Authors: Peters DD.
Title: Evaluation of prophylactic alveolar trephination to avoid pain.
Journal: J Endod
Date: Apr 1980
Citation: 6(4):518-26
Category: Endodontic Emergencies
Evidence-based Ranking: 2
Purpose/Objectives: To determine statistically the efficacy of trephination in preventing and relieving pain.

Materials & Methods: 100 cases with apical lesions shown by radiographs were opened, instrumented, and filled at the first appointment. Regardless of symptoms presented, every other case was trephined, making 50 cases of alveolar trephination, group 1A, and 50 control cases, group 1B. Any patients in the control group who reported pain and was not adequately controlled with aspirin or acetaminophen were listed as having severe pain. These patients were seen immediately and the lesions were trephined to evaluate the effect in relieving pain. Group2 consisted of 125 teeth that had been opened on an emergency basis by general dentists. The teeth had been medicated, and temporary fillings were placed. Patients then were referred for endodontic treatment. These teeth were instrumented and obturated when seen. Only those teeth that caused pain after they were filled were trephined.

Results: Of those roots treated during one appointment and not trephined, 16% of the patients had pain whereas pain occurred in 9.6% of those treated in two appointments. 69 of 70 cases of trephination were asymptomatic. Statistical analysis showed a greater incidence of pain when trephination was not used.

Conclusions: Prophylactic trephination of all teeth with apical lesions appears to be unsound treatment. Nevertheless trephination, where indicated, is a valuable procedure. ReviewerÂ’s Comments: The outcome of the study based mainly on patientsÂ’ perception of pain. However, trephination was a significant factor in relief of severe pain after either one or two appointment treatment.