{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T22:08:33Z","timestamp":1777500513614,"version":"3.51.4"},"reference-count":35,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,2,10]],"date-time":"2023-02-10T00:00:00Z","timestamp":1675987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Deanship of Scientific Research, Qassim University"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: One of the main reasons for post endodontic pain is the polymicrobial intracanal flora that may survive the initial disinfection. A single antimicrobial agent might not provide adequate disinfection, and an antimicrobial combination such as triple antibiotic paste was tested to achieve this goal. Aim: The study aimed to assess the efficacy of three intra-canal medicaments on post root canal preparation pain. Materials and Methods: Eighty patients with single-rooted necrotic teeth and symptomatic apical periodontitis were randomly assigned to four treatment groups (n = 20). Their preoperative pain was recorded on Wong-Baker\u2019s FACES pain rating scale. After chemo-mechanical canal preparation, intracanal medications were applied to the groups (Group 1 (20% calcium hydroxide), Group 2 (2% chlorhexidine), Group 3 (tri-antibiotic paste), Group 4 (no medication (Control group)). Patients were instructed to record pain on the Wong-Baker FACES pain rating scale at 4, 48, 72 and 96 hrs, postoperatively. Pain scores were analyzed using a one-way ANOVA test and Tukey\u2019s post hoc test and, if significant, Dunn\u2019s test was used for pair-wise comparisons. The significance level was set at a p-value \u2264 0.05. Results: Tukey\u2019s post hoc test revealed significantly lower pain scores in Group 3 compared with other groups at all follow up intervals. Dunnett\u2019s test showed significantly lower pain in Group 3 compared with the Control group at 48, 72 and 96 hrs, postoperatively. Conclusions: Triple-antibiotic paste showed effective pain control as an intracanal medication on necrotic teeth with symptomatic apical periodontitis.<\/jats:p>","DOI":"10.3390\/ijerph20043091","type":"journal-article","created":{"date-parts":[[2023,2,10]],"date-time":"2023-02-10T02:33:27Z","timestamp":1675996407000},"page":"3091","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["The Effect of Calcium Hydroxide, Triple Antibiotic Paste and Chlorhexidine on Pain in Teeth with Symptomatic Apical Periodontitis: A Randomised Controlled Trial"],"prefix":"10.3390","volume":"20","author":[{"given":"Asma Munir","family":"Khan","sequence":"first","affiliation":[{"name":"Department of Conservative Dental Sciences and Endodontics, College of Dentistry, Qassim University, Buraidah 52571, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irfana Khursheed Ahmed","family":"Gangoo","sequence":"additional","affiliation":[{"name":"Endodontics Specialty Clinics, Qassim University Medical City, Buraidah 52571, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naila Amir","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Operative Dentistry, Bolan University of Medical and Health Sciences, Quetta 87300, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mansoor","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Operative Dentistry, Foundation University College of Dentistry, Foundation University, Rawalpindi 44000, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7586-4319","authenticated-orcid":false,"given":"Muhammad Qasim","family":"Javed","sequence":"additional","affiliation":[{"name":"Department of Conservative Dental Sciences and Endodontics, College of Dentistry, Qassim University, Buraidah 52571, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mustafa Hussein","family":"AlAttas","sequence":"additional","affiliation":[{"name":"Department of Conservative Dental Sciences and Endodontics, College of Dentistry, Qassim University, Buraidah 52571, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7214-0967","authenticated-orcid":false,"given":"Ayman M.","family":"Abulhamael","sequence":"additional","affiliation":[{"name":"Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, P.O. Box 80209, Jeddah 21589, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5946-5337","authenticated-orcid":false,"given":"Hammam Ahmed","family":"Bahammam","sequence":"additional","affiliation":[{"name":"Department of Pediatric Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0430-0268","authenticated-orcid":false,"given":"Loai","family":"Alsofi","sequence":"additional","affiliation":[{"name":"Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, P.O. Box 80209, Jeddah 21589, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rayan Suliman Al","family":"Yahya","sequence":"additional","affiliation":[{"name":"Department of Conservative Dental Sciences and Endodontics, College of Dentistry, Qassim University, Buraidah 52571, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1034\/j.1601-1546.2002.30105.x","article-title":"Consideration of steroids for endodontic pain","volume":"3","author":"Marshall","year":"2002","journal-title":"Endod. Top."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1111\/j.1365-2591.2003.00735.x","article-title":"The relationship of intracanal medicaments to postoperative pain in endodontic","volume":"36","author":"Ehramann","year":"2003","journal-title":"Int. Endod. 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