Impact of Intracanal Medicaments on Interappointment Flare-up and Post Treatment Pain in Immunocompromised Patients

Abstract

Background: Interappointment flare-up and postoperative pain remain important complications in endodontic therapy, particularly in immunocompromised patients. Intracanal medicaments may reduce microbial load and inflammatory response between appointments. This study aimed to evaluate the effect of different intracanal medicaments on interappointment flare-up and post-treatment pain in immunocompromised patients undergoing root canal treatment. Methods: This study included 76 immunocompromised patients undergoing multirooted root canal treatment. Patients were equally assigned to four groups (n=19): no medicament, calcium hydroxide, triple antibiotic paste, or Ledermix paste as intra canal medicaments. Pain, swelling, and interappointment flare-ups were assessed after standardized treatment, and data were analyzed using chi-square tests (p<0.05). Results: Baseline characteristics were comparable among groups. Interappointment flare-up was highest in the no medicament group (21.1%), followed by calcium hydroxide and triple antibiotic paste groups (5.3% each), with no flare-up observed in the Ledermix group. Although the overall difference was not statistically significant, age showed a significant association with flare-up occurrence (p=0.043). Post-treatment pain progressively decreased in all groups, and all patients were asymptomatic by 7 days. No significant associations were found between systemic comorbidities and flare-up. Conclusion: Intracanal medicaments, particularly Ledermix paste, demonstrated a favorable clinical trend in reducing interappointment flare-up and early postoperative pain in immunocompromised patients, although differences among groups were not statistically significant. Age was the only significant factor associated with flare-up. Larger randomized studies are required to confirm these findings.