Can instrumentation kinematics affect postoperative pain and substance P levels? A randomized controlled trial.

BACKGROUND: This study aimed to assess the influence of continuous rotation and reciprocation kinematics on postoperative pain (POP) levels and substance P (SP) levels in patients diagnosed with irreversible pulpitis and symptomatic apical periodontitis (SAP). MATERIALS AND SUBJECTS: A total of twenty patients were randomly assigned into two groups: Continuous Rotation Group (CRG) (n = 10), subjected to mechanical preparation with the EdgeEndox7 rotary system (Albuquerque, NM, USA), and Reciprocation Group (RG) (n = 10), treated with the EdgeOne Fire reciprocating system (Albuquerque, NM, USA). Apical fluid (AF) samples were collected, and SP levels were quantified through radioimmunoassay. POP was assessed using the Numerical Rating Scale (NRS) at various time intervals (preoperatively, 6 h, 12 h, 24 h, 48 h, and 72 h). Data were statistically analyzed utilizing the independent t-test, Mann-Whitney U test, Friedman's test, and Nemenyi post hoc test. RESULTS: There was a significant increase in SP levels in the reciprocating group compared to the continuous rotation group (P </= 0.05). Additionally, patients in the reciprocating group reported significantly higher POP levels (P </= 0.05) at all measured intervals (6 h, 12 h, 24 h, and 48 h), with both groups exhibiting similar pain level reductions at the 72-hour mark. CONCLUSION: Our findings suggest that continuous rotation kinematics in root canal preparation leads to a considerable reduction in SP expression and POP. TRIAL REGISTRATION: The study protocol was retrospectively registered on the www. CLINICALTRIALS: gov database (NCT06081335) at (13/10/2023) after the approval of the Ethics Committee, Faculty of Dentistry, Ain Shams University (FDASU-RecIM012135).