postoperative pain, percussion pain, swelling, or the number of analgesic medications taken in symptomatic necrotic teeth with radiolucencies.