Comparison of Postoperative Pain After Root Canal Irrigation in Symptomatic Irreversible Pulpitis

Postoperative pain is a common concern following root canal treatment and may persist because of inflammation associated with the treatment of symptomatic irreversible pulpitis. Although corticosteroids such as dexamethasone have established anti-inflammatory effects, limited information is available regarding their use specifically as a final intracanal rinse during root canal treatment.

This study will evaluate the effect of dexamethasone used as a final intracanal rinse on postoperative pain in patients with symptomatic irreversible pulpitis undergoing two-visit root canal treatment. Participants will be randomly allocated to one of two parallel groups. The dexamethasone group will receive dexamethasone as the final intracanal rinse, whereas the control group will receive an equal volume of normal saline.

Both groups will undergo the same conventional endodontic treatment protocol, with sodium hypochlorite used during canal irrigation. In the intervention group, 1 mL of dexamethasone solution (4 mg/4 mL) will be used as the final rinse, while the control group will receive 1 mL of normal saline as the final rinse. The root canal treatment will be completed at the second appointment one week after the first visit.

Postoperative pain will be assessed using a 10-point Visual Analog Scale, with higher scores indicating greater pain intensity. The pain scores of participants receiving dexamethasone will be compared with those receiving normal saline to determine whether dexamethasone as a final intracanal rinse is associated with reduced postoperative pain.

The study will be conducted as a two-arm, parallel randomized controlled trial at the Department of Operative Dentistry, Institute of Dentistry, CMH Lahore Medical College. A total of 72 participants will be enrolled, with 36 participants allocated to each study group.

Inclusion criteria

• Adults aged 18-65 years.
• Patients diagnosed with symptomatic irreversible pulpitis in a maxillary or mandibular premolar or molar.
• Positive response to cold/thermal pulp testing and electric pulp testing.
• Clinical features consistent with symptomatic irreversible pulpitis, including spontaneous pain and/or pain elicited by thermal stimuli, with clinically evident deep carious involvement or pulpal exposure.
• Patients indicated for two-visit root canal treatment.
• Ability to understand and complete the Visual Analogue Scale (VAS) for pain assessment.
• Absence of active periodontal disease.

Exclusion criteria

• Use of analgesics, antibiotics, or anti-inflammatory medications within 24 hours before treatment.
• History of chronic pain.
• Evidence of periapical involvement or pathology, including periapical abscess, sinus tract, or periapical cyst.
• Pulp necrosis.
• Internal or external root resorption.
• Unfavourable tooth position, ankylosis, trismus, or significant malposition associated with traumatic occlusion.
• Immunocompromised status.
• Known allergy or contraindication to local anaesthetic or dexamethasone.
• Previous endodontic treatment of the study tooth.
• Non-restorable teeth or unfavourable crown-to-root ratio.
• Inability to understand or reliably use the VAS.
• Inability or unwillingness to attend follow-up assessments.