{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T12:41:45Z","timestamp":1784551305990,"version":"3.55.0"},"reference-count":35,"publisher":"Elsevier BV","issue":"3","license":[{"start":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T00:00:00Z","timestamp":1677628800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T00:00:00Z","timestamp":1677628800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.jp","jendodon.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of Endodontics"],"published-print":{"date-parts":[[2023,3]]},"DOI":"10.1016\/j.joen.2022.12.010","type":"journal-article","created":{"date-parts":[[2022,12,24]],"date-time":"2022-12-24T11:36:45Z","timestamp":1671881805000},"page":"240-247","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":7,"title":["The Effect of Trypsin-Chymotrypsin on Postoperative Pain after Single Visit Endodontic Treatment: A Randomized Controlled Trial"],"prefix":"10.1016","volume":"49","author":[{"given":"Ahmed Abdel Rahman","family":"Hashem","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaa Adly","family":"Abd El Sattar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tariq Yehia","family":"Abdel Rahman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.joen.2022.12.010_bib1","first-page":"249","article-title":"Pain terms: a list with definitions and notes on usage. Recommended by the IASP subcommittee on taxonomy","volume":"6","author":"Merskey","year":"1979","journal-title":"Pain"},{"key":"10.1016\/j.joen.2022.12.010_bib2","doi-asserted-by":"crossref","first-page":"1976","DOI":"10.1097\/j.pain.0000000000001939","article-title":"The revised International association for the study of pain definition of pain: concepts, challenges, and compromises","volume":"161","author":"Raja","year":"2020","journal-title":"Pain"},{"key":"10.1016\/j.joen.2022.12.010_bib3","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1111\/j.1365-2591.1991.tb00866.x","article-title":"Flare-up rate of single-visit endodontics","volume":"24","author":"Trope","year":"1991","journal-title":"Int Endod J"},{"key":"10.1016\/j.joen.2022.12.010_bib4","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/S0099-2399(06)81413-5","article-title":"Endodontic interappointment flare-ups: a prospective study of incidence and related factors","volume":"18","author":"Walton","year":"1992","journal-title":"J Endod"},{"key":"10.1016\/j.joen.2022.12.010_bib5","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/S0099-2399(06)81353-1","article-title":"Incidence of interappointment emergency associated with endodontic therapy","volume":"18","author":"Mor","year":"1992","journal-title":"J Endod"},{"key":"10.1016\/j.joen.2022.12.010_bib6","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1034\/j.1601-1546.2002.30107.x","article-title":"Interappointment flare-ups: incidence, related factors, prevention, and management","volume":"3","author":"Walton","year":"2002","journal-title":"Endod Top"},{"key":"10.1016\/j.joen.2022.12.010_bib7","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1097\/00004770-200407000-00005","article-title":"Flare-ups in endodontics: I. Etiological factors","volume":"30","author":"Seltzer","year":"2004","journal-title":"J Endod"},{"key":"10.1016\/j.joen.2022.12.010_bib8","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1046\/j.1365-2591.2003.00671.x","article-title":"Microbial causes of endodontic flare-ups","volume":"36","author":"Siqueira","year":"2003","journal-title":"Int Endod J"},{"key":"10.1016\/j.joen.2022.12.010_bib9","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1067\/moe.2001.122822","article-title":"A retrospective comparison of outcome of root canal treatment using two different protocols","volume":"93","author":"Hoskinson","year":"2002","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod"},{"key":"10.1016\/j.joen.2022.12.010_bib10","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1111\/j.1365-2591.2007.01322.x","article-title":"Outcome of primary root canal treatment: systematic review of the literature\u2013part 1. Effects of study characteristics on probability of success","volume":"40","author":"Ng","year":"2007","journal-title":"Int Endod J"},{"key":"10.1016\/j.joen.2022.12.010_bib11","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1111\/j.1365-2591.2007.01323.x","article-title":"Outcome of primary root canal treatment: systematic review of the literature\u2013Part 2. Influence of clinical factors","volume":"41","author":"Ng","year":"2008","journal-title":"Int Endod J"},{"key":"10.1016\/j.joen.2022.12.010_bib12","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1111\/iej.13736","article-title":"Outcomes of primary root canal therapy: an updated systematic review of longitudinal clinical studies published between 2003 and 2020","volume":"55","author":"Burns","year":"2022","journal-title":"Int Endod J"},{"key":"10.1016\/j.joen.2022.12.010_bib13","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1111\/iej.13678","article-title":"Present status and future directions-managing endodontic emergencies","volume":"55","author":"Abbott","year":"2022","journal-title":"Int Endod J"},{"key":"10.1016\/j.joen.2022.12.010_bib14","first-page":"1","article-title":"Post-operative endodontic pain management: an overview of systematic reviews on post-operatively administered oral medications and integrated evidence-based clinical recommendations","volume":"10","author":"Di Spirito","year":"2022","journal-title":"Healthcare (Basel)"},{"key":"10.1016\/j.joen.2022.12.010_bib15","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1016\/j.joen.2020.07.002","article-title":"Efficacy and safety of post-operative medications in reducing pain after nonsurgical endodontic treatment: a systematic review and network meta-analysis","volume":"45","author":"Zanjir","year":"2020","journal-title":"J Endod"},{"key":"10.1016\/j.joen.2022.12.010_bib16","doi-asserted-by":"crossref","first-page":"2254","DOI":"10.18203\/2349-2902.isj20212752","article-title":"Potential role of systemic enzyme therapy with trypsin, bromelain and rutoside combination in burns","volume":"8","author":"Abhyankar","year":"2021","journal-title":"Int Surg J"},{"key":"10.1016\/j.joen.2022.12.010_bib17","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1007\/s12325-016-0444-0","article-title":"A randomized, clinical trial to evaluate efficacy and tolerability of trypsin: chymotrypsin as compared to serratiopeptidase and trypsin: bromelain: rutoside in wound management","volume":"34","author":"Chandanwale","year":"2017","journal-title":"Adv Ther"},{"key":"10.1016\/j.joen.2022.12.010_bib18","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/s12325-017-0648-y","article-title":"The role of trypsin:chymotrypsin in tissue repair","volume":"35","author":"Shah","year":"2018","journal-title":"Adv Ther"},{"key":"10.1016\/j.joen.2022.12.010_bib19","doi-asserted-by":"crossref","first-page":"15","DOI":"10.2165\/00044011-200019010-00003","article-title":"Short-term treatment of painful osteoarthritis of the knee with oral enzymes","volume":"19","author":"Klein","year":"2000","journal-title":"Clin Drug Investig"},{"key":"10.1016\/j.joen.2022.12.010_bib20","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/j.ijom.2008.12.013","article-title":"A randomized, double-blind, placebo-controlled study comparing the efficacy and safety of paracetamol, serratiopeptidase, ibuprofen and betamethasone using the dental impaction pain model","volume":"38","author":"Chopra","year":"2009","journal-title":"Int J Oral Maxillofac Surg"},{"key":"10.1016\/j.joen.2022.12.010_bib21","first-page":"1","article-title":"Efficacy of sub-mucosal injection of chymotrypsin, oral serratiopeptidase and oral corticosteroids for reducing postoperative complications following impacted mandibular third molars surgery: a randomized, three-arm, double-blind, controlled clinical trial","volume":"1","author":"Al-Moraissi","year":"2020","journal-title":"Front Oral Heal"},{"key":"10.1016\/j.joen.2022.12.010_bib22","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1007\/s13311-020-00937-z","article-title":"Novel analgesics with peripheral targets","volume":"17","author":"Ciotu","year":"2020","journal-title":"Neurotherapeutics"},{"key":"10.1016\/j.joen.2022.12.010_bib23","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1111\/iej.13294","article-title":"PRIRATE 2020 guidelines for reporting randomized trials in endodontics: a consensus-based development","volume":"53","author":"Nagendrababu","year":"2020","journal-title":"Int Endod J"},{"key":"10.1016\/j.joen.2022.12.010_bib24","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1111\/iej.13304","article-title":"PRIRATE 2020 guidelines for reporting randomized trials in endodontics: explanation and elaboration","volume":"53","author":"Nagendrababu","year":"2020","journal-title":"Int Endod J"},{"key":"10.1016\/j.joen.2022.12.010_bib25","first-page":"70","article-title":"Doing a pilot study: why is it essential?","volume":"1","author":"Hassan","year":"2006","journal-title":"Malays Fam Physician"},{"key":"10.1016\/j.joen.2022.12.010_bib26","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.joen.2019.10.016","article-title":"Risk of bias and its impact on intervention effect estimates of randomized controlled trials in endodontics","volume":"46","author":"Yi","year":"2020","journal-title":"J Endod"},{"key":"10.1016\/j.joen.2022.12.010_bib27","doi-asserted-by":"crossref","first-page":"851","DOI":"10.2147\/JPR.S158847","article-title":"Test\u2013retest reliability, validity, and minimum detectable change of visual analog, numerical rating, and verbal rating scales for measurement of osteoarthritic knee pain","volume":"11","author":"Alghadir","year":"2018","journal-title":"J Pain Res"},{"key":"10.1016\/j.joen.2022.12.010_bib28","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/j.jclinepi.2008.06.007","article-title":"AHRQ series paper 4: assessing harms when comparing medical interventions: AHRQ and the effective Health-care Program","volume":"63","author":"Chou","year":"2010","journal-title":"J Clin Epidemiol"},{"key":"10.1016\/j.joen.2022.12.010_bib29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18231\/j.aprd.2021.001","article-title":"Role of orally administered enzymes in dental practice: a review","volume":"7","author":"Sharma","year":"2021","journal-title":"IP Ann Prosthodont Restor Dent"},{"key":"10.1016\/j.joen.2022.12.010_bib30","doi-asserted-by":"crossref","first-page":"310467","DOI":"10.1155\/2012\/310467","article-title":"Postoperative pain after root canal treatment: a prospective cohort study","volume":"2012","author":"Gotler","year":"2012","journal-title":"Int J Dent"},{"key":"10.1016\/j.joen.2022.12.010_bib31","first-page":"1","article-title":"Efficacy of four local anaesthesia protocols for mandibular first molars with symptomatic irreversible pulpitis: a randomized clinical trial","volume":"55","author":"Saber","year":"2021","journal-title":"Int Endod J"},{"key":"10.1016\/j.joen.2022.12.010_bib32","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1111\/iej.13215","article-title":"Is articaine more effective than lidocaine in patients with irreversible pulpitis? An umbrella review","volume":"53","author":"Nagendrababu","year":"2020","journal-title":"Int Endod J"},{"key":"10.1016\/j.joen.2022.12.010_bib33","doi-asserted-by":"crossref","first-page":"283","DOI":"10.18203\/2349-2902.isj20185488","article-title":"Proteases and tissue repair: peri operative role of chymotrypsin: trypsin in surgical patients","volume":"6","author":"Kondreddy","year":"2018","journal-title":"Int Surg J"},{"key":"10.1016\/j.joen.2022.12.010_bib34","first-page":"169","article-title":"Clinical evaluation of the efficacy of orthal-forte (prolytic enzymes, trypsin and chymotrypsin) on postoperative sequel following the removal of lower impacted third molar","volume":"3","author":"Al-Sandook","year":"2014","journal-title":"Int J Enhanc Res Sci Technol Eng"},{"key":"10.1016\/j.joen.2022.12.010_bib35","first-page":"1","article-title":"A systematic review of devices and techniques that objectively measure patients' pain","volume":"22","author":"Wagemakers","year":"2019","journal-title":"Pain Phys"}],"container-title":["Journal of Endodontics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0099239922008482?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0099239922008482?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T19:54:15Z","timestamp":1758830055000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0099239922008482"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3]]},"references-count":35,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2023,3]]}},"alternative-id":["S0099239922008482"],"URL":"https:\/\/doi.org\/10.1016\/j.joen.2022.12.010","relation":{},"ISSN":["0099-2399"],"issn-type":[{"value":"0099-2399","type":"print"}],"subject":[],"published":{"date-parts":[[2023,3]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"The Effect of Trypsin-Chymotrypsin on Postoperative Pain after Single Visit Endodontic Treatment: A Randomized Controlled Trial","name":"articletitle","label":"Article Title"},{"value":"Journal of Endodontics","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.joen.2022.12.010","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2022 American Association of Endodontists.","name":"copyright","label":"Copyright"}]}}