Effect of Occlusal Reduction on Post-operative Pain in Diabetic and Non-diabetic Patients With Symptomatic Apical Periodontitis in a Single Visit: An In Vivo Study.

BACKGROUND: Pain is a common and significant sensory and emotional experience that often drives patients to seek medical care. In dentistry, managing pain, especially during and after endodontic treatment, remains a critical challenge. Endodontics focuses on treating diseases of the dental pulp and periradicular tissues. Although root canal treatment (RCT) is often perceived as painful, studies indicate that patients who have undergone RCT frequently describe it as painless. Despite advancements, postoperative pain due to acute periapical inflammation is still a concern. Apical periodontitis, often resulting from pulp infection, can also be influenced by systemic conditions such as diabetes mellitus, which is associated with impaired healing and increased risk of periodontal disease. Occlusal reduction, a technique to minimise mechanical stimulation of sensitised nociceptors, may reduce postoperative pain by decreasing pressure on inflamed periapical tissues. OBJECTIVE: This study aimed to evaluate the effect of occlusal reduction on postoperative pain in diabetic and non-diabetic patients with symptomatic apical periodontitis undergoing single-visit endodontic treatment. HYPOTHESIS: Occlusal reduction reduces postoperative pain in both diabetic and non-diabetic patients following single-visit RCT. METHODS: This study included 90 patients with symptomatic apical periodontitis (30 diabetic and 60 non-diabetic). Sensibility of the tooth was checked using a cold test and an electric pulp tester. Diagnosis was confirmed through tenderness on percussion and radiovisiography. Glycaemic control in diabetic patients was assessed using HbA1c levels. Randomisation was performed in a 1:2 ratio (diabetic: non-diabetic). Patients recorded pain intensity on a visual analogue scale at 1, 6, 12, 24, 48, and 72 hours, and 1 week post-treatment. The PICO format guided the study design. Data were analysed statistically. RCT was performed with ProTaper Gold rotary files (Dentsply Maillefer, Switzerland), sodium hypochlorite or ethylenediaminetetraacetic acid irrigation, single cone obturation, occlusal reduction, and composite restoration after 72 hours. All patients were prescribed a combination analgesic containing aceclofenac 100 mg, paracetamol 325 mg, and serratiopeptidase 15 mg, to be taken only in case of moderate-to-severe pain. RESULT: Data were analysed using SPSS version 23.0 (IBM Corp., Armonk, NY), with descriptive statistics including mean, standard deviation, frequency, and percentage. The Mann-Whitney U test was used for intergroup comparisons, and the Wilcoxon signed-rank test for intragroup comparisons. Normality was assessed using the Shapiro-Wilk test, revealing non-normal data distribution, necessitating non-parametric analysis. In the diabetic group, pain peaked at 6 hours (mean = 2.933) and reduced significantly by 48 hours (mean = 0.333), with no pain at 72 hours and 1 week. The non-diabetic group showed a similar trend, with peak pain at 6 hours (mean = 3.083) and no pain by 72 hours. Intergroup analysis showed a significant difference only at the 1-hour mark (p = 0.001), with non-diabetic patients experiencing higher pain. CONCLUSION: Both diabetic and non-diabetic groups showed significant pain reduction over 72 hours, with the most substantial decrease within the first 48 hours. The pain patterns were comparable between groups except at 1 hour, where non-diabetics reported higher pain.