Effect of Intracanal Cryotherapy and Curcuma Longa as a Final Irrigant in Reducing Post Operative Pain: An In-Vivo Study

ABSTRACT

Aim:

The point of search of present study was to assess intracanal viability of cold saline, curcumin as an irrigant, and ordinary saline as last irrigant in lessening post endodontic torment.

Material and Method:

In total, 60 individuals were chosen and divided into 3 groups: Group I: intracanal cryotherapy using 2.5°C cold saline, Group II: curcumin irrigant, and Group III: ordinary saline. After the biomechanical preparation, the above mentioned irrigant was used. On the visual analogue scale, participants were asked to rank the intensity of their discomfort following the procedure before, after 6 h and 24 h after the procedure. The outcomes were dissected utilizing ANOVA test.

Result:

Both the regimens were successful in reducing post endodontic soreness associated with infected teeth.

Conclusion:

Curcumin and cryotherapy both the regimens were successful in lessening post endodontic torment.

INTRODUCTION

Pain from post-endodontic therapy can be uncomfortable for both patients as well as for doctors; following treatment, unpleasant sensations have been observed in 35% of cases.[1]

Some well-considered strategies have been used to reduce the frequency of discomfort including occlusal clearance and pharmacological techniques such as antihistamines, NSAIDs, narcotic analgesics. Although they are generally safe treatments, the use of cyclooxygenase inhibitors, corticosteroids can result in gastrointestinal, renal, and hepatic issues.[2]

Applying cold materials to the surrounding tissues to reduce their temperature in an effort to manage pain is known as cryotherapy. As per Van’t Hoff’s law, applying cold to the dermis and the subcutaneous tissues results in cellular metabolism being lowered, vasoconstriction, and neural receptor suppression.[3] According to Vera J. et al.,[4] applying cold saline that is 2.5 degree Celsius for 5 min can reduce inflammation in the peri-radicular tissue and diminish the exterior root temperature on the outside by approximately ten degrees Celsius.

Turmeric is a famous spice in India that belongs to the Zingiberaceae family of gingers. Curcumin has been demonstrated that the analgesic and anti-inflammatory qualities of curcumin beneficial to the management of pain and inflammation.[5]

The application of cryotherapy as irrigating solutions in endodontics is not well studied. Hence, the ultimate objective of this study is to assess how cold saline and irrigation with curcumin affects healing following root canal therapy. To our knowledge, not many studies have been executed and compared the effects of curcumin as an irrigant and cryotherapy on the alleviation of permanent tooth postendodontic discomfort.

MATERIAL AND METHOD

Before examination begins, participants received education on the risks, advantages, and options for the specified process or intervention, as well as completed consent forms, were acquired from each participant. For this investigation, 60 individuals were chosen.

Patient age between 18 and 45 years were chosen with completely form root apices, vital tooth without any periapical radiolucency. Throughout the course of therapy, all patients were instructed not to take any antibiotics or analgesics. Subjects were given an explanation of visual analogue scale (VAS) and the same scale was used to record the preoperative pain score. After administering of local anaesthesia, access cavity was prepared. Working length was ascertained. Protaper Gold Universal System was used during the whole biomechanical preparation process, along with extensive irrigation using saline and 5.25% sodium hypochlorite. Employing 17% EDTA, the smear layer was eradicated. The patients were split into three groups throughout the time of irrigation depending on the final type of irrigation implemented.

Group I Cryotherapy (n = 20): Five ml normal saline was placed in the refrigerator before the root canal process, and it was continuously monitored with a digital thermometer to ensure that the temperature reached 1°. Thermometer indicates that 2.5° cold saline was used as last irrigant in the canals following the chemomechanical pretreatment.

Group II Curcumin Irrigation (n = 20)

Preparation of curcumin irrigant from curcuma longa: One gm of pure curcumin powder was dissolved with 5 mL of distilled water in a glass beaker. Using a hot plate, the solution was heated to the boiling point and mixed until it was uniform. After allowing the mixture to cool, Whatman filter paper was used to filter it. After completing biomechanical preparation, the prepared curcumin solution was used as last irrigant.

Group III: Normal Saline (n = 20): After completing biomechanical preparation, normal room temperature saline was used as last irrigant [Figure 1].

Figure 1.

(a) Cold saline irrigation, (b) 2.5°C temperature measurement using digital thermometer, (c) Curcumin irrigation, (d) Preparation of curcumin extract

In every group, sterile paper tip was placed in each canal, kept there for a minute. Six-h and 24 h VAS score was obtained.

RESULTS AND STATISTICAL ANALYSIS

Because there are more than two groups in the study, the significance of the difference was assessed using Post-hoc Tukey’s test and ANOVA. Group 1 significantly reduced the pain in both 6-h and 24-h interval. Group 2 significantly reduced the pain in 6-h, but the 24-h period showed no discernible variation [Table 1].

Table 1.

Intra-group comparison for change in Pre-operative, 6 hours and 24 hour VAS score

Pre-operative		Mean Diff	P
Group I	Group II	-0.40000	0.638 (n.s)
	Group III	-0.20000	0.893 (n.s)
Group II	Group III	0.20000	0.893 (n.s)
After 6 hours		Mean Diff	P
Group I	Group II	-0.050	0.991 (n.s)
	Group III	-1.250	0.006 (s)
Group II	Group III	-1.200	0.009 (s)
After 24 hours		Mean Diff	P
Group I	Group II	-0.50000	0.390 (n.s)
	Group III	-1.10000*	0.014 (s)
Group II	Group III	-0.60000	0.261 (n.s)

S=Significant, n.s.=Not significant

DISCUSSION

Clinical examinations reveal that bacteria remain present in the canals. Irrigation solutions also have a role in determining the prognosis of this endodontically treated teeth.[6]

Cryotherapy derives from Greek phrase “cryo,” which means “cold.” It is a phrase utilized by physical therapy to describe lowering or diminishing tissue temperature for the purpose of healing.[7]

Thus, this investigation assessed intra-canal cryotherapy, curcumin irrigant, and normal saline for their antibacterial as well as anti-inflammatory efficacy based on their capacity to alleviate post-endodontic discomfort in the quest for the perfect irrigant for root canal procedures. In their research, Al-Nahlawi T et al.[8] found that employing cold saline for 4 min can lower the temperature of the root’s outer layer by more than ten degrees Celsius, which has an impact on the peri-radicular tissue.

Sylvia Western et al.[9] demonstrated that the intracanal cryotherapy group’s mean pain scores (2°C–4°C) were substantially considerably lower than those of the other group. However, this could be explained by the fact that peripheral nerve transmission is decreased when body temperature is lowered. Specifically, Franz and Iggo[10] found at near 3°C, non-myelinated C-fibers start to gradually deactivate, whereas myelinated A-delta fibers ultimately deactivate at around 7°C.

Balasubramaniam R et al.[11] expressed that curcumin has great antibacterial action against Enterococcus faecalis. Moreover, curcumin has been deeply grounded in different fields of medication as it has great cell reinforcement, hostile to platelet accumulation, and antimutagenic benefits. In the dental field, curcumin has demonstrated its remedial activities in periodontal issues, subgingival irrigant, therapy of dental torment.

Curcumin was deemed safe in six human experiments that showed substantial anti-inflammatory activity, in accordance with Chainani-Wu’s[12] analysis of the drug’s safety and anti-inflammatory qualities.

CONCLUSION

Within the restrictions of investigation, we can presume that the two regimens - the curcumin-irrigating solution and the 2.5° cold saline cryotherapy—were successful in reducing post-endodontic soreness associated with infected teeth.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.