Down the canal or down the gullet - which form of ibuprofen is best for post-endo instrumentation pain?

Study population and design This randomised observational study compared the analgesic efficacy of intra-canal local ibuprofen paste (Odontocide) with systemic ibuprofen capsules. Ninety patients with symptomatic apical periodontitis scheduled to undergo endodontic therapy were randomised to receive either local ibuprofen, systemic ibuprofen, or no ibuprofen (control). Using a visual analogue scale, pain scores were measured at set time points in the first 48 hours after endodontic instrumentation. The endodontic instrumentation procedures were standardised to use the same endodontic files, sodium hypochlorite, and EDTA irrigants. Canals were dressed with either Odontocide (local ibuprofen paste) or calcium oxide in the systemic ibuprofen and control groups.Data analysis Friedman and Wilcoxon tests were used to compare groups. A power calculation was listed in the methods of the paper which is an important and appropriate step.Results Systemic ibuprofen gave statistically significant better pain relief compared with local ibuprofen paste applied to root canals but only in the first 24 hours after root canal instrumentation. After the 24-hour mark, the systemic ibuprofen had a lower mean pain score but this was not statistically significant. Systemic ibuprofen was always statistically better at providing pain relief than the control.