2. Pain related to endodontics is both annoying and perplexing
problem to the patient as well as dental surgeon
Though the pain may not be a sign of endodontic failure
relieving pain is off utmost importance.
3. The causative factors of interappointment pain comprise
mechanical, chemical, and/or microbial injury to the pulp or
periradicular tissues, which are induced or exacerbated
during root canal treatment
The intensity of the inflammatory response is directly
proportional to the intensity of tissue injury
Mechanical and chemical injuries are often associated with
iatrogenic factors, but microbial injury is arguably the
major and the most common cause of interappointment
pain
4. RATIONALE FOR PAIN IN ENDODODNTICS
Periapical extrusion of debris
Vigorous instrumentation beyond the root apex an lead to
pain
Thorough recapitulation and
proper irrigation of root canals
prevents post operative pain
5. Apical Extrusion Of Debris
If during chemomechanical preparation microorganisms are
extruded into the periradicular tissues, the host will face a
situation in which it is now challenged by a larger number of
irritants than it was before. Consequently, there will be a
transient disruption in the balance between aggression and
defense, in such a way that an acute inflammatory response
is mounted to re-establish equilibrium.
6. Incomplete instrumentation of root canal
Incomplete chemomechanical preparation can disrupt the
balance within the microbial community by eliminating some
inhibitory species and leaving behind other previously
inhibited species, which can then overgrow.
If overgrown strains are virulent and/or reach sufficient
numbers, damage to the periradicular tissues can be
intensified and then result in lesion exacerbation.
7. Incorrect measurement of root canal length – may cause
post operative pain
Instrumentation before measurement of root canal
Proper angulated x rays and apex locators help in
attaining the exact working length of the root canal.
8. Keeping the canal empty for long time after
instrumentation will cause periapical flow of bacteria
Continous hyperocclusion from the temporary filling will
cause periapical injury causing post operative pain
Empty root canal
9. Crack of septa- between two closely placed canals from
overzealous instrumentaion leads to post operative pain
Eg- mandibular molars-distal roots , mesiobuccal roots of
upper molars
10. Pulpal tissue in the isthmus region of upper molars and
lower molars is difficult to be eradicated as thus causes pain
60% of mesiobuccal roots of upper molars and 30% of distal
roots of lower molars have isthmus which is difficult to
remove.
11. Endodontic irrigation with hydrogen peroxide or sodium
chloride beyond the apex leads to post operative pain.
Nascent oxygen remains beyond tooth closure and can
cause pain
12. Silver cone obturation causes microleakage and corrosion
of the metal causing pain.
More pain can also occur after lateral condensation when
compared to single cone technique
13. Missed canals in the mandibular molars and maxillary
centrals can cause severe post operative pain
Invaginated tooth and deep palatogingival groove in
incisors can lead to pain if improperly treated
Invaginated toothMissed canal Palato gingival groove
14. Calcified canals- canals which are calcified will have
microscopically bacterial passage through narrow spaces
and can cause pain
Single visit endodontics- flare ups and pain can occur if
treatment plan fails
15. Other reasons are
1. patients with mobile teeth
2. low threshold for pain-emotional problems like tension
and depression
3.patients with low immunity
4.unknown reasons
22% of cases fail because of poor case selection
Eg- poor restorability of tooth, unnegotiable canals, root
resorption, medically compromised patient, separated
instruments
16. Clinical Measures To Improve Success
Success rests on well planned and executed steps
Rubber dam application-asepsis, prevents aspiration of
instruments
Avoid insulting periapical tissues by instruments, debris and
filling materials
Proper working length determination
Disocclude the tooth whenever necessary
Through irrigation
Discard when flutes open up or disturbed
Use of vision enhancing devices- magnifying lens,
microscopes