summary

Patients report more discomfort aftersurgical endodontic retreatment thannon-surgicalKvist T, Reit C. Postoperative discomfort associated with surgical and nonsurgical endodontic retreatment. Endod DentTraumatol 2000; 16:71±74

Objective To observe any systematic difference between surgicaland non-surgical endodontic retreatment of endodontic failures.

Design Randomised controlled trial.

Intervention Surgical or non-surgical endodontic retreatment.

Outcome measures Patients recorded pain and swelling eachpostoperative day for 1 week using a visual analogue scale (VAS). Use ofanalgesia was also recorded.

Results Ninety-two patients were included in the study. Pain and

swelling was significantly higher in the surgically retreated patients with67% of patients in the surgical group recording use of analgesicscompared with 16% in the non-surgical group. Only surgical patientsreported absences from work post-treatment.

Conclusion Surgical retreatment resulted in more pain and swellingthan non-surgical retreatment.

Address for reprints: Thomas Kvist, Gothenburg University, Institute ofOdontology, PO Box 450, SE 405 30 Gothenburg, Sweden.

CommentaryThis trial was designed to compare theincidence of postoperative pain, swellingand subsequent absence from work as a resultof non-surgical or surgical retreatment of apreviously root-canal-treated-tooth whichfailed to heal. Using the same population ofpatients included in a previous study,1 92patients with 95 previously treated maxillaryand mandibular anterior teeth were randomlyselected using the `minimization method' fornon-surgical or surgical retreatment. For 7days following either retreatment modality,the patients assessed their own respectivepostoperative swelling and pain using a VASwhich ranged from ``no swelling'' to ``verysevere swelling'' and ``no pain'' to ``intoler-able pain''. The patients were also asked torecord whether they required analgesics forpain relief and if they had to take any time offfrom work as a result of the pain and/orswelling. It should be noted that the patientswere not prescribed any medication post-operatively, nor instructed to use coldcompresses postsurgically. Thus, if needed,over-the-counter analgesics had to be used.The results were analysed using a chi-square

test with Yates' correction and Wilcoxon'srank sum test.

The authors reported an excellent return of93 questionnaires. The results indicated thatthe patients in the surgical retreatment groupexperienced significantly more postoperativepain and swelling than those in the non-surgical retreatment group. In addition, morepatients in the surgical group required analge-sics to control their pain, and absence fromwork was only reported by patients in thesurgical group and the main reasons for theabsence were swelling and discoloration, notpain.

Although the results of this study indicatedthat there is more postoperative discomfort,swelling, absence from work and increasedindirect costs to the patient after havingsurgical retreatment of an endodonticallytreated tooth which has failed to heal, thereis no indication that nonsurgical retreatmentis the preferred treatment. What it doesindicate is that practitioners should informtheir patients that they may experience morepostoperative pain and swelling and that theyshould consider prescribing a non-steroidalanti-inflammatory drug post-treatment and

instructing their patients in the use of coldcompresses.

In pain studies such as this one, it is alwaysdifficult to control variables such as thecomplexity and length of the surgical proce-dure, individual differences in pain tolerance,and the fact that patients have a preconceivednotion that surgery results in increased painand swelling. Although the authors attemptedto control these variables, they are inherent inthis type of clinical trial and the patients couldnot be blinded from the procedure that hadbeen performed.

1. Kvist T, Reit C. Results of endodonticretreatment: a randomised clinical studycomparing surgical and non-surgicalprocedures. J Endod 1999; 25:814±817.

Jeffrey W HutterDepartment of Endodontics

Goldman School ofDental Medicine,

Boston University, Boston,Massachusetts,

USA

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