• Fatima Ali AFID, Rawalpindi
  • Ajmal Yousaf AFID, Rawalpindi
  • Zoobia Daud AFID, Rawalpindi
  • Syed Muzammil Hussain AFID, Rawalpindi
  • Mohib Ullah AFID, Rawalpindi
  • Muzammil Jamil Ahmed Rana AFID, Rawalpindi


Background: Post-operative pain is the most annoying factor for the patients for which different intra-canal medicaments are used. The aim of this study was to compare calcium hydroxide mixed with dexamethasone and triple antibiotic paste as intra-canal medicaments on the incidence of post-operative endodontic pain. Methods: This was a randomized controlled trail in which a total of 120 patients presenting to the department of Operative Dentistry AFID, Rawalpindi from 20–50 years of age from both gender presenting with acute apical periodontitis in their maxillary and mandibular central incisors were selected and randomly divided into three equal groups of 40 patients with the help of scientific random number table. Group A patients were given calcium hydroxide mixed with dexamethasone, group B patients were given triple antibiotic paste and in group C patients only cotton pellet was placed in the pulp chamber as a placebo. Endodontic therapy was initiated, following pulpectomy and disinfection, canals were prepared and intra-canal dressings were placed according to the allotted group and restored with cavit. Pain was recorded at 24, 48 and 72 hours using the visual analogue scale. Data was analysed using SPSS 21. Results: After 72 hours, 55% of group A patients had no pain, 47.5% patients in group B while in group C 17.5% of the patients reported no pain. Conclusion: Both calcium hydroxide combined with dexamethasone and triple antibiotic paste are effective in reducing post-operative pain in teeth with symptomatic irreversible pulpitis while placebo showed little reduction in pain. Keywords: Acute peri-apical periodontitis; Triple antibiotic paste; Post-operative pain

Author Biographies

Fatima Ali, AFID, Rawalpindi

FCPS-II Resident Operative Dentistry in AFID Rawalpindi

Ajmal Yousaf, AFID, Rawalpindi

FCPS-II Consultant Operative Dentistry in AFID Rawalpindi

Zoobia Daud, AFID, Rawalpindi

FCPS-II Resident Operative Dentistry in AFID Rawalpindi

Syed Muzammil Hussain, AFID, Rawalpindi

FCPS-II Consultant Operative Dentistry in AFID Rawalpindi

Mohib Ullah, AFID, Rawalpindi

FCPS-II Consultant Operative Dentistry in AFID Rawalpindi

Muzammil Jamil Ahmed Rana, AFID, Rawalpindi

FCPS-II Consultant Operative Dentistry in AFID Rawalpindi


Lu Y, Liu Z, Huang J, Liu C. Therapeutic effect of one-time root canal treatment for irreversible pulpitis. J Int Med Res 2019;030006051987928.

Shresha R, Shrestha D, Kayastha R. Post-operative pain and associated factors in patients undergoing single visit root canal treatment on teeth with vital pulp. Kathmandu Univ Med J 2018;62(2):120–3.

Samir AS, Mohamed IS, Gameel SO, Mohamed AG. Evaluation of postoperative pain in infected root canals after using double antibiotic paste versus calcium hydroxide as intra-canal medication: A randomized controlled trial. F1000Res 2018;7:1768.

Jayakodi H, Kailasam S, Kumaravadivel K, Thangavelu B, Mathew S. Clinical and pharmacological management of endodontic flare-up. J Pharm Bioal Sci 2012;4(6):294.

Jafarzadeh H, Mohammadi Z, Shalavi S and Kinoshita J. Establishing Apical Patency: To be or not to be? J Contemp Dent Pract 2017;18(4):326–9.

Yaylali I, Kurnaz S, Tunca Y. Maintaining apical patency does not increase postoperative pain in molars with necrotic pulp and apical periodontitis: A randomized controlled trial. J Endod 2018;44(3):335–40.

Silva E, Teixeira J, Kudsi N, Sassone L, Krebs R, Coutinho-Filho T. Influence of apical preparation size and working length on debris extrusion. Braz Dent J 2016;27(1):28–31.

Valverde M, Baca P, Ceballos L, Fuentes M, Ruiz-Linares M, Ferrer-Luque C. Antibacterial efficacy of several intracanal medicaments for endodontic therapy. Dent Mater J 2017;36(3):319–24.

Ranmanesh F, Parirokh M, Haghdoost AA, Abbott PV. Effect of corticosteroids on pain relief following root canal treatment: A systematic review. Iran Endod J 2017;12(2):123–30.

Alshehri A, Alshraim R, Abo Dawood A. Endodontic flare-ups: A study of incidence and related factors. Egypt J Hosp Med 2018;70(2):349–53.

Dall AQK, Tasleem F, Khan MF, Channar KA, Batool S, Bari MA. Reduction of pain and bacterial presence by using double and triple antibiotic pastes in symptomatic apical periodontitis. J Liaquat Univ Med Health Sci 2019;18(02):129–35.

Kaur M, Kendre S, Gupta P, Singh N, Sethi H, Gupta N, et al. Comparative evaluation of anti microbial effects of triple antibiotic paste and amox and its derivatives against e. faecalis: An in vitro study. J Clin Exp Dent 2017;9(6):799–804.

Khalid N, Ahmed A, Raa I, Khalid W. Post-operative pain after use of intra-canal corticosteroid in root canal treatment of vital teeth. Pak Oral Dent J 2016;36(2):327–30.

Sinhal TM, Shah RP, Shah NC, Jais PS, Hadwani KD. Comparative evaluation of 2% chlorhexidine gel and triple antibiotic paste with calcium hydroxide paste on incidence of interappointment flare-up in diabetic patients: A randomized double-blinded clinical study. Endodontology 2017;29(2):136–41.

Siqueira Junior J, Rôças I, Marceliano-Alves M, Pérez A, Ricucci D. Unprepared root canal surface areas: causes, clinical implications, and therapeutic strategies. Braz Oral Res 2018;32(suppl 1):e65.

Arash G, Ajami M, Mohsen A. The effect of different combinations of calcium hydroxide as intra-canal medicament on endodontic pain: a randomized clinical trial study. Iran Endod J 2019;14(1):1–6.

Abdel HE, Abdel AS, Sadek HS, Ibrahim AM. Effectiveness of triple antibiotic paste as an intra-canal medication for the root canal treatment of non-vital teeth with apical periodontitis: A systematic review. F1000Res 2018;7:1627.

Pai S, Pai Vivekananda AR, Thomas MS, Bhat V. Effect of calcium hydroxide and triple antibiotic paste as intracanal medicaments on the incidence of inter-appointment flare-up in diabetic patients: An in vivo study. J Conserv Dent 2014;17:208–11.

Pogatzki-Zahn E, Segelcke D, Schug S. Postoperative pain-from mechanisms to treatment. Pain Rep 2017;2(2):e588.

Nath R, Daneshmand A, Sizemore D, Guo J, Enciso R. Efficacy of corticosteroids for postoperative endodontic pain: A systematic review and meta-analysis. J Dent Anesth Pain Med 2018;18(4):205.

Zahed M. Systemic and local applications of steroids in endodontics: an update review. Int Dent J 2009;59:297–304.

Menakaya IN, Adegbulugbe IC, Oderinu OH, Shaba OP. The efficacy of calcium hydroxide powder mixed with 0.2% chlorhexidine digluconate or mixed with normal saline as intracanal medicament in the treatment of apical periodontitis. J Contemp Dent Pract 2015;16(8)657–64.

Jafarzadeh H, Mohammadi Z, Shalavi S, Sahebalam R, Kinoshita J. Additive and reducing effects between calcium hydroxide and current irrigation solutions. J Contemp Dent Pract 2017;18(3)246–9.

Jindal V, Monga S, Jindal D. Comparative evaluation of the interappointment pain by using different intracanal medicaments-An in vivo study. Dent J Adv Stud 2019;07(01):19–22.

Virdee S. Effective pain management strategies in endodontic therapy. Dent Update 2016;43(6)575–87.

Elzaki W, Abubakr N, Ziada H, Ibrahim Y. Double-blind randomized placebo-controlled clinical trial of efficiency of nonsteroidal anti-inflammatory drugs in the control of post-endodontic pain. J Endod 2016;42(6)835–42.