Comparative Evaluation of Diclofenac Sodium and Ibuprofen for Post-Endodontic Pain Management

Post-endodontic pain is a frequently encountered complication following root canal therapy and may occur due to inflammatory responses caused by mechanical instrumentation, chemical irritation, or microbial factors affecting the periapical tissues. Effective pain management following endodontic procedures is important for improving patient comfort, treatment satisfaction, and recovery.

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for dental pain because they inhibit cyclooxygenase enzymes responsible for prostaglandin synthesis, thereby reducing inflammation and pain. Among NSAIDs, diclofenac sodium and ibuprofen are widely used due to their analgesic and anti-inflammatory properties. However, differences in pharmacological action, tissue penetration, potency, and duration of effect may influence their comparative effectiveness in controlling post-endodontic pain.

This randomized controlled trial will be conducted at the Department of Operative Dentistry, Armed Forces Institute of Dentistry, Rawalpindi, Pakistan. A total of 60 participants aged 18-65 years diagnosed with irreversible pulpitis involving a single maxillary or mandibular first molar will be enrolled. Participants will be randomly allocated into two equal groups. One group will receive diclofenac sodium 50 mg, while the other group will receive ibuprofen 400 mg following completion of single-visit root canal therapy.

Standardized endodontic procedures will be performed by an experienced operator under local anesthesia using 2% lidocaine with epinephrine. Root canal preparation, irrigation, obturation, and temporary restoration will be completed using standardized techniques to minimize procedural variability.

Pain intensity will be assessed using a Visual Analogue Scale (VAS) before treatment and at 6, 12, 24, and 48 hours after treatment. Participants will maintain a pain diary to record pain levels and rescue analgesic intake. Secondary outcomes include the frequency of rescue medication use and monitoring of adverse effects.

Data analysis will be performed using Statistical Package for Social Sciences (SPSS) version 23. Appropriate descriptive and inferential statistical methods will be applied following assessment of data normality. Comparative analysis between treatment groups will evaluate differences in postoperative pain scores and rescue analgesic requirements.

The results of this study may provide evidence regarding the comparative analgesic efficacy of diclofenac sodium and ibuprofen in endodontic pain management. This may support clinicians in selecting optimal postoperative analgesic protocols for patients undergoing root canal treatment.

Inclusion criteria

Patients diagnosed with Irreversible Pulpitis involving a single maxillary or mandibular first molar Age between 18 and 65 years Patients requiring single-visit root canal treatment Patients able to understand and record pain using Visual Analogue Scale (VAS) Systemically healthy individuals (ASA I-II) Willingness to participate and provide informed consent

Exclusion criteria

Pregnant or lactating women Presence of periapical pathology on radiographic examination Patients with generalized periodontal disease affecting prognosis Use of analgesics or anti-inflammatory drugs within 6 hours prior to treatment Known allergy to Ibuprofen, Diclofenac sodium, or other NSAIDs Patients on medications affecting pain perception (e.g., opioids, antidepressants, anticonvulsants) History of drug abuse or substance dependence Non-vital pulp detected during access opening or instrumentation Inability to complete endodontic treatment in a single visit Failure to achieve proper bleeding response confirming diagnosis of irreversible pulpitis