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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 (39.6%)
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%). When flare-ups were
combined with both swelling and pain, the incidence was 77.4%, with no statistically
significant difference between periapical instrumentation (71.7%) and intracanal instrumentation
(83.0%). When non-flare-up-associated mild pain was combined with the category of
no postoperative problems, the incidence was 63.2%, with no statistically significant
difference between periapical instrumentation (71.7%) and intracanal instrumentation
(54.7%). A sign test analysis of the nine previous categories showed that periapical
instrumentation was significantly better than intracanal instrumentation (8/9; p < 0.001). A review of similar cases showed that patients with whom periapical instrumentation
was used had significantly better periapical healing than patients in whom the apex
could not be negotiated. Hence, for patients with PN/PL without symptoms, it appears
that periapical instrumentation is preferable to intracanal instrumentation.
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© 1987 The C. V. Mosby Company. Published by Elsevier Inc.