1. The effect of Ibuprofen premedication on postoperative pain following primary teeth pulpotomy : a randomized clinical trial

2. Introduction

3. pain
37% to 95%
tooth extraction,pulpotomy and SSC
Facial expression

4. Wong- Baker faces

5. Pulpotomy The most common treatment of primary teeth.
Shafie:65/6% of patients reported pain after pulpotomy

6. premedication
Several studies pre-treatment with analgesic medications reduces post-operative pain after RCT
following tooth extraction in children
Ibuprofen, paracetamol, diclofenac, tramadol
paracetamol and ibuprofen for post-operative pain in children and OTC
ibuprofen (4-10 mg/kg) = paracetamol (7-15 mg/kg) for moderate to severe pain

7. Method & Material Randomized clinical trial –split mouth
IRCT N1
The mean pain score during the first 24 h following treatment was considered the primary outcome
Sample size : (6-10 years)
informed consent

8. The inclusion criteria were:
patients aged 6-10 years old
bilateral primary molar teeth with carious lesions
the teeth were restorable, no tenderness to percussion and no pain except after eating
no clinical and/or radiographic signs of pulp degeneration
no sinus tract, no or minimal physiological resorption

9. Exclusion criteria were:
Usage of analgesic in last 24 hours
any systemic diseases that contra-indicated conservative pulp therapy (such as leukemia and some types of malignancies)
radiographic findings
internal resorption & widening of PDL
furcation or periapical radiolucency
root canal calcifications

17. Results

18. Results 49 children 45 children 17 girls and 28 boys
Mean of age year
All of the patients reported post-operative pain in both groups

19. روز اول روز دوم روز سوم Mean of pain(placebo/ibuprofen) P value
Mean of pain(placebo/ibuprofen)
P value
روز اول
( 2.09±0.79/ 1.76±0.91)
0.032
روز دوم
(1/24±0/061 1/07±0/72)
0.154
روز سوم
(0.69± ±0/62)
0.197

20. The number of patient who had pain at different days after pulpotomy

22. Incidence of use of analgesia among 2 groups

23. Discussion

24. Discussion
pre-treatment with ibuprofen significantly decreased post-operative pain
MTA & CEM :
pulp capping, perforation repair, apical plug and root- end filling & as pulpotomy agents in primary molar teeth
In the present study, CEM cement was used as the pulpotomy agent

25. mean pain score(day 1)
Placebo /09± 0/79
Ibuprofen /76±0/91

26. Discussion
the mean pain score(day 2 and 3) in the placebo group was  higher than ibuprofen(not significant)
Baygin(2011) ibuprofen-paracetamol
Gazal(2007) (ibuprofen+paracetamol)-ibuprofen
Primosch(1995) acetaminophen-ibuprofen- placebo

27. Discussion following dental extractions or GA
administration of paracetamol, ibuprofen and diclofenac

28. Discussion
ibuprofen and paracetamol had the same analgesic and antipyretic effect
higher pain relief with ibuprofen when compared to paracetamol(meta-analysis)
400 mg ibuprofen provided superior analgesia over 1,000 mg paracetamol
both medications have similar safety spectra

29. Conclusion

30. The amount of post-operative pain was significantly lower in patients who received ibuprofen before treatment in comparison with placebo group

31. If it is not contraindicated, using ibuprofen as a premedication can be useful.it can be administrated 45 min before procedure to decrease postoperative pain