Postoperative pain after single-visit root canal treatment in teeth with periapical lesion using different irrigation activation techniques: a randomized clinical trial

The aim of this study is to evaluate the effect of different irrigation activation methods used during single-visit endodontic treatment of teeth with periapical lesions on postoperative pain. This randomized clinical study included single-rooted teeth diagnosed with apical periodontitis. Patients were allocated into three groups according to the irrigation activation technique used: EDDY, passive ultrasonic irrigation (PUI), and XP-endo Finisher. Postoperative pain was assessed using the Visual Analogue Scale (VAS) at 6, 24, 48, 72 h, and 7 days. Analgesic intake was recorded. Statistical analysis was performed using appropriate parametric or non-parametric tests based on data distribution assessed with the Shapiro–Wilk test. Group comparisons were conducted using t-test/Mann–Whitney U test and ANOVA/Kruskal–Wallis test as appropriate, while categorical data were analyzed using chi-square or Fisher’s exact test. Repeated measurements were evaluated using the Friedman test. A p -value < 0.05 was considered statistically significant. The highest postoperative pain level was observed at the 6th hour in all groups. The decrease in pain levels over time was significant in all groups ( p < 0.05). No statistically significant difference was found among the groups in terms of postoperative pain at any time point ( p > 0.05). A significant association was identified only between the percussion finding and the activation method. ( p < 0.05). It was observed that different irrigation activation methods have similar effects on pain levels following single-visit endodontic treatment. Percussion sensitivity may be higher when ultrasonic activation is used. Clinical trial registration: Registration number is “NCT07410832”.