title: A prospective randomized trial comparing periapical instrumentation to intracanal instrumentation in cases of asymptomatic pulpal-periapical lesions.
abstract: To clarify the divergent viewpoints with respect to method of instrumentation in asymptomatic teeth with pulpal necrosis and associated periapical radiolucent lesions (PN/PL), this prospective study was undertaken. The subjects were 106 patients with quiescent cases of PN/PL. Alternately, 53 had periapical instrumentation and 53 had intracanal instrumentation. Prophylactic antibiotics were not administered but the patients were told to take an antibiotic at the first sign of swelling. Flare-ups, non-flare-up-associated swelling and pain, and cases in which there were no postoperative problems were evaluated at 1-day, at 1 week, and at 2 months. A 6.6% incidence of flare-up was found with no statistically significant difference between periapical instrumentation (7.5%) and intracanal instrumentation (5.7%). A 27.4% incidence of swelling was found with no statistically significant difference between periapical instrumentation (24.5%) and intracanal instrumentation (30.2%). A 43.4% incidence of pain was found, with no statistically significant difference between periapical instrumentation (15.1%) and intracanal instrumentation (47.2%). When moderate pain and severe pain were combined, the incidence was 21.7%, with no statistically significant difference between periapical instrumentation (15.1%) and intracanal instrumentation (28.3%). An incidence of patients having no postoperative problems of 41.5% was found, with no statistically significant difference between periapical instrumentation (47.2%) and intracanal instrumentation (35.8%). When flare-ups were combined with swelling, the incidence was 34.0%, with no statistically significant difference between periapical instrumentation (32.1%) and intracanal instrumentation (35.8%). When flare-ups were combined with pain, the incidence was 50.0%, with no statistically significant difference between periapical instrumentation (47.2%) and intracanal instrumentation (52.8%).(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Endodontology, Temple University School of Dentistry, Philadelphia, Pa.
authors.forename: D R
authors.initials: DR
authors.lastname: Morse
authors.forename: M L
authors.initials: ML
authors.lastname: Furst
authors.forename: R M
authors.initials: RM
authors.lastname: Belott
authors.forename: R D
authors.initials: RD
authors.lastname: Lefkowitz
authors.forename: I B
authors.initials: IB
authors.lastname: Spritzer
authors.forename: B H
authors.initials: BH
authors.lastname: Sideman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002986:Clinical Trials as Topic; D003790:Dental Pulp Necrosis / Q000628:therapy*; D004487:Edema / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D010149:Postoperative Pain; D010483:Periapical Diseases / Q000209:etiology / Q000628:therapy*; D011446:Prospective Studies; D011897:Random Allocation; D012390:Root Canal Therapy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods