Post-endodontic pain remains one of the most common challenges faced by dental practitioners and patients undergoing root canal treatment. While calcium hydroxide has long been used as an intracanal medicament for its antimicrobial and anti-inflammatory properties, the potential role of nonsteroidal anti-inflammatory drugs (NSAIDs) such as diclofenac sodium in pain management is gaining increasing attention.
In this double-blinded, parallel-group study, 90 patients with first or second mandibular molars diagnosed with symptomatic irreversible pulpitis were enrolled. Participants were randomly assigned to one of three groups based on the intracanal medicament used — calcium hydroxide (CH), diclofenac sodium (DCS), or a combination of both (CH + DCS), with 30 patients in each group.
After the initial visit, patients were instructed to record their pain intensity using a visual analog scale (VAS) that categorized pain as none, mild, moderate, severe, or very severe. They were also asked to note the number of analgesic tablets consumed over a seven-day follow-up period. The collected data were statistically analyzed using the Kruskal–Wallis, Friedman, Wilcoxon signed-rank, and Chi-square tests, with significance set at p < 0.05.
The study revealed the following notable findings:
- Postoperative pain scores significantly decreased in all groups after the first visit compared to preoperative pain levels.
- Diclofenac sodium alone produced a greater reduction in post-treatment pain than calcium hydroxide or the combination therapy.
- The number of analgesic tablets taken after treatment was similar across all three groups.
These findings indicate that diclofenac sodium, when used as an intracanal medicament, can effectively minimize postoperative discomfort in endodontic cases. The study also suggests that combining DCS with calcium hydroxide does not provide additional benefits over the use of DCS alone.
The authors emphasized that the significant reduction in postoperative pain achieved with diclofenac sodium supports its use as an alternative to calcium hydroxide in endodontic practice. Further research involving larger populations and longer follow-up durations could help confirm the long-term efficacy and safety of diclofenac sodium as an intracanal medicament in managing pain associated with root canal treatment.
Reference:
Fidanoğlu, B., Tufenkci, P. & Sarı, M. The effects of calcium hydroxide and diclofenac sodium as root canal medicaments on post-endodontic pain: a double-blinded, parallel group, randomized controlled clinical trial. Odontology (2025). https://doi.org/10.1007/s10266-025-01252-9
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