Effects of Intracanal Medicaments on Postoperative Pain: A Comparative Study of Calcium Hydroxide, Triple Antibiotic Paste, and Chlorhexidine

Introduction: Postoperative pain is a common concern following endodontic treatment and may be influenced by intracanal medication.This study compared postoperative pain associated with calcium hydroxide (Ca(OH)₂), triple antibiotic paste (TAP), 2% chlorhexidine (CHX), and saline.Materials and methods: This prospective study included 120 patients (30 per group).The patients received Ca(OH)₂, TAP, 2% CHX, or saline as intracanal medicaments during routine endodontic treatment.Pain intensity was recorded using a visual analog scale (VAS) preoperatively and at 6, 12, 24, 48, 72 hours, and 7 days postoperatively.Between-group differences were assessed using the Kruskal-Wallis test, followed by Bonferroni-adjusted Mann-Whitney U tests.Within-group changes were assessed using the Wilcoxon signed-rank test.Results: Baseline pain was comparable between the groups (median, 7.0; p = 0.936).Significant betweengroup differences were observed at all postoperative intervals (p < 0.001).At six hours, the median VAS scores for Ca(OH)₂, TAP, 2% CHX, and saline were 5.0, 4.0, 5.0, and 6.0, respectively.At 24 hours, the scores were 3.0, 2.0, 3.0, and 5.0, while at 7 days, they were 0.0, 0.0, 0.0, and 2.0.The effect size increased from ε² = 0.208 at six hours to 0.509 at seven days.TAP showed less pain than calcium hydroxide and 2% CHX from 24 hours onward.Conclusion: Postoperative pain decreased in all groups, with lower pain scores observed in the Ca(OH)₂, TAP, and 2% CHX groups than in the saline comparison group.TAP was associated with the lowest pain scores, while Ca(OH)₂ and CHX showed comparable outcomes.These findings suggest that the choice of intracanal medicament may influence postoperative pain; however, the results should be interpreted in light of the observational study design and the limited antimicrobial role of saline as a comparison condition.