***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*** 
    ***EXAMPLES*** 
    Input: AIM This r and omized double-blinded controlled trial was performed to compare the efficacy of inferior alveolar nerve block ( IANB ) injection for m and ibular first molar teeth with irreversible pulpitis with or without supplementary buccal infiltration and intraligamentary injection . METHODOLOGY Eighty-two patients with asymptomatic irreversible pulpitis received either a combination of intraligamentary injection + buccal infiltration+ IANB or with traditional IANB injection in m and ibular first molar teeth with irreversible pulpitis . Each patient recorded their pain score on a Heft-Parker visual analogue scale before commencing treatment , in response to a cold test 15 min after the design ated anaesthetic injection , during access cavity preparation and during root canal instrumentation . No or mild pain at any stage was considered a success . Data were analysed by chi-square test . RESULTS At the final stage of treatment , 69 of the 82 patients were eligible to be included in the study . No significant difference was found between age ( P = 0.569 ) and gender ( P = 0.570 ) amongst the patients in the two groups . The success rate of anaesthesia in the IANB and the combination groups were 22 % and 58 % , respectively . The success rate of anaesthesia in the combination group was significantly higher than the traditional IANB injection ( P = 0.003 ) . CONCLUSION A combination of anaesthetic techniques can improve the success rate of anaesthesia for m and ibular first molar teeth with irreversible pulpitis This study investigated the effect of potent intracanal corticosteroids on periodontal  healing of replanted avulsed teeth and evaluated the systemic absorption of these corticosteroids .  Sixty-seven extracted dog premolar roots were r and omly assigned to one of the following groups : groups 1 - 3 filled with gutta-percha and replanted immediately and after 40 and 60 minutes , respectively ; groups 4 and 5 filled with 0.05 % clobetasol ; and groups 6 and 7 filled with 0.05 % fluocinonide . Groups 4 and 6 were replanted after 40 minutes and groups 5 and 7 after 60 minutes . After 4 months , roots were evaluated histologically for signs of periodontal healing . Roots treated with clobetasol and fluocinonide  healed more favorably than roots filled with gutta-percha and were different from each other at 60 minutes . No change in the systemic corticosteroid blood concentration was observed in any group . Corticosteroids were efficacious in the beagle model as intracanal medicaments for promoting favorable postavulsion periodontal healing INTRODUCTION Achieving anesthesia in m and ibular molar teeth with irreversible pulpitis is very difficult . The aim of this study was to compare the efficacy of 1.8 mL and 3.6 mL articaine for an inferior alveolar nerve  block ( IANB ) when treating molars with symptomatic irreversible pulpitis . METHODS In a r and omized , double-blind clinical trial , 82 first m and ibular molar teeth with symptomatic irreversible pulpitis r and omly received conventional IANB injection either with 1 ( 1.8 mL ) or 2 cartridges ( 3.6 mL ) of 4 % articaine with 1:100,000 epinephrine . The patients recorded their pain before and during access cavity preparation as well as during root canal instrumentation using a Heft-Parker visual analog scale . No or mild pain was considered as successful anesthesia . Data were analyzed by t and chi-square tests . RESULTS Eighty patients were eligible to participate in this study , which showed that 3.6 mL articaine provided a significantly higher success rate ( 77.5 % ) of IANBs compared with 1.8 mL of the same anesthetic solution ( 27.5 % ) although neither group had 100 % successful anesthesia ( P < .001 ) . CONCLUSIONS Increasing the volume of articaine provided a significantly higher success rate of IANBs in m and ibular first molar teeth with symptomatic irreversible pulpitis , but it did not result in 100 % anesthetic success AIM To compare the effects of two different concentrations of NaOCl solution on postoperative pain following single-visit root canal treatment in m and ibular molars with irreversible pulpitis . METHODOLOGY A total of 122 patients who had m and ibular molars with irreversible pulpitis were treated . The patients were r and omly divided into two groups according to the concentration of NaOCl used during root canal instrumentation - either 2.5 % or 5.25 % . RaCe rotary instruments were used for root canal preparation , and all root canals were filled in one visit . Postoperative pain was evaluated using the visual analogue scale . Data were analysed by independent t-test , chi-square and Mann-Whitney tests . RESULTS Twelve patients were excluded for various reasons . Pain reported by 110 patients who were eligible to be included in the study was analysed . No significant differences were found in the age and gender of the patients between the two groups ( P = 0.50 , P = 0.51 , respectively ) . The patients who had 5.25 % NaOCl reported significantly lower postoperative pain compared to those who had 2.5 % NaOCl during the first 72 h following treatment ( P = 0.021 ) ; however , there was no significant difference in pain felt by the patients during the rest of the study period , that is 4 - 7 days following treatment ( P = 0.185 ) when the four-level pain categorization method was used . When the two-level pain categorization method was used , the results revealed that patients who had 5.25 % NaOCl reported significantly less pain for the first 3 days after treatment ( P = 0.026 ) . The number of analgesics taken by patients who had 2.5 % NaOCl was significantly higher than that taken by patients who had 5.25 % NaOCl ( P = 0.001 ) . CONCLUSION 5.25 % NaOCl was associated with significantly lower postoperative pain compared to 2.5 % NaOCl during the first 72 h following one-visit root canal treatment of m and ibular molars with irreversible pulpitis The purpose of this prospect i ve clinical trial was to investigate the analgesic efficacy of three oral medication groups on postoperative endodontic pain in male and female dental patients , with an emphasis on analgesic differences between the sexes . Forty-three patients were administered ibuprofen 600 mg , placebo , or pentazocine 50 mg/0.5 mg naloxone in a r and omized , double-blinded manner . Beginning immediately after endodontic treatment , patients took the assigned medication every 6 hours for 24 hours and recorded their degree of discomfort on a 100-mm visual analog scale . Statistical analysis of the data showed that ibuprofen 600 mg provided statistically significantly greater analgesia than placebo at 6 and 12 hours ( P = 0.0014 and 0.0024 ) , and pentazocine/naloxone provided statistically significantly greater analgesia than placebo at 12 hours ( P = 0.0084 ) . Sex-dependent differences were noted within the pentazocine/naloxone group , which showed significantly greater analgesia in females compared with males ( P = 0.007 ) 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 INTRODUCTION Pain management after  root canal treatment  is a very important issue in clinical practice . The purpose of this study was to evaluate the effect of occlusal reduction on postoperative pain in teeth with irreversible pulpitis and tenderness to percussion . METHODS Fifty-four posterior vital teeth with sensitivity to percussion requiring endodontic treatment were included in this study . After administration of local anesthesia , the root canals were instrumented , and an intracanal calcium hydroxide dressing was placed . The patients were r and omly divided into 2 groups of 27 each . In 1 group the occlusal surface was reduced ( OR group ) , whereas in the other group the occlusal surface was not modified ( no occlusal reduction , NOR group ) . Each patient was asked to record their postoperative pain on a visual analogue scale with 4 categories at 6 hours , 12 hours , 18 hours , 1 day , and then daily for 6 days after this treatment . Data were analyzed by t test , Cochran Q , χ(2 ) , and Mann-Whitney tests . RESULTS Forty-six patients returned the visual analogue scale forms . There was no significant difference in postoperative pain between the 2 groups ( P > .05 ) after root canal preparation and calcium hydroxide dressing . CONCLUSIONS 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 prospect i ve r and omized , double-blind factorial study aim ed to compare the efficacy of three different intracanal medicaments with the placebo in controlling the postoperative pain after complete root canal preparation . The study was performed on 64 m and ibular molars of 64 patients with diagnosis of pulp necrosis and acute apical periodontitis . After chemomechanical procedures using the stepback technique and 1 % sodium hypochlorite , the teeth were r and omized into four treatment groups ( n=16 ) . In group I , canals were filled with calcium hydroxide paste mixed with 2 % chlorhexidine gel , group II received 2 % chlorhexidine gel , group III was treated with calcium hydroxide paste , and group IV received no dressing ( control ) . Before dismissal , preoperative pain experience was recorded using a visual analog pain scale . Patients were then instructed to quantify the degree of pain experienced 4h after treatment and daily for a further 24 , 48 , 72 and 96h . Two-way repeated measures ANOVA test and post hoc Tukey 's HSD test revealed that at each time interval groups I and II were significantly more effective in reducing the postoperative pain values than groups III and IV ( p<0.05 ) . Dunnett 's test showed that groups I and II differed significantly from control whereas difference between group III and control was not significant ( p>0.05 ) . Patients with pulp necrosis and acute apical periodontitis that had been dressed with chlorhexidine alone and calcium hydroxide plus chlorhexidine gave rise to less pain than that experienced by patients who had a calcium hydroxide dressing alone or no dressing at all Aim : Study aim ed to evaluate the efficacy of two different pretreatment single oral doses of betamethasone on the incidence of inter-appointment flare up and postoperative discomfort . Material s and Methods : Fifty-four patients aged 18–59 years requiring endodontic treatment were selected and r and omly assigned to three groups ; single pretreatment oral dose of placebo or betamethasone in two different oral doses of 0.5 mg and 1 mg , respectively . Endodontic therapy was completed in two visits using triple antibiotic paste as intracanal medicament . Patients were given a question naire to record their pain at 1 , 2 , 3 , and 7 days after treatment . In the second visit , obturation was done , and the patients were again instructed to record their pain scores after treatment and discharged . The verbal rating scale was used for recording the pain scores . Statistical analysis was done using ANOVA and the Friedman test . Results : 0.5 mg betamethasone group showed least mean pain scores among all experimental groups ; however , there was no statistically significant difference between any of the groups ( P > 0.05 ) . Conclusion : Pretreatment single oral dose of betamethasone is an effective in managing endodontic flare-ups ; however , the results were statistically insignificant Acute pain and swelling following endodontic treatment are a challenge for both the patient and the dentist . According to previous studies , the incidence of flare-ups increases after endodontic treatment of teeth with necrotic pulps . Calcium hydroxide is currently used as a multi- purpose drug in root canal therapy . The aim of this study was to evaluate the incidence and severity of flare-ups after treatment of pulpless teeth using calcium hydroxide as an intracanal dressing .  Sixty patients with single-root necrotic teeth participated in this 
    Output:
    
Most of these papers showed pain reducing effect of GCS on post-endodontic pain .
Based on the results of this systematic review , there is a vast heterogeneity amongst articles regarding the use of GCS and their effect on post-operative pain after endodontic treatment .