***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
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    Input: INTRODUCTION The extrusion of irrigation solutions beyond the apical constriction may result in postoperative pain .  Sodium hypochlorite can cause severe tissue irritation and necrosis outside the root canal system if extruded into the periodontal ligament ( PDL ) space . Different delivery techniques were discussed to reduce this potential risk . The aim of this study was to compare the postoperative level of pain after root canal therapy using either endodontic needle irrigation or a negative apical pressure device . MATERIAL AND METHODS In a prospect i ve r and omized clinical trial , 110 asymptomatic single-rooted anterior and premolar teeth were treated endodontically with two different irrigation techniques . The teeth were r and omly assigned to two groups . In the MP group ( n = 55 ) , procedures were performed using an endodontic irrigating syringe ( Max-i-Probe ; Dentsply Rinn , Elgin , IL ) . The EV group ( n = 55 ) used an irrigation device based on negative apical pressure ( EndoVac ; Discus Dental , Culver City , CA ) . Postoperatively , the patients were prescribed ibuprofen 200 mg to take every 8 hours if required . Pain levels were assessed by an analog scale question naire after 4 , 24 , and 48 hours . The amount of ibuprofen taken was recorded at the same time intervals . RESULTS During the 0- to 4- , 4- to 24- , and 24- to 48-hour intervals after treatment , the pain experience with the negative apical pressure device was significantly lower than when using the needle irrigation ( p < 0.0001 [ 4 , 24 , 48 hours ] ) . Between 0 and 4 and 4 and 24 hours , the intake of analgesics was significantly lower in the group treated by the negative apical pressure device ( p < 0.0001 [ 0 - 4 hours ] , p = 0.001 [ 4 - 24 hours ] ) . The difference for the 24- to 48-hour period was not statistically different ( p = 0.08 ) . The Pearson correlation coefficient revealed a strongly positive and significant relationship for the MP group ( r = 0.851 , p < 0.001 ) and the EV group ( r = 0.596 , p < 0.0001 ) between pain intensity and the amount of analgesics . CONCLUSION The outcome of this investigation indicates that the use of a negative apical pressure irrigation device can result in a significant reduction of postoperative pain levels in comparison to conventional needle irrigation OBJECTIVES This prospect i ve study was conducted to determine whether there is any significant difference in the incidence of postobturation pain after single- and multiple-visit root canal treatment ( RCT ) . METHODS The frequency of postobturation pain was recorded and evaluated over an observation period of 30 days in 291 of 300 consecutive patients receiving RCT .  The patients were assigned r and omly and consecutively into either single- or multiple-visit groups . The canals of all teeth were prepared and filled by a single operator using the step-back and lateral condensation techniques . The data were analysed statistically to determine the relationship , if any , between the pain experienced and pulpal vitality , tooth type , pre-operative pain , and the sex and age of the patient . RESULTS Nine of the 300 patients were excluded from the analysis as they failed to attend for postoperative review s. A significantly higher incidence ( P < 0.01 ) of postobturation pain was found in the multiple-visit group ( 38 % ) than in the single-visit group ( 27 % ) within 24 h of obturation . The incidence of pain decreased thereafter , with all patients being sysmptom free at the end of the observation period . No significant correlation was found between postobturation pain and any other factor , with the exception that teeth which had nonvital pulp prior to treatment were associated with a significantly greater ( P < 0.005 ) incidence of postobutration pain . CONCLUSIONS Pain was significantly higher in the multiple-visit RCT group and significantly associated with the treatment of the nonvital pulp AIM To investigate the efficacy of using antibiotics in post endodontic treatment as a method to alleviate post-treatment pain . MATERIAL S AND METHODS After completion of endodontic treatment 129 patients were r and omly divided into two groups : Group A ( 65 patients ) received Ibuprofen 400 mg one tablet before procedure and one tablet every 8 hours for the first day , then one tablet once indicated by pain . Group B ( 64 patients ) received the same regimen as group A in addition to amoxicillin , clavulanic acid tablets ( one tablet before the procedure , and then one tablet twice daily for a total of 3 days ) . Intensity of pain at 8 hours interval using visual analog scale ( VAS ) and total number of Ibuprofen tablets used was recorded by patients . RESULTS Peak postoperative pain occurred at 16 hours post-treatment in both groups , there was a significant difference in the pain scale between the two groups in favor for group B over group A ( 3.8 vs 2.1 respectively ) . Pain scale was significantly lower in group B at 24 , 32 , 40 , and 48 hours post-treatment with a p-value of < 0.05 . The pain scale at 56 , 64 and 72 hours were also less in group B , although could not show up as statistical difference . Patients in group A used statistically significant more Ibuprofen than patients in group B ( 486 vs 402 ) . CONCLUSION Antibiotic prescription to manage post endodontic treatment pain results in less pain with less consumption of Ibuprofens . CLINICAL SIGNIFICANCE Pain management in endodontics is a real challenge , nonsteroidal anti-inflammatory drugs ( NSAIDS ) are used effectively in many patients to alleviate post endodontic pain . Nonsteroidal anti-inflammatory drugs may have adverse reactions or may be contraindicated . Short-term use of antibiotics to alleviate pain can be of clinical benefits in these patients INTRODUCTION Profound pulpal anesthesia in posterior m and ibular teeth with irreversible pulpitis usually requires administering an inferior alveolar nerve block ( IANB ) plus other supplemental injections . The purpose of this prospect i ve , r and omized , double-blind study was to compare the anesthetic success rate of buccal infiltration injections of articaine and lidocaine when supplemented with an IANB . METHODS One hundred twenty-five emergency patients who had their first or second m and ibular molar diagnosed with irreversible pulpitis participated in the study and received the IANB by using either 2 % lidocaine with 1:100,000 epinephrine or 4 % articaine with 1:100,000 epinephrine . One hundred two of the patients reported moderate-to-severe pain upon initiation of their endodontic treatment or through filing of their tooth canals and received supplemental buccal infiltration injections by using the same anesthetic that the IANB had been performed . After the block or the supplemental buccal infiltration injections , success was achieved with no or mild pain during instrumentation of the tooth canals . RESULTS The success rate after the administration of the infiltration injections after an incomplete IANB by using lidocaine was 29 % , whereas by using articaine it was 71 % ( P < .001 ) . No statistical differences were detected in the success rates between the 2 anesthetics after the block injections . CONCLUSIONS Supplementing an incomplete articaine IANB with articaine infiltration raises the anesthetic success more effectively compared with lidocaine in m and ibular molars with irreversible pulpitis Introduction Post endodontic pain is often linked to the inflammatory process as well as additional central mechanisms . The purpose of the present double-blind r and omized clinical trial study was to compare the prophylactic effects of a derivative of Zingiber Officinale , Zintoma , and Ibuprofen on  post endodontic pain of molars with irreversible pulpitis . Material s and Methods The post endodontic pain of 72 enrolled patients suffering from irreversible pulpitis was assessed after prophylactic use of 400 mg Ibuprofen , 2 gr Zintoma and placebo . Using the Heft-Parker Visual Analogue Scale , the patients recorded their perceived pain before taking the medicament ( baseline ) , immediately after and also at 4 , 8 , 12 , 24 , 48 , and 72 h post one-visit endodontic treatment . The statistical analysis was done using Kruskal-Wallis , Mann-Whitney , and Freedman tests ( P<0.05 ) . Results At all times , there was significant difference between the Ibuprofen and Zintoma ( P<0.05 ) and also between the Ibuprofen and placebo ( P<0.05 ) . However , there was no significant difference between Zintoma and the placebo in any of time intervals ( P>0.05 ) . No side effects were observed . Conclusion The obtained results of the trial revealed that prophylactic use of 2 gr Zintoma is not an effective pain relieving agent OBJECTIVE To evaluate success of pulpal anaesthesia of m and ibular 1st molar by using 4 % articaine in buccal infiltration versus 2 % lidocaine in inferior alveolar nerve block . STUDY DESIGN R and omized control trial . PLACE AND DURATION OF STUDY Department of Operative Dentistry , Sardar Begum Dental College , G and hara University , Peshawar , from March to August 2014 . METHODOLOGY One hundred and fifty-six emergency patients , who had 1st molar diagnosed with irreversible pulpitis , participated in the study . Subjects were divided into two groups by r and om allocation . One group received 4 % articaine buccal infiltration and the other group received inferior alveolar nerve block of 2 % lidocaine . Subjects’self-reported pain response was recorded on Heft Parker Visual Analogue Scale after local anaesthetic administration during access cavity preparation and pulp extirpation . RESULTS Mean age of subjects was 31.46 ±10.994 years . The success rate of 4 % buccal infiltration was 76.9 % ; whereas the success rate of 2 % lidocaine inferior alveolar nerve block was 62.8 % . There was no statistically significant difference between the two groups . CONCLUSION 4 % articaine buccal infiltration can be considered a viable alternative to 2 % lidocaine inferior alveolar nerve block in securing successful pulpal anaesthesia for endodontic therapy OBJECTIVE The purpose of this study was to determine whether premedication with ibuprofen or meloxicam increases the success rate of anaesthesia in teeth with irreversible pulpitis . MATERIAL S AND METHODS In this parallel , double-blind clinical trial , 92 patients diagnosed with irreversible pulpitis were r and omly divided into four groups of 23 patients . The first group ( the no-premedication group ) received no premedication , the second group ( the meloxicam group ) received 7.5 mg of meloxicam , the third group ( the ibuprofen group ) received 600 mg of ibuprofen , and the fourth group ( the placebo group ) received placebo 1 hour before intervention . Before taking the medication , electrical pulp testing ( EPT ) and the Heft-Parker visual analogue scale ( VAS ) were used to evaluate sensitivity and pain at baseline . Then , local anaesthesia was injected , and after 15 minutes , EPT was used again to evaluate tooth sensitivity . The pain during access preparation was also recorded using the Heft-Parker VAS . RESULTS Ninety-two patients were analysed . The success rates of local anaesthesia were 21.7 % , 34.8 % , 78.3 % and 73.9 % in the no-premedication , placebo , ibuprofen and meloxicam groups , respectively , according to the EPT values . Considering the Heft-Parker VAS values , no premedication gave a 21.7 % success rate , placebo gave a 34.8 % success rate , ibuprofen gave an 82.6 % success rate and meloxicam gave a 65.2 % success rate . The ibuprofen and meloxicam groups showed significantly better results than the placebo and no-premedication groups ( P < 0.001 ) . However , the difference between meloxicam and ibuprofen groups was not significant . CONCLUSIONS Premedication with meloxicam and ibuprofen significantly increased the success rates of inferior alveolar nerve block anaesthesia for teeth with irreversible pulpitis ; however , neither drug provided profound anaesthesia OBJECTIVE To comparatively evaluate the amount of apically extruded debris when ProTaper , ProFile , and HERO Shaper were used for the instrumentation of root canals . STUDY DESIGN Sixty human m and ibular central incisor teeth were r and omly assigned to 3 groups , 20 teeth in each . The teeth in the 3 groups were instrumented according to the manufacturers ' instructions until the working length , with ProTaper , ProFile , and HERO Shaper rotary instruments respectively . The debris produced was collected in polyethylene tubes . The liquid inside the tubes was removed by lyophilization and the remaining debris was calculated for each group and compared . RESULTS All instruments tested produced a measurable amount of debris . No statistically significant difference was observed between ProTaper and HERO Shaper in terms of debris extrusion ( P > .05 
    Output:
    
Conclusion Results of the present systematic review indicate that there is no clear evidence supporting that preoperative ibuprofen is better than other drugs in reducing the risk and intensity of postendodontic pain