Postoperative Pain and Periapical Healing after Endodontic Treatment Using Pachymic Acid-Modified Epoxy Resin Root Canal Sealer: A Double-Blind Randomized Controlled Trial.

Introduction: This study evaluated the effect of adding pachymic acid (PAC) to an epoxy resin root canal sealer (AH Plus) on the postoperative pain and periapical (PA) healing in teeth with necrotic pulp and apical periodontitis.

Methods: Fifty single-rooted teeth with necrotic pulp and apical periodontitis were randomly assigned to two groups according to the sealer (n = 25), AH Plus (AHP) and AHP modified with PAC (AHP/PAC). Endodontic treatment was conducted in 2 visits, with calcium hydroxide as an intracanal medicament. Pain scores were recorded using visual analog scale at baseline, 24 hours and 7 days postoperatively. PA healing was evaluated by measuring lesion size at baseline and postoperatively at 3, 6, 9, and 12 months using digital radiograph. Cone-beam computed tomography (CBCT) was used to assess PA lesion volume and PA volume index score at baseline and 1-year follow-up. Statistical analysis was done using Mann-Whitney U test.

Results: Postoperative pain in AHP/PAC was significantly lower than AHP at 24 hours (P = .03), with no pain in either group at day 7. PA lesion size at 3-month follow-up showed no significant difference (P = .10) between the groups, but a significant reduction was seen in AHP/PAC at 6-, 9-, and 12-months (P < .001). A significant reduction in lesion volume and PA volume index score score were also seen in AHP/PAC at 1-year follow-up (P < .001).

Conclusions: The addition of PAC to AHP decreased the immediate postoperative pain and improved the long-term healing of PA lesions, with a marked reduction in lesion size from 6-month onward.