Effect of photobiomodulation on post-operative symptoms in teeth with asymptomatic apical periodontitis treated with foraminal enlargement: A randomized clinical trial

Abstract

Aim: To assess the efficacy of photobiomodulation in reducing post-operative symptoms and use of analgesics in teeth with asymptomatic apical periodontitis treated with foraminal enlargement in a single visit.

Methodology: This prospective double-blind, controlled, superiority, randomized clinical trial enrolled 70 patients requiring root canal treatment of one single-rooted tooth with asymptomatic apical periodontitis. The participants were randomized into one of the following two groups: 35 patients in the control group (C.G) - root canal treatment with foraminal enlargement, without any additional treatment and 35 patients in the photobiomodulation group (PBM.G) - root canal treatment with foraminal enlargement associated with photobiomodulation (antimicrobial photodynamic therapy and low-level laser therapy). The outcome variables were post-operative pain, tenderness, oedema and the use of analgesics. Pain intensity was measured using a visual analogue scale (recorded every day for 7 days, then the 14th and 30th days after root canal treatment). Facial oedema was assessed subjectively by two independent evaluators using photographs taken by one of the researchers at 48 h, 72 h and 7 days after the procedures. Data were tabulated and analysed using the Mann-Whitney U, Chi-Square, Fisher`s Exact, Student T and Ordinal Logistic Regression by Generalized Estimating Equations tests in SPSS software.

Results: There were no significant differences in post-operative pain and tenderness between the groups at any observation period (p > .05). Photobiomodulation (beta = -0.77 / p = .01), time (beta = -0.23 / p < .01), and male gender (beta = -1.20 / p < .01) were associated with decreased post-operative pain. Only time (beta: -0.10; p < .01) and male gender (beta: -1.04; p < .01) were associated with decreased tenderness. For oedema and use of analgesics, there was no difference between the groups (p > .05).

Conclusions: Photobiomodulation had no significant effect on post-operative pain, tenderness, oedema and the use of analgesics after root canal treatment with foraminal enlargement, in single-rooted teeth treated in a single visit. Register of Clinical Trials: NCT03704857. Research Ethics Committee: no 2.353.996 / CAAE 74185417.9.0000.5626.

Keywords: antimicrobial photodynamic therapy; low-level laser therapy; oedema; pain; photobiomodulation therapies; root canal preparation.