Small trial suggests limited benefit for occlusal reduction in endodontic treatment


Occlusal reduction is one possible technique to reduce postoperative pain in patients suffering from irreversible pulpitis and tenderness to percussion. The aim of this study was to assess the effectiveness of this procedure

Patients with irreversible pulpitis and mild tenderness to percussion without moderate-to-severe spontaneous pain underwent standardized root canal treatment (RoCT) performed by a single operator. Patients were randomly divided into 2 groups of 27 each, the occlusal reduction (OR) group and the no occlusal reduction (NOR) group. A visual analogue pain scale (VAS) was used to evaluate pain levels before treatment and at 6,12,18, 24 hours, and then daily for 6 days after treatment.  Ibuprofen (600 mg 6hrly) was used as analgesia as required by patients.

  • Of the 54 patients there were 2 drop outs in the OR group and 6 on the NOR group
  • The pain levels in both groups significantly decreased after root canal treatment but there was no significant difference between the 2 groups.

The authors concluded

Occlusal surface reduction did not provide any further reduction in postoperative pain for teeth with irreversible pulpitis and mild tenderness to percussion compared with no occlusal reduction.


This is a relatively small trial and no power calculation is presented.  The drop out rate is higher in the NOR group (22.2%) compared with the OR group (7.4%). A previous study (Rosenburg et al  1998) , noted by the authors suggested a benefit from occlusal reduction.


Parirokh M, Rekabi  AR, Ashouri R,  Nakhaee, N MD, Abbott PV, Gorjestani H. Effect of Occlusal Reduction on Postoperative Pain in Teeth with Irreversible Pulpitis and Mild Tenderness to Percussion . J of Endod.  Article in press, available online 28 Sept. 2012

Rosenberg PA, Babick PJ, Schertzer L, Leung A. The effect of occlusal reduction on pain after endodontic instrumentation. J Endod. 1998 Jul;24(7):492-6. PubMed PMID: 9693578.


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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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