The effect of triple antibiotic paste as an intracanal medicament with an anti-inflammatory agent on post-operative pain of asymptomatic uniradicular necrotic teeth: a double blind randomized clinical trial.

Background: Flare-ups may occur after root canal treatment which consist of acute exacerbation of asymptomatic pulpal and/or periradicular pathologic condition. The causative factors of interappointment pain include mechanical, chemical or microbial irritation to the pulp or periradicular tissues. The potential role of microorganisms in interappointment pain is why the success of endodontic treatment depends on complete eradication of microorganisms capable of causing an intraradicular or extraradicular infection. This can be achieved by mechanical cleaning and shaping, in conjunction with irrigation and antibacterial agents. The aim of this study was to assess the ability of triple antibiotic paste with the anti-inflammatory drug diclofenac potassium versus calcium hydroxide used as an intra-canal medication in reducing post-operative pain. Methods: 84 patients with asymptomatic uniradicular necrotic teeth were randomly assigned into two groups according to the intra-canal medication used: calcium hydroxide group (CH) and triple antibiotic paste with diclofenac potassium group (TAPC). In the first treatment session, intracoronal cavity preparation was performed after rubber dam isolation followed by chemo-mechanical preparation using rotary Protaper Universal files with saline irrigation followed by intra-canal medication placement then postoperative pain was assessed at 24, 48 and 72 hours postoperatively using Visual Analogue Scale (VAS). In the second treatment session, intracanal medications were removed by irrigation using saline followed by obturation. Results: Both intracanal medicaments resulted in a statistically significant decrease in mean pain value from 24 to 48 and 72 hours postoperatively. While when comparing both groups, TAPC intracanal medication showed less post-operative pain compared to that of the CH group at 24, 48 and 72 hours with a statistically significant difference at 48 hours only. Conclusion: Both intracanal medicaments were efficient in reducing post-operative pain in asymptomatic uniradicular necrotic teeth. Trial registration: Clinicaltrial.gov NCT02907489, 20/09/2016.