Clinical Oral Investigations

, Volume 22, Issue 7, pp 2623–2631 | Cite as

Postoperative pain after removal of gutta-percha from root canals in endodontic retreatment using rotary or reciprocating instruments: a prospective clinical study

  • Marc Garcia-FontEmail author
  • F. Durán-Sindreu
  • S. Morelló
  • S. Irazusta
  • F. Abella
  • M. Roig
  • J. G. Olivieri
Original Article



The aim of this clinical study was to evaluate and compare the incidence and intensity of postoperative pain following removal of gutta-percha from root canals using rotary and reciprocating instruments.

Materials and methods

One hundred and sixty patients scheduled for a non-surgical endodontic retreatment were included for evaluation. Preoperative pain was recorded with using a questionnaire with a 10-cm visual analogical scale (VAS). Endodontic filling material was removed with Reciproc (VDW, Munich, Germany) or ProFile (Dentsply Tulsa Dental Specialties, Tulsa, OK) instruments. Patients then recorded their postoperative pain in a VAS pain scale at 4, 8, 16, 24, 48, and 72 h post-treatment. Results were analyzed using the Mann-Whitney U, Kruskal-Wallis, and Chi-square tests. Multivariate logistic and a multiple regression analysis were used to detect the effect of confounding factors.


Results showed a direct relation between the intensity of pre-operative pain and that of postoperative pain (P < .05). No significant differences were observed between the two groups regarding postoperative pain (P > .05) as a qualitative variable. As numerical values, statistically significant differences were found regarding sex and the system used (P < .05).


The method for pain evaluation was determinant in postoperative pain findings. Endodontic retreatment preparation with Reciproc results in lower values of postoperative pain compared with ProFile. Women are more susceptible to postoperative pain than are men.

Clinical relevance

One of the most significant contributions of this research is the importance given to the method used for pain evaluation. The present study analyzed postoperative pain resulting from the use of reciprocating or continuous rotary instruments during removal of gutta-percha in retreatment procedures.


Postoperative pain Endodontic retreatment Reciproc ProFile 


Compliance with ethical standards

This study was approved by the Institutional Ethics in Research Committee (END-ECL-2013-01). All patients included in this study were previously given an informed consent about the procedure, risks and benefits, as well as their right to decide whether to participate or not.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All applicable international, national, and/or institutional guidelines for the care and use of animals were followed. Project n. END-ECL-2013-01 was approved by the Committee of Research and Ethics of the Universitat Internacional de Catalunya, Barcelona, Spain.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Siqueira JF Jr (2001) Aetiology of root canal treatment failure: why welltreated teeth can fail. Int Endod J 34(1):1–10. CrossRefPubMedGoogle Scholar
  2. 2.
    Alley BS, Kitchens GG, Alley LW, Eleazer PD (2004) A comparison of survival of teeth following endodontic treatment performed by general dentists or by specialists. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 98(1):115–118. CrossRefPubMedGoogle Scholar
  3. 3.
    Ng YL, Mann V, Gulabivala K (2011) A prospective study of the factors affecting outcomes of non-surgical root canal treatment, part 2: tooth survival. Int Endod J 44(7):610–625. CrossRefPubMedGoogle Scholar
  4. 4.
    Marfisi K, Mercadé M, Plotino G, Clavel T, Duran-Sindreu F, Roig M (2015) Efficacy of Reciproc(®) and Profile(®) instruments in the removal of Gutta-Percha from straight and curved root canals ex vivo. J Oral Maxillofac Res 6:e1CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Zuolo AS, Mello JE Jr, Cunha RS, Zuolo ML, Bueno CES (2013) Efficacy of reciprocating and rotary techniques for removing filling material during root canal retreatment. Int Endod J 46(10):947–953. CrossRefPubMedGoogle Scholar
  6. 6.
    Cunningham C, Mullaney T (1992) Pain control in endodontics. Dent Clin N Am 36(2):393–408PubMedGoogle Scholar
  7. 7.
    Alí A, Olivieri JG, Duran-Sindreu F, Abella F, Roig M, García-Font M (2016) Influence of preoperative pain intensity on postoperative pain after root canal treatment: a prospective clinical study. J Dent 45:39–42. CrossRefPubMedGoogle Scholar
  8. 8.
    Siqueira JF Jr, Rôças IN, Favieri A et al (2002) Incidence of postoperative pain after intracanal procedures based on an antimicrobial strategy. J Endod 28(6):457–460. CrossRefPubMedGoogle Scholar
  9. 9.
    Uzunoglu E, Turker SA (2016) Impact of different file systems on the amount of apically extruded debris during endodontic retreatment. Eur J Dent 10(2):210–214. CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Dincer AN, Er O, Canakci BC (2015) Evaluation of apically extruded debris during root canal retreatment with several NiTi systems. Int Endod J 48(12):1194–1198. CrossRefPubMedGoogle Scholar
  11. 11.
    Çanakçi BC, Ustun Y, Er O, Genc Sen O (2016) Evaluation of apically extruded debris from curved root canal filling removal using 5 nickel-titanium systems. J Endod 42(7):1101–1104. CrossRefPubMedGoogle Scholar
  12. 12.
    Comparin D, Moreira EJL, Souza EM, De-Deus G, Arias A, Silva EJNL (2017) Postoperative pain after endodontic retreatment using rotary or reciprocating instruments: a randomized clinical trial. J Endod 43(7):1084–1088. CrossRefPubMedGoogle Scholar
  13. 13.
    Topçuoğlu HS, Topçuoğlu G (2017) Postoperative pain after the removal of root canal filling material using different techniques in teeth with failed root canal therapy: a randomized clinical trial. Acta Odontol Scand 75(4):249–254. CrossRefPubMedGoogle Scholar
  14. 14.
    Huskinsson EC (1974) Measurement of pain. Lancet 2:1127–1131CrossRefGoogle Scholar
  15. 15.
    Pak JG, White SN (2011) Pain prevalence and severity before, during, and after root canal treatment: a systematic review. J Endod 37(4):429–438. CrossRefPubMedGoogle Scholar
  16. 16.
    Eyuboglu TF, Olcay K, Özcan M (2017) A clinical study on single-visit root canal retreatments on consecutive 173 patients: frequency of periapical complications and clinical success rate. Clin Oral Investig 21(5):1761–1768. CrossRefPubMedGoogle Scholar
  17. 17.
    Torabinejad M, Kettering JD, McGraw JC, Cummings RR, Dwyer TG, Tobias TS (1988) Factors associated with endodontic interappointment emergencies of teeth with necrotic pulps. J Endod 14(5):261–266. CrossRefPubMedGoogle Scholar
  18. 18.
    Spångberg LS (2001) Evidence-based endodontics: the one-visit treatment idea. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 91(6):617–618. CrossRefPubMedGoogle Scholar
  19. 19.
    Yoldas O, Topuz A, Isçi AS, Oztunc H (2004) Postoperative pain after endodontic retreatment: single- versus two-visit treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 98(4):483–487. CrossRefPubMedGoogle Scholar
  20. 20.
    El Mubarak AH, Abu-bakr NH, Ibrahim YE (2010) Postoperative pain in multiplevisit and single-visit root canal treatment. J Endod 36(1):36–39. CrossRefPubMedGoogle Scholar
  21. 21.
    Sadaf D, Ahmad MZ (2014) Factors associated with postoperative pain in endodontic therapy. Int J Biomed Sci 10:243–247PubMedPubMedCentralGoogle Scholar
  22. 22.
    Genet JM, Wesselink PR, Thoden van Velzen SK (1986) The incidence of preoperative and postoperative pain in endodontic therapy. Int Endod J 19(5):221–229. CrossRefPubMedGoogle Scholar
  23. 23.
    Yesilsoy C, Koren LZ, Morse DR, Rankow H, Bolanos OR, Furst ML (1988) Post-endodontic obturation pain: a comparative evaluation. Quintessence Int 19(6):431–438PubMedGoogle Scholar
  24. 24.
    Glennon JP, Ng YL, Setchell DJ, Gulabivala K (2004) Prevalence of and factors affecting postpreparation pain in patients undergoing two-visit root canal treatment. Int Endod J 37(1):29–37. CrossRefPubMedGoogle Scholar
  25. 25.
    Sathorn C, Parashos P, Messer H (2008) The prevalence of postoperative pain and flare-up in single-and multiple-visit endodontic treatment: a systematic review. Int Endod J 41(2):91–99. PubMedGoogle Scholar
  26. 26.
    Yaylali IE, Teke A, Tunca YM (2017) The effect of foraminal enlargement of necrotic teeth with a continuous rotary system on postoperative pain: a randomized controlled trial. J Endod 43(3):359–363. CrossRefPubMedGoogle Scholar
  27. 27.
    Silva EJ, Menaged K, Ajuz N, Monteiro MR, Coutinho-Filho Tde S (2013) Postoperative pain after foraminal enlargement in anterior teeth with necrosis and apical periodontitis: a prospective and randomized clinical trial. J Endod 39(2):173–176. CrossRefPubMedGoogle Scholar
  28. 28.
    Huang X, Ling J, Wei X, Gu L (2007) Quantitative evaluation of debris extruded apically by using ProTaper universal Tulsa rotary system in endodontic retreatment. J Endod 33(9):1102–1105. CrossRefPubMedGoogle Scholar
  29. 29.
    Siqueira JF Jr (1997) Tratamento das Infecções Endodônticas. Medsi, Rio de Janeiro, BrazilGoogle Scholar
  30. 30.
    Silva EJ, Sa L, Belladonna FG et al (2014) Reciprocating versus rotary systems for root filling removal: assessment of the apically extruded material. J Endod 40(12):2077–2080. CrossRefPubMedGoogle Scholar
  31. 31.
    Caviedes-Bucheli J, Castellanos F, Vasquez N, Ulate E, Munoz HR (2016) The influence of two reciprocating single-file and two rotary-file systems on the apical extrusion of debris and its biological relationship with symptomatic apical periodontitis. A systematic review and meta-analysis. Int Endod J 49(3):255–270. CrossRefPubMedGoogle Scholar
  32. 32.
    Caviedes-Bucheli J, Azuero-Holguin MM, Gutierrez-Sanchez L, Higuerey-Bermudez F, Pereira-Nava V, Lombana N, Munoz HR (2010) The effect of three different rotary instrumentation systems on substance P and calcitonin gene-related peptide expression in human periodontal ligament. J Endod 36(12):1938–1942. CrossRefPubMedGoogle Scholar
  33. 33.
    Wise EA, Price DD, Myers CD, Heft MW, Robinson ME (2002) Gender role expectations of pain: relationship to experimental pain perception. Pain 96(3):335–342. CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Robinson ME, Riley JL III, Myers CD, Papas RK, Wise EA, Waxenberg LB, Fillingim RB (2001) Gender role expectations of pain: relationship to sex differences in pain. J Pain 2(5):251–257. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of EndodonticsUniversitat Internacional de CatalunyaBarcelonaSpain
  2. 2.Dentistry FacultyUniversitat Internacional de CatalunyaSant Cugat del VallèsSpain
  3. 3.Department of Restorative DentistryUniversitat Internacional de CatalunyaBarcelonaSpain

Personalised recommendations